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Tartarin H, Morotti A, Van Etten ES, Hausman-Kedem M, Charidimou A, Jouvent E, Susen S, Cordonnier C, Pasi M, Boulouis G. Uncommon Causes of Nontraumatic Intracerebral Hemorrhage. Stroke 2024; 55:1416-1427. [PMID: 38572651 DOI: 10.1161/strokeaha.123.043917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Nontraumatic intracerebral hemorrhage is an important health issue. Although common causes such as hypertension and cerebral amyloid angiopathy predominantly affect the elderly, there exists a spectrum of uncommon etiologies that contribute to the overall incidence of intracerebral hemorrhage. The identification of these rare causes is essential for targeted clinical management, informed prognostication, and strategic secondary prevention where relevant. This topical review explores the uncommon intracerebral hemorrhage causes and provides practical clues for their clinical and imaging identification. By expanding the clinician's differential diagnosis, this review aims to bridge the gap between standard intracerebral hemorrhage classification systems and the nuanced reality of clinical practice.
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Affiliation(s)
- Hugo Tartarin
- Diagnostic and Interventional Neuroradiology, University Hospital, Tours, France (H.T., G.B.)
| | - Andrea Morotti
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy (A.M.)
| | - Ellis S Van Etten
- Department of Neurology, Leiden University Medical Center, the Netherlands (E.S.V.E.)
| | - Moran Hausman-Kedem
- Pediatric Neurology Institute, Dana-Dewk Children's Hospital, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv Unisversity, Israel (M.H.-K.)
| | | | - Eric Jouvent
- Neurology Department, Lariboisière Hosp, APHP and Université Paris Cité, France (E.J.)
| | - Sophie Susen
- Hematology and Transfusion Department, Centre Hospitalier Universitaire de Lille, France (S.S.)
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience and Cognition, France (C.C.)
| | - Marco Pasi
- Stroke unit, CHU Tours, Centre Val de Loire, France (M.P.)
| | - Grégoire Boulouis
- Diagnostic and Interventional Neuroradiology, University Hospital, Tours, France (H.T., G.B.)
- INSERM 1253 iBrain, Tours, Centre Val de Loire, France (G.B.)
- CIC-IT 14.15, Tours, Centre Val de Loire, France (G.B.)
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Senff JR, Singh SD, Pasi M, Jolink WMT, Rodrigues MA, Schreuder FHBM, Staals J, Schreuder T, Douwes JPJ, Talsma J, McKaig BN, Kourkoulis C, Yechoor N, Anderson CD, Puy L, Cordonnier C, Wermer MJH, Rothwell PM, Rosand J, Klijn CJM, Al-Shahi Salman R, Rinkel GJE, 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 DOI: 10.1161/strokeaha.123.044622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [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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Scopelliti G, Rossi C, Kuchcinski G, Boulouis G, Moulin S, Cordonnier C, Hénon H, Casolla B. Fatigue after spontaneous intracerebral haemorrhage: prevalence and associated factors. Neurol Sci 2024; 45:2127-2135. [PMID: 37993682 DOI: 10.1007/s10072-023-07196-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Fatigue is a major complaint in stroke survivors, but data focusing on intracerebral haemorrhage (ICH) survivors are scarce. In a cohort of spontaneous ICH survivors, we assessed the long-term prevalence of fatigue and its associated factors. METHODS We included consecutive 1-year ICH survivors from the prospective, observational, single-centre Prognosis of Intracerebral Haemorrhage (PITCH) study. We evaluated fatigue (defined as a score ≥ 4 in Chalder Fatigue Scale); the severity of neurological, depressive, and anxiety symptoms; and functional disability 1, 3, and 6 years after ICH. We performed univariable and multivariable models to evaluate clinical factors and brain magnetic resonance imaging (MRI) small vessel disease (SVD) markers associated with fatigue. RESULTS Of 255 1-year ICH survivors, 153 (60%) underwent fatigue screening and were included in this study. Seventy-eight patients (51%) reported fatigue at 1-year, 56/110 (51%) at 3-year, and 27/67 (40%) at 6-year follow-up. Patients with fatigue exhibited more severe concomitant depressive/anxiety symptoms, but the severity of depressive symptoms was the only clinical factor significantly associated with 1-year fatigue in multivariable analysis (adjusted odds ratio 1.4 for one-point increase; 95% confidence interval 1.2-1.6). Patients with severe cortical atrophy at baseline had increased risk of fatigue at 1-year follow-up compared to patients with mild/no cortical atrophy (adjusted odds ratio 2.5; 95% confidence interval 1.1-5.8). CONCLUSIONS Fatigue after ICH is frequent and long-lasting, and it is associated with cortical atrophy (but not with other MRI markers of cerebral SVD). The link between fatigue and depressive symptoms may represent a potential therapeutic target.
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Affiliation(s)
- Giuseppe Scopelliti
- Department of Neurology, Inserm, U1172-LilNCog-Lille Neuroscience & Cognition, CHU-Lille, Univ. Lille, F-59000, Lille, France
- Neurology and Stroke Unit, Luigi Sacco Hospital, Milan, Italy
| | - Costanza Rossi
- Department of Neurology, Inserm, U1172-LilNCog-Lille Neuroscience & Cognition, CHU-Lille, Univ. Lille, F-59000, Lille, France
| | - Grégory Kuchcinski
- Department of Neuroradiology, Inserm, U1172-Lille Neuroscience & Cognition, CHU-Lille, Univ. Lille, F-59000, Lille, France
| | - Grégoire Boulouis
- Diagnostic and Interventional Neuroradiology Department, INSERM U1253 iBrain, University Hospital of Tours, Centre Val de Loire, Tours, France
| | | | - Charlotte Cordonnier
- Department of Neurology, Inserm, U1172-LilNCog-Lille Neuroscience & Cognition, CHU-Lille, Univ. Lille, F-59000, Lille, France.
| | - Hilde Hénon
- Department of Neurology, Inserm, U1172-LilNCog-Lille Neuroscience & Cognition, CHU-Lille, Univ. Lille, F-59000, Lille, France
| | - Barbara Casolla
- Department of Neurology, Inserm, U1172-LilNCog-Lille Neuroscience & Cognition, CHU-Lille, Univ. Lille, F-59000, Lille, France
- UR2CA-URRIS, Stroke Unit, CHU Pasteur 2, Nice Cote d'Azur University, Nice, France
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Gurol U, Scopelliti G, Cordonnier C, Puy L. Long-term headache after spontaneous intracerebral haemorrhage. Eur J Neurol 2024; 31:e16247. [PMID: 38348521 DOI: 10.1111/ene.16247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/12/2024] [Accepted: 01/30/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Though headache is commonly observed after stroke and may affect survivors' quality of life, it has rarely been studied after spontaneous intracerebral haemorrhage (ICH). In a cohort of ICH survivors, we assessed the long-term prevalence and determinants of headache. METHODS We screened consecutive ICH survivors enrolled in the prospective, single-centre Prognosis of Intracerebral Haemorrhage study for headache 1, 3, and 6 years after ICH, according to the International Headache Society's criteria. Depressive and anxiety symptoms severity was measured at 1-year follow-up. Variables associated with the presence of headache 1 year after ICH were analyzed using univariate and multivariable models. RESULTS Among the 146 patients included in this study, 31 (21%), 25 (19%), and 14 (20%) patients reported headache at 1-, 3-, and 6-year follow-up, respectively. In an age-adjusted model, patients with headache at ICH onset (adjusted odds ratio [aOR] 2.75; 95% CI 1.02-7.42) and previous history of headache (aOR 4.60; 95% CI 1.74-12.1) were associated with headache at 1-year follow-up. Patients with headache were more likely to report depressive and anxiety symptoms at 1-year follow-up (both p < 0.02). CONCLUSIONS One in five ICH survivors suffered from headache and patients who reported headache at ICH onset were especially at risk.
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Affiliation(s)
- Ugur Gurol
- Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience and Cognition, University of Lille, Lille, France
- Neuroscience Institute, The University of Chicago, Chicago, Illinois, USA
| | - Giuseppe Scopelliti
- Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience and Cognition, University of Lille, Lille, France
| | - Charlotte Cordonnier
- Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience and Cognition, University of Lille, Lille, France
| | - Laurent Puy
- Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience and Cognition, University of Lille, Lille, France
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Weller J, Krzywicka K, van de Munckhof A, Dorn F, Althaus K, Bode FJ, Bandettini di Poggio M, Buck B, Kleinig T, Cordonnier C, Dizonno V, Duan J, Elkady A, Chew BLA, Garcia-Esperon C, Field TS, Legault C, Morin Martin M, Michalski D, Pelz J, Schoenenberger S, Nagel S, Petruzzellis M, Raposo N, Skjelland M, Zimatore DS, Aaron S, Sanchez van Kammen M, Aguiar de Sousa D, Lindgren E, Jood K, Scutelnic A, Heldner MR, Poli S, Arauz A, Conforto AB, Putaala J, Tatlisumak T, Arnold M, Coutinho JM, Günther A, Zimmermann J, Ferro JM. Endovascular treatment of cerebral sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia. Eur Stroke J 2024; 9:105-113. [PMID: 37771138 PMCID: PMC10916823 DOI: 10.1177/23969873231202363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/03/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION There is little data on the role of endovascular treatment (EVT) of cerebral venous sinus thrombosis (CVST) due to vaccine-induced immune thrombotic thrombocytopenia (VITT). Here, we describe clinical characteristics and outcomes of CVST-VITT patients who were treated with EVT. PATIENTS AND METHODS We report data from an international registry of patients who developed CVST within 28 days of SARS-CoV-2 vaccination, reported between 29 March 2021 and 6 March 2023. VITT was defined according to the Pavord criteria. RESULTS EVT was performed in 18/136 (13%) patients with CVST-VITT (92% aspiration and/or stent retrieval, 8% local thrombolysis). Most common indications were extensive thrombosis and clinical or radiological deterioration. Compared to non-EVT patients, those receiving EVT had a higher median thrombus load (4.5 vs 3). Following EVT, local blood flow was improved in 83% (10/12, 95% confidence interval [CI] 54-96). One (6%) asymptomatic sinus perforation occurred. Eight (44%) patients treated with EVT also underwent decompressive surgery. Mortality was 50% (9/18, 95% CI 29-71) and 88% (8/9, 95% CI 25-66) of surviving EVT patients achieved functional independence with a modified Rankin Scale score of 0-2 at follow-up. In multivariable analysis, EVT was not associated with increased mortality (adjusted odds ratio, 0.66, 95% CI 0.16-2.58). DISCUSSION AND CONCLUSION We describe the largest cohort of CVST-VITT patients receiving EVT. Half of the patients receiving EVT died during hospital admission, but most survivors achieved functional independence.
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Affiliation(s)
- Johannes Weller
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Katarzyna Krzywicka
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Anita van de Munckhof
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | | | - Felix J Bode
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | | | - Brian Buck
- Division of Neurology, University of Alberta Hospital, Edmonton, AB, Canada
| | - Timothy Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 – LilNCog – Lille Neuroscience & Cognition, Lille, France
| | - Vanessa Dizonno
- Vancouver Stroke Program, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Jiangang Duan
- Department of Neurology and Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ahmed Elkady
- Department of Neurology, Saudi German Hospital, Jeddah, Saudi Arabia
| | | | | | - Thalia S Field
- Vancouver Stroke Program, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Catherine Legault
- Division of Neurology, McGill University Health Centre, Montreal, QC, Canada
| | - Mar Morin Martin
- Department of Neurology, Hospital Complex of Toledo, Toledo, Spain
| | | | - Johann Pelz
- Department of Neurology, University of Leipzig, Leipzig, Germany
| | | | - Simon Nagel
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - Marco Petruzzellis
- Neuroradiology Unit, Azienda Ospedaliera Consorziale Policlinico di Bari, Italy
| | - Nicolas Raposo
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France and Inserm, Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | | | - Sanjith Aaron
- Neurology Unit, Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Mayte Sanchez van Kammen
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Diana Aguiar de Sousa
- CEEM and Institute of Anatomy, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Stroke Centre, Lisbon Central University Hospital, Lisbon, Portugal
| | - Erik Lindgren
- Department of Neurology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Adrian Scutelnic
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Poli
- Department of Neurology & Stroke, Eberhard-Karls University, Tuebingen, Germany and Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tuebingen, Germany
| | - Antonio Arauz
- Instituto Nacional de Neurologia y Neurocirugia, Mexico City, Mexico
| | - Adriana B Conforto
- Hospital das Clinicas/São Paulo University and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Albrecht Günther
- Department of Neurology, Jena University Hospital, Jena, Germany
| | | | - José M Ferro
- Centro de Estudas Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Portugal
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Accettone T, Personnic T, Bretzner M, Behal H, Cordonnier C, Henon H, Puy L. Impact of prodromal symptoms on the prognosis of patients with basilar artery occlusion treated with mechanical thrombectomy. Eur Stroke J 2024:23969873241234844. [PMID: 38403919 DOI: 10.1177/23969873241234844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION Even with reperfusion therapies, the prognosis of patients with basilar artery occlusion (BAO) related stroke remains poor. We aimed to test the hypothesis that the presence of prodromal symptoms, an easily available anamnestic data, is a key determinant of poor functional outcome. PATIENTS AND METHODS Data from patients with BAO treated in Lille, France, with mechanical thrombectomy (MT) between 2015 and 2021 were prospectively collected. The presence of prodromal symptoms was defined by previous transient neurological deficit or gradual progressive clinical worsening preceding a secondary sudden clinical worsening. We compared the characteristics of patients with and without prodromal symptoms. We built multivariate logistic regression models to study the association between the presence of prodromal symptoms and functional (mRS 0-3 and mortality), and procedural (successful recanalization and early reocclusion) outcomes. RESULTS Among the 180 patients, 63 (35%) had prodromal symptoms, most frequently a vertigo. Large artery atherosclerosis was the predominant cause of stroke (41.3%). The presence of prodromal symptoms was an independent predictor of worse 90-day functional outcome (mRS 0-3: 25.4% vs 47.0%, odds ratio (OR) 0.39; 95% confidence interval (CI) 0.16-0.86) and 90-day mortality (OR 2.17; 95% CI 1.02-4.65). Despite similar successful recanalization rate, the proportion of early basilar artery reocclusion was higher in patients with prodromal symptoms (23.8% vs 5.6%, p = 0.002). DISCUSSION AND CONCLUSION More than one third of BAO patients treated with MT had prodromal symptoms, especially patients with large-artery atherosclerosis. Clinicians should systematically screen for prodromal symptoms given the poor related functional outcome and increased risk of early basilar artery reocclusion.
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Affiliation(s)
- Thomas Accettone
- Univ. Lille, Inserm, CHU Lille, UMR-S1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Thomas Personnic
- Department of Interventional Neuroradiology, Lille University, CHU Lille, Lille, France
| | - Martin Bretzner
- Department of Interventional Neuroradiology, Lille University, CHU Lille, Lille, France
| | - Helene Behal
- Department of Biostatistics, CHU Lille, Lille, France
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, UMR-S1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Hilde Henon
- Univ. Lille, Inserm, CHU Lille, UMR-S1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Laurent Puy
- Univ. Lille, Inserm, CHU Lille, UMR-S1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
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7
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Agbonon R, Forestier G, Bricout N, Benhassen W, Turc G, Bretzner M, Pasi M, Benzakoun J, Seners P, Derraz I, Legrand L, Trystram D, Rodriguez-Regent C, Charidimou A, Rost NS, Bracard S, Cordonnier C, Eker OF, Oppenheim C, Naggara O, Henon H, Boulouis G. Cerebral microbleeds and risk of symptomatic hemorrhagic transformation following mechanical thrombectomy for large vessel ischemic stroke. J Neurol 2024:10.1007/s00415-024-12205-7. [PMID: 38355868 DOI: 10.1007/s00415-024-12205-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/08/2024] [Accepted: 01/16/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND AND PURPOSE In patients with acute ischemic stroke (AIS) treated with endovascular therapy (EVT), the association of pre-existing cerebral small vessel disease (cSVD) with symptomatic intracerebral hemorrhage (sICH) remains controversial. We tested the hypothesis that the presence of cerebral microbleeds (CMBs) and their burden would be associated with sICH after EVT of AIS. METHODS We conducted a retrospective study combining cohorts of patients that underwent EVT between January 1st 2015 and January 1st 2020. CMB presence, burden, and other cSVD markers were assessed on a pre-treatment MRI, evaluated independently by two observers. Primary outcome was the occurrence of sICH. RESULTS 445 patients with pretreatment MRI were included, of which 70 (15.7%) demonstrated CMBs on baseline MRI. sICH occurred in 36 (7.6%) of all patients. Univariate analysis did not demonstrate an association between CMB and the occurrence of sICH (7.5% in CMB+ group vs 8.6% in CMB group, p = 0.805). In multivariable models, CMBs' presence was not significantly associated with increased odds for sICH (-aOR- 1.19; 95% CI [0.43-3.27], p = 0.73). Only ASPECTs (aOR 0.71 per point increase; 95% CI [0.60-0.85], p < 0.001) and collaterals status (aOR 0.22 for adequate versus poor collaterals; 95% CI [0.06-0.93], p 0.019) were independently associated with sICH. CONCLUSION CMB presence and burden is not associated with increased occurrence of sICH after EVT. This result incites not to exclude patients with CMBs from EVT. The risk of sICH after EVT in patients with more than10 CMBs will require further investigation. REGISTRATION Registration-URL: http://www. CLINICALTRIALS gov ; Unique identifier: NCT01062698.
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Affiliation(s)
- Rémi Agbonon
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Géraud Forestier
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France.
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France.
- Neuroradiology Department, Limoges University Hospital, 2 avenue Martin Luther-King, 87042, Limoges, France.
| | - Nicolas Bricout
- Neuroradiology Department, Univ. Lille, Inserm, CHU Lille, U1172-LilNCog (JPARC)-Lille Neurosciences & Cognition, 59000, Lille, France
| | - Wagih Benhassen
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Guillaume Turc
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
- Neurology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Martin Bretzner
- Neuroradiology Department, Univ. Lille, Inserm, CHU Lille, U1172-LilNCog (JPARC)-Lille Neurosciences & Cognition, 59000, Lille, France
| | - Marco Pasi
- Univ. Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience & Cognition, 59000, Lille, France
| | - Joseph Benzakoun
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Pierre Seners
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
- Neurology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Imad Derraz
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, Montpellier, France
| | - Laurence Legrand
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Denis Trystram
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Christine Rodriguez-Regent
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Andreas Charidimou
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Natalia S Rost
- Department of Neurology, J. Philip Kistler Stroke Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Serge Bracard
- Neuroradiology Department, Lorraine University, INSERM U1254 CHRU Nancy, Nancy, France
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience & Cognition, 59000, Lille, France
| | - Omer F Eker
- Department of Neuroradiology of Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon, France
| | - Catherine Oppenheim
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Olivier Naggara
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
| | - Hilde Henon
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
- Neurology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
| | - Grégoire Boulouis
- Neuroradiology Department, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, IMA-BRAIN INSERM U1266, Université de Paris, Paris, France
- Neuroradiology Department, CHU de Tours, Centre Val de Loire Region, Tours, France
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8
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Abdalkader M, Ning S, Qureshi MM, Haussen DC, Strbian D, Nagel S, Demeestere J, Puetz V, Mohammaden MH, Olive Gadea M, Winzer S, Yamagami H, Tanaka K, Marto JP, Tomppo L, Henon H, Sheth SA, Ortega-Gutierrez S, Martinez-Majander N, Caparros F, Lemmens R, Dusart A, Bellante F, Zaidi SF, Siegler JE, Nannoni S, Kaesmacher J, Dobrocky T, Farooqui M, Salazar-Marioni S, Virtanen P, Vandewalle L, Wouters A, Jesser J, Ventura R, Castonguay AC, Uchida K, Puri AS, Masoud HE, Klein P, Mansoor Z, Bui J, Kang M, Mujanovic A, Rizzo F, Kokkonen T, Ramos JN, Strambo D, Michel P, Möhlenbruch MA, Lin E, Kaiser DPO, Yoshimura S, Sakai N, Cordonnier C, Ringleb PA, Roy D, Zaidat OO, Fischer U, Ribo M, Raymond J, Nogueira RG, Nguyen TN. Sex Differences in Outcomes of Late-Window Endovascular Stroke Therapy. Stroke 2024; 55:278-287. [PMID: 38252759 DOI: 10.1161/strokeaha.123.045015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND The association between sex and outcome after endovascular thrombectomy of acute ischemic stroke is unclear. The aim of this study was to compare the clinical and safety outcomes between men and women treated with endovascular thrombectomy in the late 6-to-24-hour window period. METHODS This multicenter, retrospective observational cohort study included consecutive patients who underwent endovascular thrombectomy of anterior circulation stroke in the late window from 66 clinical sites in 10 countries from January 2014 to May 2022. The primary outcome was the 90-day ordinal modified Rankin Scale score. Secondary outcomes included 90-day functional independence (FI), return of Rankin (RoR) to prestroke baseline, FI or RoR, symptomatic intracranial hemorrhage, and mortality. Multivariable and inverse probability of treatment weighting methods were used. We explored the interaction of sex with baseline characteristics on the outcomes ordinal modified Rankin Scale and FI or RoR. RESULTS Of 1932 patients, 1055 were women and 877 were men. Women were older (77 versus 69 years), had higher rates of atrial fibrillation, hypertension, and greater prestroke disability, but there was no difference in baseline National Institutes of Health Stroke Scale score. Inverse probability of treatment weighting analysis showed no difference between women and men in ordinal modified Rankin Scale (odds ratio, 0.98 [95% CI, 0.79-1.21]), FI or RoR (odds ratio, 0.98 [95% CI, 0.78-1.22]), severe disability or mortality (odds ratio, 0.99 [95% CI, 0.80-1.23]). The multivariable analysis of the above end points was concordant. There were no interactions between baseline characteristics and sex on the outcomes of ordinal modified Rankin Scale and FI or RoR. CONCLUSIONS In late presenting patients with anterior circulation stroke treated with endovascular thrombectomy in the 6 to 24-hour window, there was no difference in clinical or safety outcomes between men and women.
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Affiliation(s)
- Mohamad Abdalkader
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Shen Ning
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Muhammad M Qureshi
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
- Radiation Oncology (M.M.Q.), Boston Medical Center
| | - Diogo C Haussen
- Departments of Neurology, Grady Memorial Hospital (D.C.H., M.H.M., R.G.N.)
| | - Daniel Strbian
- Departments of Neurology (D. Strbian, L.T., N.M.-M.), Helsinki University Hospital, Finland
| | - Simon Nagel
- Department of Neurology, Klinikum Ludwigshafen, Germany (S. Nagel)
- Departments of Neurology (S. Nagel, P.A.R.). Heidelberg University Hospital, Germany
| | - Jelle Demeestere
- Laboratory for Neurobiology, KU Leuven, Belgium (J.D., R.L., L.V., A.W.)
- Department of Neurology, UZ Leuven, Belgium (J.D., R.L., L.V., A.W.)
| | - Volker Puetz
- Department of Neurology (V.P., S.W.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
- Dresden Neurovascular Center, Germany (V.P., S.W., D.P.O.K.)
| | | | - Marta Olive Gadea
- Department of Neurology, Hospital Vall d'Hebron, Spain (M.O.G., F.R., M.R.)
| | - Simon Winzer
- Department of Neurology (V.P., S.W.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
- Dresden Neurovascular Center, Germany (V.P., S.W., D.P.O.K.)
| | - Hiroshi Yamagami
- Department of Stroke Neurology, NHO Osaka National Hospital, Japan (H.Y.)
| | - Kanta Tanaka
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T.)
| | - João Pedro Marto
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Liisa Tomppo
- Departments of Neurology (D. Strbian, L.T., N.M.-M.), Helsinki University Hospital, Finland
| | - Hilde Henon
- Department of Neurology, University of Lille, CHU Lille, Inserm, France (H.H., F.C., C.C.)
| | - Sunil A Sheth
- Department of Neurology, UTHealth McGovern Medical School, Houston (S.A.S., S.S.-M.)
| | | | | | - Francois Caparros
- Department of Neurology, University of Lille, CHU Lille, Inserm, France (H.H., F.C., C.C.)
| | - Robin Lemmens
- Laboratory for Neurobiology, KU Leuven, Belgium (J.D., R.L., L.V., A.W.)
- Department of Neurology, UZ Leuven, Belgium (J.D., R.L., L.V., A.W.)
| | - Anne Dusart
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium (A.D., F.B.)
| | - Flavio Bellante
- Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium (A.D., F.B.)
| | - Syed F Zaidi
- Department of Neurology, University of Toledo, Toledo (S.F.Z., A.C.C.)
| | | | - Stefania Nannoni
- Clinical Neurosciences, University of Cambridge, United Kingdom (S. Nannoni)
| | - Johannes Kaesmacher
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Switzerland (J.K., T.D., A.M.)
| | - Tomas Dobrocky
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Switzerland (J.K., T.D., A.M.)
| | | | | | - Pekka Virtanen
- Radiology (P.V., T.K.), Helsinki University Hospital, Finland
| | - Lieselotte Vandewalle
- Laboratory for Neurobiology, KU Leuven, Belgium (J.D., R.L., L.V., A.W.)
- Department of Neurology, UZ Leuven, Belgium (J.D., R.L., L.V., A.W.)
| | - Anke Wouters
- Laboratory for Neurobiology, KU Leuven, Belgium (J.D., R.L., L.V., A.W.)
- Department of Neurology, UZ Leuven, Belgium (J.D., R.L., L.V., A.W.)
| | - Jessica Jesser
- Radiology (J.J., M.A.M.). Heidelberg University Hospital, Germany
| | - Rita Ventura
- Departments of Neurology (J.P.M., R.V.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Occidental, Portugal
| | | | - Kazutaka Uchida
- Department of Neurosurgery, Hyogo Medical University, Japan (K.U., S.Y.)
| | - Ajit S Puri
- Interventional Neuroradiology, University of Massachusetts Memorial Medical Center (A.S.P.)
| | - Hesham E Masoud
- Department of Neurology, State University of New York (H.E.M.)
| | - Piers Klein
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Zain Mansoor
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Jenny Bui
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Matthew Kang
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
| | - Adnan Mujanovic
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Switzerland (J.K., T.D., A.M.)
| | - Federica Rizzo
- Department of Neurology, Hospital Vall d'Hebron, Spain (M.O.G., F.R., M.R.)
| | - Tatu Kokkonen
- Radiology (P.V., T.K.), Helsinki University Hospital, Finland
| | - João Nuno Ramos
- Radiology (J.N.R.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Occidental, Portugal
| | - Davide Strambo
- Department of Neurology, Lausanne University Hospital, Switzerland (D. Strambo, P.M.)
| | - Patrik Michel
- Department of Neurology, Lausanne University Hospital, Switzerland (D. Strambo, P.M.)
| | | | - Eugene Lin
- Neuroscience and Stroke Program, Mercy Health St. Vincent Hospital, Toledo (E.L., O.O.Z.)
| | - Daniel P O Kaiser
- Institute of Neuroradiology (D.P.O.K.), University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
- Dresden Neurovascular Center, Germany (V.P., S.W., D.P.O.K.)
| | - Shinichi Yoshimura
- Department of Neurosurgery, Hyogo Medical University, Japan (K.U., S.Y.)
| | - Nobuyuki Sakai
- Neurovascular Research, Kobe City Medical Center General Hospital, Japan (N.S.)
| | - Charlotte Cordonnier
- Department of Neurology, University of Lille, CHU Lille, Inserm, France (H.H., F.C., C.C.)
| | - Peter A Ringleb
- Departments of Neurology (S. Nagel, P.A.R.). Heidelberg University Hospital, Germany
| | - Daniel Roy
- Interventional Neuroradiology, CHU Montreal, Canada (D.R., J.R.)
| | - Osama O Zaidat
- Neuroscience and Stroke Program, Mercy Health St. Vincent Hospital, Toledo (E.L., O.O.Z.)
| | - Urs Fischer
- Department of Neurology, University Hospital Basel, Switzerland (U.F.)
| | - Marc Ribo
- Department of Neurology, Hospital Vall d'Hebron, Spain (M.O.G., F.R., M.R.)
| | - Jean Raymond
- Interventional Neuroradiology, CHU Montreal, Canada (D.R., J.R.)
| | - Raul G Nogueira
- Departments of Neurology, Grady Memorial Hospital (D.C.H., M.H.M., R.G.N.)
- Department of Neurology, University of Pittsburgh Medical Center (R.G.N.)
| | - Thanh N Nguyen
- Departments of Radiology (M.A., S. Ning, M.M.Q., P.K., Z.M., J.B., M.K., T.N.N.), Boston Medical Center
- Neurology (T.N.N.), Boston Medical Center
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9
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Sharma M, Molina CA, Toyoda K, Bereczki D, Bangdiwala SI, Kasner SE, Lutsep HL, Tsivgoulis G, Ntaios G, Czlonkowska A, Shuaib A, Amarenco P, Endres M, Yoon BW, Tanne D, Toni D, Yperzeele L, von Weitzel-Mudersbach P, Sampaio Silva G, Avezum A, Dawson J, Strbian D, Tatlisumak T, Eckstein J, Ameriso SF, Weber JR, Sandset EC, Goar Pogosova N, Lavados PM, Arauz A, Gailani D, Diener HC, Bernstein RA, Cordonnier C, Kahl A, Abelian G, Donovan M, Pachai C, Li D, Hankey GJ. Safety and efficacy of factor XIa inhibition with milvexian for secondary stroke prevention (AXIOMATIC-SSP): a phase 2, international, randomised, double-blind, placebo-controlled, dose-finding trial. Lancet Neurol 2024; 23:46-59. [PMID: 38101902 PMCID: PMC10822143 DOI: 10.1016/s1474-4422(23)00403-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND People with factor XI deficiency have lower rates of ischaemic stroke than the general population and infrequent spontaneous bleeding, suggesting that factor XI has a more important role in thrombosis than in haemostasis. Milvexian, an oral small-molecule inhibitor of activated factor XI, added to standard antiplatelet therapy, might reduce the risk of non-cardioembolic ischaemic stroke without increasing the risk of bleeding. We aimed to estimate the dose-response of milvexian for recurrent ischaemic cerebral events and major bleeding in patients with recent ischaemic stroke or transient ischaemic attack (TIA). METHODS AXIOMATIC-SSP was a phase 2, randomised, double-blind, placebo-controlled, dose-finding trial done at 367 hospitals in 27 countries. Eligible participants aged 40 years or older, with acute (<48 h) ischaemic stroke or high-risk TIA, were randomly assigned by a web-based interactive response system in a 1:1:1:1:1:2 ratio to receive one of five doses of milvexian (25 mg once daily, 25 mg twice daily, 50 mg twice daily, 100 mg twice daily, or 200 mg twice daily) or matching placebo twice daily for 90 days. All participants received clopidogrel 75 mg daily for the first 21 days and aspirin 100 mg daily for the first 90 days. Investigators, site staff, and participants were masked to treatment assignment. The primary efficacy endpoint was the composite of ischaemic stroke or incident covert brain infarct on MRI at 90 days, assessed in all participants allocated to treatment who completed a follow-up MRI brain scan, and the primary analysis assessed the dose-response relationship with Multiple Comparison Procedure-Modelling (MCP-MOD). The main safety outcome was major bleeding at 90 days, assessed in all participants who received at least one dose of the study drug. This trial is registered with ClinicalTrials.gov (NCT03766581) and the EU Clinical Trials Register (2017-005029-19). FINDINGS Between Jan 27, 2019, and Dec 24, 2021, 2366 participants were randomly allocated to placebo (n=691); milvexian 25 mg once daily (n=328); or twice-daily doses of milvexian 25 mg (n=318), 50 mg (n=328), 100 mg (n=310), or 200 mg (n=351). The median age of participants was 71 (IQR 62-77) years and 859 (36%) were female. At 90 days, the estimates of the percentage of participants with either symptomatic ischaemic stroke or covert brain infarcts were 16·8 (90·2% CI 14·5-19·1) for placebo, 16·7 (14·8-18·6) for 25 mg milvexian once daily, 16·6 (14·8-18·3) for 25 mg twice daily, 15·6 (13·9-17·5) for 50 mg twice daily, 15·4 (13·4-17·6) for 100 mg twice daily, and 15·3 (12·8-19·7) for 200 mg twice daily. No significant dose-response was observed among the five milvexian doses for the primary composite efficacy outcome. Model-based estimates of the relative risk with milvexian compared with placebo were 0·99 (90·2% CI 0·91-1·05) for 25 mg once daily, 0·99 (0·87-1·11) for 25 mg twice daily, 0·93 (0·78-1·11) for 50 mg twice daily, 0·92 (0·75-1·13) for 100 mg twice daily, and 0·91 (0·72-1·26) for 200 mg twice daily. No apparent dose-response was observed for major bleeding (four [1%] of 682 participants with placebo, two [1%] of 325 with milvexian 25 mg once daily, two [1%] of 313 with 25 mg twice daily, five [2%] of 325 with 50 mg twice daily, five [2%] of 306 with 100 mg twice daily, and five [1%] of 344 with 200 mg twice daily). Five treatment-emergent deaths occurred, four of which were considered unrelated to the study drug by the investigator. INTERPRETATION Factor XIa inhibition with milvexian, added to dual antiplatelet therapy, did not substantially reduce the composite outcome of symptomatic ischaemic stroke or covert brain infarction and did not meaningfully increase the risk of major bleeding. Findings from our study have informed the design of a phase 3 trial of milvexian for the prevention of ischaemic stroke in patients with acute ischaemic stroke or TIA. FUNDING Bristol Myers Squibb and Janssen Research & Development.
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Affiliation(s)
- Mukul Sharma
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
| | | | - Kazunori Toyoda
- National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | | | - Shrikant I Bangdiwala
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Scott E Kasner
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Helmi L Lutsep
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - George Ntaios
- Department of Internal Medicine, University of Thessaly, Larissa, Greece
| | - Anna Czlonkowska
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Ashfaq Shuaib
- Division of Neurology, Department of Medicine, University of Alberta Hospital, Edmonton, AB, Canada
| | - Pierre Amarenco
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Department of Neurology and Stroke Center, University of Paris, Bichat Hospital, Paris, France
| | - Matthias Endres
- Department of Neurology and Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Byung-Woo Yoon
- Uijeongbu Eulji Medical Center, Eulji University, Gyeonggi-do, South Korea
| | - David Tanne
- Stroke and Cognition Institute, Rambam Health Care Campus, Haifa, Technion, Israel
| | - Danilo Toni
- Emergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Laetitia Yperzeele
- Stroke Unit and Neurovascular Center Antwerp, Department of Neurology, Antwerp University Hospital, Antwerp (Edegem), Belgium
| | | | - Gisele Sampaio Silva
- Universidade Federal de São Paulo/UNIFESP and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Alvaro Avezum
- Centro Internacional de Pesquisa, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Jesse Dawson
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary & Life Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Daniel Strbian
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Clinical Neuroscience/Neurology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jens Eckstein
- Department of Internal Medicine and Department of Digitalization & ICT, University Hospital Basel, Basel, Switzerland
| | - Sebastián F Ameriso
- Servicio de Neurología Vascular, Departamento de Neurología, FLENI, Buenos Aires, Argentina
| | - Joerg R Weber
- Department of Neurology, Klinikum Klagenfurt, Austria
| | - Else Charlotte Sandset
- Department of Neurology, Oslo University Hospital and The Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Nana Goar Pogosova
- National Medical Research Center of Cardiology after E Chazov, Moscow, Russia
| | - Pablo M Lavados
- Departamento de Neurología y Psiquiatría, Unidad de Investigación y Ensayos Clínicos, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Antonio Arauz
- Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, México City, México
| | - David Gailani
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hans-Christoph Diener
- Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Duisburg-Essen, Essen, Germany
| | - Richard A Bernstein
- Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Charlotte Cordonnier
- University of Lille, Lille, Inserm, CHU Lille, U1172 - LiINCog - Lille Neuroscience & Cognition, F-59000, Lille, France
| | - Anja Kahl
- Bristol Myers Squibb, Princeton, NJ, USA
| | | | | | | | - Danshi Li
- Bristol Myers Squibb, Princeton, NJ, USA
| | - Graeme J Hankey
- Medical School, Centre for Neuromuscular and Neurological Disorders, The University of Western Australia, Perth, WA, Australia; Perron Institute for Neurological and Translational Science, Perth, Australia
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Metayer T, Pasi M, Magro E, Lejeune JP, Thines L, Sibon I, Touze E, Cordonnier C, Gaberel T. Indications for surgical evacuation of cerebellar intracerebral hemorrhage: consensus guidelines from the French Society of Neurosurgery (SFNC) and the French Society of Vascular Neurology (SFNV). Neurochirurgie 2024; 70:101506. [PMID: 37925776 DOI: 10.1016/j.neuchi.2023.101506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Cerebellar intracerebral hemorrhage (ICH) is associated with poor functional prognosis and high mortality. Surgical evacuation has been proposed to improve outcome. The purpose of this review was to determine the benefit of surgical evacuation of cerebellar ICH and to establish guidelines for when it should be performed. METHOD The writing committee comprised 9 members of the SFNV and the SFNC. Recommendations were established based on a literature review using the PICO questions. The American Heart Association (AHA) classification was used to define recommendation level. In case of insufficient evidence, expert opinions were provided. RESULTS Levels of evidence were low to moderate, precluding definitive recommendations. Based on available data, surgical hematoma evacuation is not recommended to improve functional outcome (Class III; Level B NR). However, based on subgroup analysis, surgical evacuation may be considered in strictly selected patients (Class IIb; Level C-EO): hematoma volume 15-25 cm3, GCS 6-10, and no oral anticoagulation or antiplatelet therapy. Moreover, surgical evacuation is recommended to decrease risk of death (Class IIa; Level B NR) in patients with a hematoma volume >15 cm3 and GCS score <10. CONCLUSION These guidelines were based on observational studies, limiting the level of evidence. However, except for strictly selected patients, surgical evacuation of cerebellar ICH was not associated with improved functional outcome, limiting indications. Data from RCTs are needed in this field.
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Affiliation(s)
- Thomas Metayer
- Department of Neurosurgery, University Hospital of Caen, Caen, F-14000, France; Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France.
| | - Marco Pasi
- Department of Neurology, University Hospital of Tours, Tours, F-37000, France
| | - Elsa Magro
- Department of Neurosurgery, University Hospital of Brest, Brest, F-29200, France
| | - Jean Paul Lejeune
- Department of Neurosurgery, University Hospital of Lille, Lille, F-59037, France
| | - Laurent Thines
- Université de Franche-Comté, CHU de Besançon, Department of neurosurgery, F-25000 Besançon, France
| | - Igor Sibon
- Department of Neurology, University Hospital of Bordeaux, Bordeaux, F-33000, France
| | - Emmanuel Touze
- Department of Neurology, University Hospital of Caen, Caen, F-14000, France; Medical University of Caen, Normandy, Caen, F-14000, France
| | | | - Thomas Gaberel
- Department of Neurosurgery, University Hospital of Caen, Caen, F-14000, France; Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, 14000 Caen, France.
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11
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Baumgartner P, Kook L, Altersberger VL, Gensicke H, Ardila-Jurado E, Kägi G, Salerno A, Michel P, Gopisingh KM, Nederkoorn PJ, Scheitz JF, Nolte CH, Heldner MR, Arnold M, Cordonnier C, Della Schiava L, Hametner C, Ringleb PA, Leker RR, Jubran H, Luft AR, Engelter ST, Wegener S. Safety and effectiveness of IV Thrombolysis in retinal artery occlusion: A multicenter retrospective cohort study. Eur Stroke J 2023; 8:966-973. [PMID: 37421135 PMCID: PMC10683723 DOI: 10.1177/23969873231185895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/13/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Retinal artery occlusion (RAO) may lead to irreversible blindness. For acute RAO, intravenous thrombolysis (IVT) can be considered as treatment. However, due to the rarity of RAO, data about IVT safety and effectiveness is limited. METHODS From the multicenter database ThRombolysis for Ischemic Stroke Patients (TRISP), we retrospectively analyzed visual acuity (VA) at baseline and within 3 months in IVT and non-IVT treated RAO patients. Primary outcome was difference of VA between baseline and follow up (∆VA). Secondary outcomes were rates of visual recovery (defined as improvement of VA ⩾ 0.3 logMAR), and safety (symptomatic intracranial hemorrhage (sICH) according to ECASS II criteria, asymptomatic intracranial hemorrhage (ICH) and major extracranial bleeding). Statistical analysis was performed using parametric tests and a linear regression model adjusted for age, sex and baseline VA. RESULTS We screened 200 patients with acute RAO and included 47 IVT and 34 non-IVT patients with complete information about recovery of vision. Visual Acuity at follow up significantly improved compared to baseline in IVT patients (∆VA 0.5 ± 0.8, p < 0.001) and non-IVT patients (∆VA 0.40 ± 1.1, p < 0.05). No significant differences in ∆VA and visual recovery rate were found between groups at follow up. Two asymptomatic ICH (4%) and one (2%) major extracranial bleeding (intraocular bleeding) occurred in the IVT group, while no bleeding events were reported in the non-IVT group. CONCLUSION Our study provides real-life data from the largest cohort of IVT treated RAO patients published so far. While there is no evidence for superiority of IVT compared to conservative treatment, bleeding rates were low. A randomized controlled trial and standardized outcome assessments in RAO patients are justified to assess the net benefit of IVT in RAO.
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Affiliation(s)
- Philipp Baumgartner
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Lucas Kook
- Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
- Institute for Data Analysis and Process Design, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Valerian L Altersberger
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Henrik Gensicke
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | | | - Georg Kägi
- Department of Neurology, Kantonsspital St. Gallen, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Alexander Salerno
- Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Patrik Michel
- Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Kiran M Gopisingh
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jan F Scheitz
- Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian H Nolte
- Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Mirjam R Heldner
- Department of Neurology, 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
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Lucie Della Schiava
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | | | - Peter A. Ringleb
- Department of Neurology, University Hospital Heidelberg, Germany
| | - Ronen R Leker
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Hamza Jubran
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Andreas R Luft
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Stefan T Engelter
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Susanne Wegener
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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12
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Scutelnic A, van de Munckhof A, Krzywicka K, van Kammen MS, Lindgren E, Cordonnier C, Kleinig TJ, Field TS, Poli S, Lemmens R, Middeldorp S, Aaron S, Borhani-Haghighi A, Arauz A, Kremer Hovinga JA, Günther A, Putaala J, Wasay M, Conforto AB, de Sousa DA, Jood K, Tatlisumak T, Ferro JM, Coutinho JM, Arnold M, Heldner MR. Sex differences in cerebral venous sinus thrombosis after adenoviral vaccination against COVID-19. Eur Stroke J 2023; 8:1001-1010. [PMID: 37434312 PMCID: PMC10345391 DOI: 10.1177/23969873231185213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/13/2023] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION Cerebral venous sinus thrombosis associated with vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) is a severe disease with high mortality. There are few data on sex differences in CVST-VITT. The aim of our study was to investigate the differences in presentation, treatment, clinical course, complications, and outcome of CVST-VITT between women and men. PATIENTS AND METHODS We used data from an ongoing international registry on CVST-VITT. VITT was diagnosed according to the Pavord criteria. We compared the characteristics of CVST-VITT in women and men. RESULTS Of 133 patients with possible, probable, or definite CVST-VITT, 102 (77%) were women. Women were slightly younger [median age 42 (IQR 28-54) vs 45 (28-56)], presented more often with coma (26% vs 10%) and had a lower platelet count at presentation [median (IQR) 50x109/L (28-79) vs 68 (30-125)] than men. The nadir platelet count was lower in women [median (IQR) 34 (19-62) vs 53 (20-92)]. More women received endovascular treatment than men (15% vs 6%). Rates of treatment with intravenous immunoglobulins were similar (63% vs 66%), as were new venous thromboembolic events (14% vs 14%) and major bleeding complications (30% vs 20%). Rates of good functional outcome (modified Rankin Scale 0-2, 42% vs 45%) and in-hospital death (39% vs 41%) did not differ. DISCUSSION AND CONCLUSIONS Three quarters of CVST-VITT patients in this study were women. Women were more severely affected at presentation, but clinical course and outcome did not differ between women and men. VITT-specific treatments were overall similar, but more women received endovascular treatment.
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Affiliation(s)
- Adrian Scutelnic
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anita van de Munckhof
- Department of Neurology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | - Katarzyna Krzywicka
- Department of Neurology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | - Mayte Sánchez van Kammen
- Department of Neurology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | - Erik Lindgren
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Timothy J Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia
| | - Thalia S Field
- Devision of Neurology, Vancouver Stroke Program, University of British Columbia, Vancouver, Canada
| | - Sven Poli
- Department of Neurology & Stroke, University Hospital Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Saskia Middeldorp
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sanjith Aaron
- Department of Neurosciences, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | | | - Antonio Arauz
- Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suárez, Mexico City
| | - Johanna A Kremer Hovinga
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Albrecht Günther
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | | | - Diana Aguiar de Sousa
- Lisbon Central University Hospital and Faculdade de Medicina da Universidade de Lisboa, Portugal
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - José M Ferro
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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13
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Al-Shahi Salman R, Stephen J, Tierney JF, Lewis SC, Newby DE, Parry-Jones AR, White PM, Connolly SJ, Benavente OR, Dowlatshahi D, Cordonnier C, Viscoli CM, Sheth KN, Kamel H, Veltkamp R, Larsen KT, Hofmeijer J, Kerkhoff H, Schreuder FHBM, Shoamanesh A, Klijn CJM, van der Worp HB. Effects of oral anticoagulation in people with atrial fibrillation after spontaneous intracranial haemorrhage (COCROACH): prospective, individual participant data meta-analysis of randomised trials. Lancet Neurol 2023; 22:1140-1149. [PMID: 37839434 DOI: 10.1016/s1474-4422(23)00315-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/09/2023] [Accepted: 08/15/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND The safety and efficacy of oral anticoagulation for prevention of major adverse cardiovascular events in people with atrial fibrillation and spontaneous intracranial haemorrhage are uncertain. We planned to estimate the effects of starting versus avoiding oral anticoagulation in people with spontaneous intracranial haemorrhage and atrial fibrillation. METHODS In this prospective meta-analysis, we searched bibliographic databases and trial registries using the strategies of a Cochrane systematic review (CD012144) on June 23, 2023. We included clinical trials if they were registered, randomised, and included participants with spontaneous intracranial haemorrhage and atrial fibrillation who were assigned to either start long-term use of any oral anticoagulant agent or avoid oral anticoagulation (ie, placebo, open control, another antithrombotic agent, or another intervention for the prevention of major adverse cardiovascular events). We assessed eligible trials using the Cochrane Risk of Bias tool. We sought data for individual participants who had not opted out of data sharing from chief investigators of completed trials, pending completion of ongoing trials in 2028. The primary outcome was any stroke or cardiovascular death. We used individual participant data to construct a Cox regression model of the time to the first occurrence of outcome events during follow-up in the intention-to-treat dataset supplied by each trial, followed by meta-analysis using a fixed-effect inverse-variance model to generate a pooled estimate of the hazard ratio (HR) with 95% CI. This study is registered with PROSPERO, CRD42021246133. FINDINGS We identified four eligible trials; three were restricted to participants with atrial fibrillation and intracranial haemorrhage (SoSTART [NCT03153150], with 203 participants) or intracerebral haemorrhage (APACHE-AF [NCT02565693], with 101 participants, and NASPAF-ICH [NCT02998905], with 30 participants), and one included a subgroup of participants with previous intracranial haemorrhage (ELDERCARE-AF [NCT02801669], with 80 participants). After excluding two participants who opted out of data sharing, we included 412 participants (310 [75%] aged 75 years or older, 249 [60%] with CHA2DS2-VASc score ≤4, and 163 [40%] with CHA2DS2-VASc score >4). The intervention was a direct oral anticoagulant in 209 (99%) of 212 participants who were assigned to start oral anticoagulation, and the comparator was antiplatelet monotherapy in 67 (33%) of 200 participants assigned to avoid oral anticoagulation. The primary outcome of any stroke or cardiovascular death occurred in 29 (14%) of 212 participants who started oral anticoagulation versus 43 (22%) of 200 who avoided oral anticoagulation (pooled HR 0·68 [95% CI 0·42-1·10]; I2=0%). Oral anticoagulation reduced the risk of ischaemic major adverse cardiovascular events (nine [4%] of 212 vs 38 [19%] of 200; pooled HR 0·27 [95% CI 0·13-0·56]; I2=0%). There was no significant increase in haemorrhagic major adverse cardiovascular events (15 [7%] of 212 vs nine [5%] of 200; pooled HR 1·80 [95% CI 0·77-4·21]; I2=0%), death from any cause (38 [18%] of 212 vs 29 [15%] of 200; 1·29 [0·78-2·11]; I2=50%), or death or dependence after 1 year (78 [53%] of 147 vs 74 [51%] of 145; pooled odds ratio 1·12 [95% CI 0·70-1·79]; I2=0%). INTERPRETATION For people with atrial fibrillation and intracranial haemorrhage, oral anticoagulation had uncertain effects on the risk of any stroke or cardiovascular death (both overall and in subgroups), haemorrhagic major adverse cardiovascular events, and functional outcome. Oral anticoagulation reduced the risk of ischaemic major adverse cardiovascular events, which can inform clinical practice. These findings should encourage recruitment to, and completion of, ongoing trials. FUNDING British Heart Foundation.
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Affiliation(s)
- Rustam Al-Shahi Salman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK.
| | - Jacqueline Stephen
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Jayne F Tierney
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Steff C Lewis
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | | | - Philip M White
- Department of Neuroradiology, Newcastle-upon-Tyne Hospitals National Health Service Trust, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Stuart J Connolly
- Department of Medicine (Neurology), Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Oscar R Benavente
- Department of Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
| | - Dar Dowlatshahi
- Department of Medicine, University of Ottawa and Hospital Research Institute, Ottawa, ON, Canada
| | - Charlotte Cordonnier
- University of Lille, INSERM, CHU Lille, U1172-Lille Neuroscience & Cognition, Lille, France
| | - Catherine M Viscoli
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Kevin N Sheth
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Roland Veltkamp
- Department of Brain Sciences, Imperial College London, London, UK
| | - Kristin T Larsen
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway; Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Jeannette Hofmeijer
- Department of Neurology and Clinical Neurophysiology, Rijnstate Hospital, and University of Twente, Arnhem, Netherlands
| | - Henk Kerkhoff
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | - Floris H B M Schreuder
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Ashkan Shoamanesh
- Department of Medicine (Neurology), Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Catharina J M Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
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14
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van de Munckhof A, Borhani-Haghighi A, Aaron S, Krzywicka K, van Kammen MS, Cordonnier C, Kleinig TJ, Field TS, Poli S, Lemmens R, Scutelnic A, Lindgren E, Duan J, Arslan Y, van Gorp ECM, Kremer Hovinga JA, Günther A, Jood K, Tatlisumak T, Putaala J, Heldner MR, Arnold M, de Sousa DA, Wasay M, Arauz A, Conforto AB, Ferro JM, Coutinho JM. Cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia in middle-income countries. Int J Stroke 2023; 18:1112-1120. [PMID: 37277922 PMCID: PMC10614174 DOI: 10.1177/17474930231182901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/26/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Adenovirus-based COVID-19 vaccines are extensively used in low- and middle-income countries (LMICs). Remarkably, cases of cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) have rarely been reported from LMICs. AIMS We studied the frequency, manifestations, treatment, and outcomes of CVST-VITT in LMICs. METHODS We report data from an international registry on CVST after COVID-19 vaccination. VITT was classified according to the Pavord criteria. We compared CVST-VITT cases from LMICs to cases from high-income countries (HICs). RESULTS Until August 2022, 228 CVST cases were reported, of which 63 were from LMICs (all middle-income countries [MICs]: Brazil, China, India, Iran, Mexico, Pakistan, Turkey). Of these 63, 32 (51%) met the VITT criteria, compared to 103 of 165 (62%) from HICs. Only 5 of the 32 (16%) CVST-VITT cases from MICs had definite VITT, mostly because anti-platelet factor 4 antibodies were often not tested. The median age was 26 (interquartile range [IQR] 20-37) versus 47 (IQR 32-58) years, and the proportion of women was 25 of 32 (78%) versus 77 of 103 (75%) in MICs versus HICs, respectively. Patients from MICs were diagnosed later than patients from HICs (1/32 [3%] vs. 65/103 [63%] diagnosed before May 2021). Clinical manifestations, including intracranial hemorrhage, were largely similar as was intravenous immunoglobulin use. In-hospital mortality was lower in MICs (7/31 [23%, 95% confidence interval (CI) 11-40]) than in HICs (44/102 [43%, 95% CI 34-53], p = 0.039). CONCLUSIONS The number of CVST-VITT cases reported from LMICs was small despite the widespread use of adenoviral vaccines. Clinical manifestations and treatment of CVST-VITT cases were largely similar in MICs and HICs, while mortality was lower in patients from MICs.
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Affiliation(s)
- Anita van de Munckhof
- Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Katarzyna Krzywicka
- Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | - Mayte Sánchez van Kammen
- Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172—LilNCog—Lille Neuroscience & Cognition, Lille, France
| | | | | | - Sven Poli
- University Hospital Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | | | - Adrian Scutelnic
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Erik Lindgren
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jiangang Duan
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yıldız Arslan
- Medicana İzmir International Hospital, Izmir, Turkey
| | | | | | | | - Katarina Jood
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Turgut Tatlisumak
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jukka Putaala
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mirjam R Heldner
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Antonio Arauz
- National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - José M Ferro
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Jonathan M Coutinho
- Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
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15
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Duering M, Biessels GJ, Brodtmann A, Chen C, Cordonnier C, de Leeuw FE, Debette S, Frayne R, Jouvent E, Rost NS, Ter Telgte A, Al-Shahi Salman R, Backes WH, Bae HJ, Brown R, Chabriat H, De Luca A, deCarli C, Dewenter A, Doubal FN, Ewers M, Field TS, Ganesh A, Greenberg S, Helmer KG, Hilal S, Jochems ACC, Jokinen H, Kuijf H, Lam BYK, Lebenberg J, MacIntosh BJ, Maillard P, Mok VCT, Pantoni L, Rudilosso S, Satizabal CL, Schirmer MD, Schmidt R, Smith C, Staals J, Thrippleton MJ, van Veluw SJ, Vemuri P, Wang Y, Werring D, Zedde M, Akinyemi RO, Del Brutto OH, Markus HS, Zhu YC, Smith EE, Dichgans M, Wardlaw JM. Neuroimaging standards for research into small vessel disease-advances since 2013. Lancet Neurol 2023; 22:602-618. [PMID: 37236211 DOI: 10.1016/s1474-4422(23)00131-x] [Citation(s) in RCA: 80] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/03/2023] [Accepted: 03/28/2023] [Indexed: 05/28/2023]
Abstract
Cerebral small vessel disease (SVD) is common during ageing and can present as stroke, cognitive decline, neurobehavioural symptoms, or functional impairment. SVD frequently coexists with neurodegenerative disease, and can exacerbate cognitive and other symptoms and affect activities of daily living. Standards for Reporting Vascular Changes on Neuroimaging 1 (STRIVE-1) categorised and standardised the diverse features of SVD that are visible on structural MRI. Since then, new information on these established SVD markers and novel MRI sequences and imaging features have emerged. As the effect of combined SVD imaging features becomes clearer, a key role for quantitative imaging biomarkers to determine sub-visible tissue damage, subtle abnormalities visible at high-field strength MRI, and lesion-symptom patterns, is also apparent. Together with rapidly emerging machine learning methods, these metrics can more comprehensively capture the effect of SVD on the brain than the structural MRI features alone and serve as intermediary outcomes in clinical trials and future routine practice. Using a similar approach to that adopted in STRIVE-1, we updated the guidance on neuroimaging of vascular changes in studies of ageing and neurodegeneration to create STRIVE-2.
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Affiliation(s)
- Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany; Medical Image Analysis Center, University of Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
| | - Geert Jan Biessels
- Department of Neurology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Amy Brodtmann
- Cognitive Health Initiative, Central Clinical School, Monash University, Melbourne, VIC, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Christopher Chen
- Department of Pharmacology, Memory Aging and Cognition Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Psychological Medicine, Memory Aging and Cognition Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Charlotte Cordonnier
- Université de Lille, INSERM, CHU Lille, U1172-Lille Neuroscience and Cognition (LilNCog), Lille, France
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Center for Medical Neuroscience, Radboudumc, Nijmegen, Netherlands
| | - Stéphanie Debette
- Bordeaux Population Health Research Center, University of Bordeaux, INSERM, UMR 1219, Bordeaux, France; Department of Neurology, Institute for Neurodegenerative Diseases, CHU de Bordeaux, Bordeaux, France
| | - Richard Frayne
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Seaman Family MR Research Centre, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Eric Jouvent
- AP-HP, Lariboisière Hospital, Translational Neurovascular Centre, FHU NeuroVasc, Université Paris Cité, Paris, France; Université Paris Cité, INSERM UMR 1141, NeuroDiderot, Paris, France
| | - Natalia S Rost
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Walter H Backes
- School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands; School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea; Cerebrovascular Disease Center, Seoul National University Bundang Hospital, Seongn-si, South Korea
| | - Rosalind Brown
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Hugues Chabriat
- Centre Neurovasculaire Translationnel, CERVCO, INSERM U1141, FHU NeuroVasc, Université Paris Cité, Paris, France
| | - Alberto De Luca
- Image Sciences Institute, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Charles deCarli
- Department of Neurology and Center for Neuroscience, University of California, Davis, CA, USA
| | - Anna Dewenter
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Fergus N Doubal
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Michael Ewers
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Thalia S Field
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada; Vancouver Stroke Program, Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Aravind Ganesh
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB, Canada
| | - Steven Greenberg
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Karl G Helmer
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Athinoula A Martinos Center for Biomedical Imaging, Boston, MA, USA; Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Saima Hilal
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Angela C C Jochems
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Hanna Jokinen
- Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Hugo Kuijf
- Image Sciences Institute, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Bonnie Y K Lam
- Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Gerald Choa Neuroscience Institute, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Margaret KL Cheung Research Centre for Management of Parkinsonism, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Lau Tat-chuen Research Centre of Brain Degenerative Diseases in Chinese, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Nuffield Department of Clinical Neurosciences, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Jessica Lebenberg
- AP-HP, Lariboisière Hospital, Translational Neurovascular Centre, FHU NeuroVasc, Université Paris Cité, Paris, France; Université Paris Cité, INSERM UMR 1141, NeuroDiderot, Paris, France
| | - Bradley J MacIntosh
- Sandra E Black Centre for Brain Resilience and Repair, Hurvitz Brain Sciences, Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada; Computational Radiology and Artificial Intelligence Unit, Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Pauline Maillard
- Department of Neurology and Center for Neuroscience, University of California, Davis, CA, USA
| | - Vincent C T Mok
- Division of Neurology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Gerald Choa Neuroscience Institute, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Margaret KL Cheung Research Centre for Management of Parkinsonism, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China; Lau Tat-chuen Research Centre of Brain Degenerative Diseases in Chinese, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Leonardo Pantoni
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
| | - Salvatore Rudilosso
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Claudia L Satizabal
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Department of Population Health Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Department of Neurology, Boston University Medical Center, Boston, MA, USA; Framingham Heart Study, Framingham, MA, USA
| | - Markus D Schirmer
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Colin Smith
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Julie Staals
- School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, Netherlands; Department of Neurology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Michael J Thrippleton
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | | | - Yilong Wang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - David Werring
- Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Department of Neuromotor Physiology and Rehabilitation, Azienda Unità Sanitaria-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Rufus O Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oscar H Del Brutto
- School of Medicine and Research Center, Universidad de Especialidades Espiritu Santo, Ecuador
| | - Hugh S Markus
- Stroke Research Group, Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK
| | - Yi-Cheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - Eric E Smith
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany; German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK.
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16
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Scopelliti G, Benzakoun J, Ben Hassen W, Bretzner M, Bricout N, Puy L, Turc G, Boulouis G, Oppenheim C, Naggara O, Cordonnier C, Henon H, Pasi M. Diffusion-Weighted Imaging Lesion Reversal in Older Patients With Stroke Treated With Mechanical Thrombectomy. Stroke 2023. [PMID: 37203564 DOI: 10.1161/strokeaha.123.042491] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
BACKGROUND Diffusion-weighted imaging lesion reversal (DWIR) is frequently observed after mechanical thrombectomy for acute ischemic stroke, but little is known about age-related differences and impact on outcome. We aimed to compare, in patients <80 versus ≥80 years old, (1) the effect of successful recanalization on DWIR and (2) the impact of DWIR on functional outcome. METHODS We retrospectively analyzed data of patients treated for an anterior circulation acute ischemic stroke with large vessel occlusion in 2 French hospitals, who underwent baseline and 24-hour follow-up magnetic resonance imaging, with baseline DWI lesion volume ≥10 cc. The percentage of DWIR (DWIR%), was calculated as follows: DWIR%=(DWIR volume/baseline DWI volume)×100. Data on demographics, medical history, and baseline clinical and radiological characteristics were collected. RESULTS Among 433 included patients (median age, 68 years), median DWIR% after mechanical thrombectomy was 22% (6-35) in patients ≥80, and 19% (interquartile range, 10-34) in patients <80 (P=0.948). In multivariable analyses, successful recanalization after mechanical thrombectomy was associated with higher median DWIR% in both ≥80 (P=0.004) and <80 (P=0.002) patients. In subgroup analyses performed on a minority of subjects, collateral vessels status score (n=87) and white matter hyperintensity volume (n=131) were not associated with DWIR% (P>0.2). In multivariable analyses, DWIR% was associated with increased rates of favorable 3-month outcomes in both ≥80 (P=0.003) and <80 (P=0.013) patients; the effect of DWIR% on outcome was not influenced by the age group (P interaction=0.185) Conclusions: DWIR might be an important and nonage-dependent effect of arterial recanalization, as it seems to beneficially impact 3-month outcomes of both younger and older subjects treated with mechanical thrombectomy for acute ischemic stroke and large vessel occlusion.
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Affiliation(s)
- Giuseppe Scopelliti
- University of Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, France (G.S., L.P., C.C., H.H., M.P.)
| | - Joseph Benzakoun
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, France (J.B., W.B.H., G.T., C.O., O.N.)
- Department of Radiology, GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, France. (J.B., W.B.H., C.O., O.N.)
| | - Wagih Ben Hassen
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, France (J.B., W.B.H., G.T., C.O., O.N.)
- Department of Radiology, GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, France. (J.B., W.B.H., C.O., O.N.)
| | - Martin Bretzner
- Department of Neuroradiology, Roger Salengro Hospital, CHU Lille, University of Lille, France (M.B., N.B.)
| | - Nicolas Bricout
- Department of Neuroradiology, Roger Salengro Hospital, CHU Lille, University of Lille, France (M.B., N.B.)
| | - Laurent Puy
- University of Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, France (G.S., L.P., C.C., H.H., M.P.)
| | - Guillaume Turc
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, France (J.B., W.B.H., G.T., C.O., O.N.)
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, France. (G.T.)
| | - Grégoire Boulouis
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Centre Val de Loire, INSERM U1253 iBrain, France (G.B.)
| | - Catherine Oppenheim
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, France (J.B., W.B.H., G.T., C.O., O.N.)
- Department of Radiology, GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, France. (J.B., W.B.H., C.O., O.N.)
| | - Olivier Naggara
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, France (J.B., W.B.H., G.T., C.O., O.N.)
- Department of Radiology, GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, France. (J.B., W.B.H., C.O., O.N.)
| | - Charlotte Cordonnier
- University of Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, France (G.S., L.P., C.C., H.H., M.P.)
| | - Hilde Henon
- University of Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, France (G.S., L.P., C.C., H.H., M.P.)
| | - Marco Pasi
- University of Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, France (G.S., L.P., C.C., H.H., M.P.)
- Neurology Department, University Hospital of Tours, Centre Val de Loire Region, France (M.P.)
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17
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Altersberger VL, Sibolt G, Enz LS, Hametner C, Scheitz JF, Henon H, Bigliardi G, Strambo D, Martinez-Majander N, Stolze LJ, Heldner MR, Grisendi I, Jovanovic DR, Bejot Y, Pezzini A, Leker RR, Kägi G, Wegener S, Cereda CW, Ntaios G, De Marchis GM, Bonati LH, Psychogios M, Lyrer P, Räty S, Tiainen M, Wouters A, Caparros F, Heyse M, Erdur H, Padjen V, Zedde M, Arnold M, Nederkoorn PJ, Michel P, Zini A, Cordonnier C, Nolte CH, Ringleb PA, Curtze S, Engelter ST, Gensicke H. Intravenous Thrombolysis 4.5-9 Hours After Stroke Onset - a Cohort Study from the TRISP Collaboration. Ann Neurol 2023. [PMID: 37114466 DOI: 10.1002/ana.26669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/27/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To investigate the safety and effectiveness of intravenous thrombolysis (IVT) >4.5-9 hours after stroke onset and the relevance of advanced neuroimaging for patient selection. METHODS Prospective multicenter cohort study from the ThRombolysis in Ischemic Stroke Patients (TRISP) collaboration. Outcomes were symptomatic intracranial hemorrhage (sICH), poor 3-month functional outcome (mRS 3-6) and mortality. We compared (i) IVT >4.5-9 hours versus 0-4.5 hours after stroke onset and (ii) within the >4.5-9 hours-group baseline advanced neuroimaging (CT perfusion, MR perfusion or MR DWI/FLAIR) versus non-advanced neuroimaging. RESULTS Of 15'827 patients, 663 (4.2%) received IVT >4.5-9 hours and 15'164 (95.8%) within 4.5 hours after stroke onset. The main baseline characteristics were evenly distributed between both groups. Time of stroke onset was known in 74.9% of patients treated between >4.5-9 hours. Using propensity score weighted binary logistic regression analysis (OTT >4.5-9 hours vs. OTT 0-4.5 hours), the probability of sICH (ORadjusted 0.80[0.53-1.17]), poor functional outcome (ORadjusted 1.01[0.83-1.22]) and mortality (ORadjusted 0.80[0.61-1.04]) did not differ significantly between both groups. In patients treated between >4.5-9 hours, the use of advanced neuroimaging was associated with a 50% lower mortality compared to non-advanced imaging only (9.9% vs 19.7%; ORadjusted 0.51[0.33-0.79]). INTERPRETATION This study showed no evidence in difference of sICH, poor outcome and mortality in selected stroke patients treated with IVT between >4.5-9 hours after stroke onset compared to those treated within 4.5 hours. Advanced neuroimaging for patient selection was associated with lower mortality. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Valerian L Altersberger
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | - Gerli Sibolt
- Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Lukas S Enz
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | | | - Jan F Scheitz
- Klinik Neurologie mit Experimenteller Neurologie, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Germany
| | - Hilde Henon
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000, Lille, France
| | - Guido Bigliardi
- Stroke Unit, Department of Neuroscience, Ospedale Civile di Baggiovara, Modena University Hospital, Modena, Italy
| | - Davide Strambo
- Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Lotte J Stolze
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Ilaria Grisendi
- Neurology Unit-Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Dejana R Jovanovic
- Neurology Clinic, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Yannick Bejot
- Department of Neurology, University Hospital Dijon, France
| | - Alessandro Pezzini
- Neurology Clinic, Department of Clinical and Experimental Sciences, University of Brescia, Italy
- Department of Neurological Sciences and Vision, ASST Spedali Civili, Brescia, Italy
| | - Ronen R Leker
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Georg Kägi
- Department of Neurology, Kantonsspital St. Gallen, Switzerland
| | - Susanne Wegener
- Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Carlo W Cereda
- Stroke Center and department of Neurology, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Georges Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Gian Marco De Marchis
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | - Leo H Bonati
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | - Marios Psychogios
- Department of Neuroradiology, University Hospital Basel and University of Basel, Switzerland
| | - Philippe Lyrer
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | - Silja Räty
- Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Marjaana Tiainen
- Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Anke Wouters
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - François Caparros
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000, Lille, France
| | - Miriam Heyse
- Department of Neurology, University Hospital Heidelberg, Germany
| | - Hebun Erdur
- Klinik Neurologie mit Experimenteller Neurologie, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Germany
| | - Visnja Padjen
- Neurology Clinic, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marialuisa Zedde
- Neurology Unit-Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Patrik Michel
- Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000, Lille, France
| | - Christian H Nolte
- Klinik Neurologie mit Experimenteller Neurologie, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Germany
| | - Peter A Ringleb
- Department of Neurology, University Hospital Heidelberg, Germany
| | - Sami Curtze
- Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Stefan T Engelter
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Henrik Gensicke
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
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18
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Alemseged F, Nguyen TN, Coutts SB, Cordonnier C, Schonewille WJ, Campbell BCV. Endovascular thrombectomy for basilar artery occlusion: translating research findings into clinical practice. Lancet Neurol 2023; 22:330-337. [PMID: 36780915 DOI: 10.1016/s1474-4422(22)00483-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/09/2022] [Accepted: 11/21/2022] [Indexed: 02/12/2023]
Abstract
BACKGROUND Basilar artery occlusion is a rare and severe condition. The effectiveness of endovascular thrombectomy in patients with basilar artery occlusion was unclear until recently, because these patients were excluded from most trials of endovascular thrombectomy for large-vessel occlusion ischaemic stroke. RECENT DEVELOPMENTS The Basilar Artery International Cooperation Study (BASICS) and the Basilar Artery Occlusion Endovascular Intervention versus Standard Medical Treatment (BEST) trials, specifically designed to investigate the benefit of thrombectomy in patients with basilar artery occlusion, did not find significant evidence of a benefit of endovascular thrombectomy in terms of disability outcomes at 3 months after stroke. However, these trials suggested a potential benefit of endovascular thrombectomy in patients presenting with moderate-to-severe symptoms. Subsequently, the Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) and the Basilar Artery Occlusion Chinese Endovascular (BAOCHE) trials, which compared endovascular thrombectomy versus medical therapy within 24 h of onset, showed clear benefit of endovascular thrombectomy in reducing disability and mortality, particularly in patients with moderate-to-severe symptoms. The risk of intracranial haemorrhage with endovascular thrombectomy was similar to the risk in anterior circulation stroke. Thrombectomy was beneficial regardless of age, baseline characteristics, the presence of intracranial atherosclerotic disease, and time from symptom onset to randomisation. Therefore, the question of whether endovascular thrombectomy is beneficial in basilar artery occlusion now appears to be settled in patients with moderate-to-severe symptoms, and endovascular thrombectomy should be offered to eligible patients. WHERE NEXT?: Key outstanding issues are the potential benefits of endovascular thrombectomy in patients with mild symptoms, the use of intravenous thrombolysis in an extended time window (ie, after 4·5 h of symptom onset), and the optimal endovascular technique for thrombectomy. Dedicated training programmes and automated software to assist with the assessment of imaging prognostic markers could be useful in the selection of patients who might benefit from endovascular thrombectomy. Large international research networks should be built to address knowledge gaps in this field and allow the conduct of clinical trials with fast and consecutive enrolment and a diverse ethnic representation.
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Affiliation(s)
- Fana Alemseged
- Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Thanh N Nguyen
- Department of Neurology and Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Shelagh B Coutts
- Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Charlotte Cordonnier
- Université Lille, INSERM UMR-S1172, Centre Hospitalier Universitaire de Lille, Lille Neuroscience et Cognition, Lille, France
| | | | - Bruce C V Campbell
- Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia.
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19
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Abstract
Intracerebral haemorrhage (ICH) is a dramatic condition caused by the rupture of a cerebral vessel and the entry of blood into the brain parenchyma. ICH is a major contributor to stroke-related mortality and dependency: only half of patients survive for 1 year after ICH, and patients who survive have sequelae that affect their quality of life. The incidence of ICH has increased in the past few decades with shifts in the underlying vessel disease over time as vascular prevention has improved and use of antithrombotic agents has increased. The pathophysiology of ICH is complex and encompasses mechanical mass effect, haematoma expansion and secondary injury. Identifying the causes of ICH and predicting the vital and functional outcome of patients and their long-term vascular risk have improved in the past decade; however, no specific treatment is available for ICH. ICH remains a medical emergency, with prevention of haematoma expansion as the key therapeutic target. After discharge, secondary prevention and management of vascular risk factors in patients remains challenging and is based on an individual benefit-risk balance evaluation.
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Affiliation(s)
- Laurent Puy
- Lille Neuroscience & Cognition (LilNCog) - U1172, University of Lille, Inserm, CHU Lille, Lille, France
| | - Adrian R Parry-Jones
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust & University of Manchester, Manchester, UK
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Else Charlotte Sandset
- Department of Neurology, Stroke Unit, Oslo University Hospital, Oslo, Norway
- The Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Dar Dowlatshahi
- Department of Medicine (Neurology), University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Wendy Ziai
- Division of Neurocritical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charlotte Cordonnier
- Lille Neuroscience & Cognition (LilNCog) - U1172, University of Lille, Inserm, CHU Lille, Lille, France.
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20
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Olindo S, Albucher JF, Bejot Y, Berge J, Cordonnier C, Guillon B, Sablot D, Tardy J, Alamowitch S, Sibon I. Tenecteplase in acute ischemic stroke: Review of the literature and expert consensus from the French Neurovascular Society. Rev Neurol (Paris) 2023; 179:150-160. [PMID: 36369068 DOI: 10.1016/j.neurol.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/04/2022] [Accepted: 08/22/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Intravenous alteplase is the only thrombolytic treatment approved for patients with acute ischemic stroke (AIS). Although no randomized controlled trial (RCT) has shown the superiority of tenecteplase over alteplase in AIS, tenecteplase is increasingly used off-label in Stroke Units. The purpose of the present work was to provide an up-to-date set of expert consensus statements on the use of tenecteplase in AIS. METHODS Members of the working group were selected by the French Neurovascular Society. RCTs comparing tenecteplase and alteplase in the treatment of AIS were reviewed. Recent meta-analysis and real-life experience data on tenecteplase published until 30th October 2021 were also analyzed. After a description of the available data, we tried to answer the subsequent questions about the use of tenecteplase in AIS: What dosage of tenecteplase should be preferred? How effective is tenecteplase for cerebral artery recanalization? What is the clinical effectiveness of tenecteplase? What is the therapeutic safety of tenecteplase? What are the benefits associated with tenecteplase ease of use? Then expert consensus statements for tenecteplase use were submitted. In October 2021 the working group was asked to review and revise the manuscript. In November 2021, the current version of the manuscript was approved. EXPERT CONSENSUS A set of three expert consensus statements for the use of tenecteplase within 4.5hours of symptom onset in AIS patients were issued: (1) It is reasonable to use tenecteplase 0.25mg/kg when mechanical thrombectomy (MT) is planned. (2) Tenecteplase 0.25mg/kg can be used as an alternative to alteplase 0.9mg/kg in patients with medium- or small-vessel occlusion not retrievable with MT. (3) Tenecteplase 0.25mg/kg could be considered as an alternative to alteplase 0.9mg/kg in patients without vessel occlusion. CONCLUSIONS These expert consensus statements could provide a framework to guide the clinical decision-making process for the use of tenecteplase according to admission characteristics of AIS patients. However, existing data are limited, requiring inclusions in ongoing RCTs or real-life registries.
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Affiliation(s)
- S Olindo
- Service de Neurovasculaire, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
| | - J-F Albucher
- Unité Neuro-Vasculaire, Hôpital Pierre-Paul-Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Y Bejot
- Service Hospitalo-Universitaire de Neurologie, CHU de Dijon Bourgogne, Dijon, France
| | - J Berge
- Service de Neuro-Radiologie, Hôpital Pellegrin, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | - C Cordonnier
- Université Lille, Inserm, CHU Lille, U1172, LiINCog, Lille Neuroscience and Cognition, Lille, France
| | - B Guillon
- Unité Neurovasculaire, Hôpital G&R Laënnec, CHU de Nantes, Nantes, France
| | - D Sablot
- Service de Neurologie, Hôpital de Perpignan, Perpignan, France
| | - J Tardy
- Unité Neuro-Vasculaire, Clinique des Cèdres, Cornebarrieu, France
| | - S Alamowitch
- Urgences Cérébro-Vasculaires, Hôpital Salpêtrière-Saint Antoine, AP-HP, Sorbonne Université, Stare Team, iCRIN, Institut du cerveau, Inserm UMRS 938, Paris, France
| | - I Sibon
- Service de Neurovasculaire, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
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21
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Puy L, Rauch A, Deramecourt V, Cordonnier C, Bérézowski V. Acute Microbleeds and Microinfarcts Within the Perihematomal Area After Intracerebral Hemorrhage. Stroke 2023; 54:e58-e62. [PMID: 36779341 DOI: 10.1161/strokeaha.122.040908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND To further our understanding of the pathophysiology of spontaneous intracerebral hemorrhage (ICH) and related injury, we provided a postmortem neuropathological examination of acute microvascular lesions (microbleeds and microinfarcts) within the perihematomal area. METHODS We included all consecutive cases (2005-2019) from the Lille University Hospital brain bank of ICH patients who died within the first month. Paraffin-embedded tissue sections from the perihematomal area were processed for several stainings and immunolabelings to investigate the presence of acute microbleeds and microinfarcts in the perihematomal area and to characterize surrounding neuronal and systemic inflammatory reaction (macrophages and neutrophils). RESULTS We included 14 ICH cases (median age, 78 years; 10 females). Acute microbleeds were observed in the perihematomal area in 12/14 patients (86%, ranging from 1 through >10) and microinfarcts in 5/14 (36%, ranging from 1 through 4). Microbleeds were observed whatever the delay from ICH onset to death was, while most cases with acute microinfarcts were observed between day 3 and day 7 (n=3/5). Both lesions were characterized by an abundant accumulation of systemic inflammatory cells and necrotic areas. CONCLUSIONS Acute microbleeds and microinfarcts might contribute to the propagation of secondary brain tissue damages after ICH. Our examinations also question the potential role of massive systemic inflammatory cells recruitment in the genesis of these microvascular injuries.
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Affiliation(s)
- Laurent Puy
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France (L.P., A.R., V.D., C.C., V.B.)
| | - Antoine Rauch
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France (L.P., A.R., V.D., C.C., V.B.).,Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID, Lille, France (A.R.)
| | - Vincent Deramecourt
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France (L.P., A.R., V.D., C.C., V.B.).,Institute of Pathology, Centre de Biologie Pathologie, Lille University Hospital, Lille, France (V.D.)
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France (L.P., A.R., V.D., C.C., V.B.)
| | - Vincent Bérézowski
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France (L.P., A.R., V.D., C.C., V.B.).,UArtois, Lens, France (V.B.)
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22
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Siegler JE, Qureshi MM, Nogueira RG, Tanaka K, Nagel S, Michel P, Vigilante N, Ribo M, Yamagami H, Yoshimura S, Abdalkader M, Haussen DC, Mohammaden MH, Nannoni S, Möhlenbruch MA, Henon H, Sheth SA, Ortega-Gutierrez S, Olive-Gadea M, Caparros F, Seker F, Zaidi S, Castonguay AC, Uchida K, Sakai N, Puri AS, Farooqui M, Toyoda K, Salazar-Marioni S, Takeuchi M, Farzin B, Masoud HE, Kuhn AL, Rana A, Morimoto M, Shibata M, Nonaka T, Klein P, Sathya A, Kiley NL, Cordonnier C, Strambo D, Demeestere J, Ringleb PA, Roy D, Zaidat OO, Jovin TG, Kaesmacher J, Fischer U, Raymond J, Nguyen TN. Endovascular vs Medical Management for Late Anterior Large Vessel Occlusion With Prestroke Disability: Analysis of CLEAR and RESCUE-Japan. Neurology 2023; 100:e751-e763. [PMID: 36332983 PMCID: PMC9969918 DOI: 10.1212/wnl.0000000000201543] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Current guidelines do not address recommendations for mechanical thrombectomy (MT) in the extended time window (>6 hours after time last seen well [TLSW]) for large vessel occlusion (LVO) patients with preexisting modified Rankin Scale (mRS) > 1. In this study, we evaluated the outcomes of MT vs medical management in patients with prestroke disability presenting in the 6- to 24-hour time window with acute LVO. METHODS We analyzed a multinational cohort (61 sites, 6 countries from 2014 to 2020) of patients with prestroke (or baseline) mRS 2 to 4 and anterior circulation LVO treated 6-24 hours from TLSW. Patients treated in the extended time window with MT vs medical management were compared using multivariable logistic regression and inverse probability of treatment weighting (IPTW). The primary outcome was the return of Rankin (ROR, return to prestroke mRS by 90 days). RESULTS Of 554 included patients (448 who underwent MT), the median age was 82 years (interquartile range [IQR] 72-87) and the National Institutes of Health Stroke Scale (NIHSS) was 18 (IQR 13-22). In both MV logistic regression and IPTW analysis, MT was associated with higher odds of ROR (adjusted OR [aOR] 3.96, 95% CI 1.78-8.79 and OR 3.10, 95% CI 1.20-7.98, respectively). Among other factors, premorbid mRS 4 was associated with higher odds of ROR (aOR, 3.68, 95% CI 1.97-6.87), while increasing NIHSS (aOR 0.90, 95% CI 0.86-0.94) and decreasing Alberta Stroke Program Early Computed Tomography Scale score (aOR per point 0.86, 95% CI 0.75-0.99) were associated with lower odds of ROR. Age, intravenous thrombolysis, and occlusion location were not associated with ROR. DISCUSSION In patients with preexisting disability presenting in the 6- to 24-hour time window, MT is associated with a higher probability of returning to baseline function compared with medical management. CLASSIFICATION OF EVIDENCE This investigation's results provide Class III evidence that in patients with preexisting disability presenting 6-24 hours from the TLSW and acute anterior LVO stroke, there may be a benefit of MT over medical management in returning to baseline function.
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Affiliation(s)
- James E Siegler
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Muhammad M Qureshi
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Raul G Nogueira
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Kanta Tanaka
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Simon Nagel
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Patrik Michel
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Nicholas Vigilante
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Marc Ribo
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Hiroshi Yamagami
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Shinichi Yoshimura
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Mohamad Abdalkader
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Diogo C Haussen
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Mahmoud H Mohammaden
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Stefania Nannoni
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Markus A Möhlenbruch
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Hilde Henon
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Sunil A Sheth
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Santiago Ortega-Gutierrez
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Marta Olive-Gadea
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Francois Caparros
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Fatih Seker
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Syed Zaidi
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Alicia C Castonguay
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Kazutaka Uchida
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Nobuyuki Sakai
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Ajit S Puri
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Mudassir Farooqui
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Kazunori Toyoda
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Sergio Salazar-Marioni
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Masataka Takeuchi
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Behzad Farzin
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Hesham E Masoud
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Anna Luisa Kuhn
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Ameena Rana
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Masafumi Morimoto
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Masunari Shibata
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Tadashi Nonaka
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Piers Klein
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Anvitha Sathya
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Nicole L Kiley
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Charlotte Cordonnier
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Davide Strambo
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Jelle Demeestere
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Peter A Ringleb
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Daniel Roy
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Osama O Zaidat
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Tudor G Jovin
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Johannes Kaesmacher
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Urs Fischer
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Jean Raymond
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
| | - Thanh N Nguyen
- From the Cooper Neurological Institute (J.E.S., A.R., T.G.J.), Cooper University Hospital, Camden, NJ; Department of Radiology (M.M.Q., M.A., P.K., A.S., N.L.K., T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Departments of Radiation Oncology (M.M.Q.) and Neurology (T.N.N.), Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA; Department of Neurology (R.G.N.), University of Pittsburgh Medical Center, PA; Division of Stroke Care Unit (Kanta Tanaka, Kazunori Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology (S. Nagel), Klinikum Ludwigshafen; Departments of Neurology (S. Nagel, P.A.R.) and Neuroradiology (M.A.M., F.S.), Heidelberg University Hospital, Germany; Department of Neurology (P.M., D.S.), Lausanne University Hospital, University of Lausanne, Switzerland; Cooper Medical School of Rowan University (N.V.), Camden, NJ; Stroke Unit (M.R., M.O.-G.), Neurology, Hospital Vall D'Hebron, Barcelona, Spain; Department of Stroke Neurology (H.Y.), NHO Osaka National Hospital, Japan; Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurology (D.C.H., M.H.M.), Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA; Department of Clinical Neurosciences (S. Nannoni), University of Cambridge, United Kingdom; University of Lille (H.H., F.C., C.C.), Inserm, Centre Hospitalier Universitaire de Lille, U1172, LilNCog-Lille Neuroscience & Cognition, France; Department of Neurology (S.A.S., S.S.-M.), UTHealth McGovern Medical School, Houston, TX; Department of Neurology (S.O.G., M.F.), University of Iowa Hospitals and Clinics, Iowa City,; Department of Neurology (S.Z., A.C.), University of Toledo, OH; Department of Neurosurgery (K.U.), Hyogo College of Medicine, Nishinomiya, Japan; Department of Neurovascular Research (N.S.), Kobe City Medical Center General Hospital, Japan; Division of Neurointerventional Radiology (A.S.P., A.L.K.), University of Massachusetts Memorial Medical Center, Worcester; Department of Neurosurgery (M.T.), Seisho Hospital, Odawara, Japan; Department of Radiology (B.F., D.R., J.R.), Centre Hospitalier de L'Université de Montréal, Canada; Department of Neurology (H.E.M.), State University of New York, Upstate Medical University, Syracuse, NY; Department of Neurosurgery (M. Morimoto), Yokohama Shintoshi Neurosurgical Hospital; Department of Neurology (M.S.), Ise Red Cross Hospital; Department of Neurosurgery (T.N.), Sapporo Shiroishi Memorial Hospital, Japan; Neurology Department (J.D.), Leuven University Hospital, Belgium; Department of Neurology (P.A.R.), Heidelberg University Hospital, Germany; Neuroscience and Stroke Program (O.O.Z.), Bon Secours Mercy Health St Vincent Hospital, Toledo, OH; Institute of Diagnostic and Interventional Neuroradiology (J.K.), University of Bern, Inselspital; Institute of Diagnostic (J.K.), Interventional and Pediatric Radiology, University Hospital Bern, Inselspital; Department of Neurology (U.F.), University Hospital Basel, University of Basel; and Department of Neurology (U.F.), University Hospital Bern, University of Bern, Switzerland
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23
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Krzywicka K, Aguiar de Sousa D, Cordonnier C, Bode FJ, Field TS, Michalski D, Pelz J, Skjelland M, Wiedmann M, Zimmermann J, Wittstock M, Zanotti B, Ciccone A, Bandettini di Poggio M, Borhani-Haghighi A, Chatterton S, Aujayeb A, Devroye A, Dizonno V, Geeraerts T, Giammello F, Günther A, Ichaporia NR, Kleinig T, Kristoffersen ES, Lemmens R, De Maistre E, Mirzaasgari Z, Payen JF, Putaala J, Petruzzellis M, Raposo N, Sadeghi-Hokmabadi E, Schoenenberger S, Umaiorubahan M, Sylaja PN, van de Munckhof A, Sánchez van Kammen M, Lindgren E, Jood K, Scutelnic A, Heldner MR, Poli S, Kruip MJHA, Arauz A, Conforto AB, Aaron S, Middeldorp S, Tatlisumak T, Arnold M, Coutinho JM, Ferro JM. Decompressive surgery in cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia. Eur J Neurol 2023; 30:1335-1345. [PMID: 36773014 DOI: 10.1111/ene.15735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/22/2023] [Accepted: 02/02/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND AND PURPOSE Cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) is an adverse drug reaction occurring after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. CVST-VITT patients often present with large intracerebral haemorrhages and a high proportion undergoes decompressive surgery. Clinical characteristics, therapeutic management and outcomes of CVST-VITT patients who underwent decompressive surgery are described and predictors of in-hospital mortality in these patients are explored. METHODS Data from an ongoing international registry of patients who developed CVST within 28 days of SARS-CoV-2 vaccination, reported between 29 March 2021 and 10 May 2022, were used. Definite, probable and possible VITT cases, as defined by Pavord et al. (N Engl J Med 2021; 385: 1680-1689), were included. RESULTS Decompressive surgery was performed in 34/128 (27%) patients with CVST-VITT. In-hospital mortality was 22/34 (65%) in the surgical and 27/94 (29%) in the non-surgical group (p < 0.001). In all surgical cases, the cause of death was brain herniation. The highest mortality rates were found amongst patients with preoperative coma (17/18, 94% vs. 4/14, 29% in the non-comatose; p < 0.001) and bilaterally absent pupillary reflexes (7/7, 100% vs. 6/9, 67% with unilaterally reactive pupil, and 4/11, 36% with bilaterally reactive pupils; p = 0.023). Postoperative imaging revealed worsening of index haemorrhagic lesion in 19 (70%) patients and new haemorrhagic lesions in 16 (59%) patients. At a median follow-up of 6 months, 8/10 of surgical CVST-VITT who survived admission were functionally independent. CONCLUSIONS Almost two-thirds of surgical CVST-VITT patients died during hospital admission. Preoperative coma and bilateral absence of pupillary responses were associated with higher mortality rates. Survivors often achieved functional independence.
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Affiliation(s)
- Katarzyna Krzywicka
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Diana Aguiar de Sousa
- Stroke Centre, Lisbon Central University Hospital Center, Lisbon, Portugal.,CEEM and Institute of Anatomy, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Charlotte Cordonnier
- INSERM, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, University of Lille, Lille, France
| | - Felix J Bode
- Department of Neurology, Universitätsklinikum Bonn, Bonn, Germany
| | - Thalia S Field
- Vancouver Stroke Program, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dominik Michalski
- Department of Neurology, Leipzig University Hospital, Leipzig, Germany
| | - Johann Pelz
- Department of Neurology, Leipzig University Hospital, Leipzig, Germany
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Markus Wiedmann
- Department of Surgery, Oslo University Hospital, Oslo, Norway
| | | | | | - Bruno Zanotti
- Department of Neuroscience, Neurology with Neurosurgical Activity, C. Poma Hospital, ASST di Mantova, Mantua, Italy
| | - Alfonso Ciccone
- Department of Neuroscience, Neurology with Neurosurgical Activity, C. Poma Hospital, ASST di Mantova, Mantua, Italy
| | | | | | - Sophie Chatterton
- Department of Neurology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Avinash Aujayeb
- Respiratory Department, Northumbria Healthcare NHS Foundation Trust, Cramlington, UK
| | - Annemie Devroye
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Vanessa Dizonno
- Vancouver Stroke Program, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Geeraerts
- Department of Anesthesiology and Critical Care, University Toulouse 3-Paul-Sabatier, University Hospital of Toulouse, Hôpital Pierre-Paul Riquet, CHU Toulouse-Purpan, Toulouse, France
| | - Fabrizio Giammello
- Translational Molecular Medicine and Surgery, XXXVI Cycle, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.,Stroke Unit, Department of Clinical and Experimental Medicine, Polyclinic Hospital G. Martino, Messina, Italy
| | - Albrecht Günther
- Department of Neurology, Jena University Hospital, Jena, Germany
| | | | - Timothy Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Espen S Kristoffersen
- Department of Neurology, Akershus University Hospital, Oslo, Norway.,Department of General Practice, University of Oslo, Oslo, Norway
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Emmanuel De Maistre
- Laboratoire d'Hématologie-Hémostase, Centre Hospitalier Universitaire Dijon, Dijon, France
| | - Zahra Mirzaasgari
- Department of Neurology, Firoozgar Hospital, School of Medicine, Iran University of Medical Science, Tehran, Iran
| | - Jean-Francois Payen
- Department of Anaesthesia and Intensive Care, Grenoble Alpes University Hospital, and Grenoble Alpes University, Grenoble Institut des Neurosciences, INSERM U1216, Grenoble, France
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marco Petruzzellis
- Department of Neurology, AOU Consorziale Policlinico di Bari, Bari, Italy
| | - Nicolas Raposo
- Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Inserm, Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France
| | - Elyar Sadeghi-Hokmabadi
- Department of Neurology, Imam-Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | - Padmavathy N Sylaja
- Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Anita van de Munckhof
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Mayte Sánchez van Kammen
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Erik Lindgren
- Department of Neurology, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Adrian Scutelnic
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Poli
- Department of Neurology & Stroke, Eberhard-Karls University, Tuebingen, Germany.,Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tuebingen, Germany
| | - Marieke J H A Kruip
- Department of Hematology, Erasmus MC, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Antonio Arauz
- National Institute of Neurology and Surgery Manuel Velasco Suarez, Mexico City, Mexico
| | - Adriana B Conforto
- Hospital das Clinicas/São Paulo University and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Sanjith Aaron
- Neurology Unit, Department of Neurological Sciences, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Saskia Middeldorp
- Department of Internal Medicine and Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - José M Ferro
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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24
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van de Munckhof A, Borhani-Haghighi A, Aaron S, Krzywicka K, Poli S, Cordonnier C, Kleinig TJ, Lemmens R, Sanchez van Kammen M, Scutelnic A, Lindgren E, Mbroh J, Ciccone A, Wittstock M, Zimmermann J, Bode FJ, Skjelland M, Devroye A, Duan J, Hiltunen S, Petruzzellis M, Kremer Hovinga JA, Günther A, Jood K, Tatlisumak T, Putaala J, Heldner M, Arnold M, Aguiar De Sousa D, Wasay M, Arauz A, Conforto AB, Ferro JM, Coutinho JM. Abstract 112: Cerebral Venous Sinus Thrombosis Due To Vaccine-induced Immune Thrombotic Thrombocytopenia In Middle-Income Countries. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction:
Adenovirus-based COVID-19 vaccines are extensively used in low- and middle-income countries (LMICs). In India alone, 1.67 billion ChAdOx1 nCoV-19 vaccines have been administered by August 23, 2022. Surprisingly however, there are only few reports of cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) from LMICs. We aimed to gain insight into the frequency, manifestations, treatment, and outcomes of CVST-VITT in LMICs.
Methods:
We report data from an international registry on CVST after COVID-19 vaccination. VITT was classified according to the Pavord criteria. We compared characteristics of CVST-VITT cases from LMICs to cases from high-income countries (HICs).
Results:
By August 15, 2022, 228 CVST cases after vaccination were reported, of which 63 cases from LMICs (all middle-income countries [MICs]: Brazil, China, India, Iran, Mexico, Pakistan, and Turkiye). Of these, 32/63 (51%) met the criteria for definite, probable or possible VITT. Only 5/32 (16%) CVST-VITT cases from MICs had definite VITT, mostly because anti-PF4 antibodies were not tested in 21/32 (66%) cases. Patients from MICs were diagnosed in a later time period than patients from HICs (1/32 [3%] vs 65/103 [63%] cases diagnosed before May 2021, respectively). Median age was 26 (IQR 20-37) vs 47 (IQR 32-58) years, and proportion of women was 25/32 (78%) vs 77/103 (75%) in MICs vs HICs, respectively. Clinical manifestations, such as focal neurologic deficits, coma, seizures, and intracranial hemorrhages, were similar. Concomitant venous thromboembolism was less frequent in MICs (3/31 [10%] vs 26/97 [27%]). Median platelet count nadir was higher in the MICs than the HICs group (65 x10
9
/L [IQR 36-115] vs 33 x10
9
/L [IQR 18-55],
p
=0.001). Intravenous immunoglobulin use was similar (19/30 [63%] vs 63/99 [64%]). In-hospital mortality was lower in the MICs than the HICs group (7/32 [22%, 95%CI 11-39] vs 44/102 [43%, 95%CI 34-53],
p
=0.031).
Conclusions:
The absolute number of CVST-VITT cases reported from LMICs was small despite the widespread use of adenoviral vaccines in these countries. Clinical manifestations and treatment of CVST-VITT cases were largely similar in MICs and HICs, while mortality was lower in patients from MICs.
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Affiliation(s)
| | | | | | | | - Sven Poli
- Dept of Neurology & Stroke, Hertie Institute for Clinical Brain Rsch, Tuebingen, Germany
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | | | | | | | | | | | - Joshua Mbroh
- Dept of Neurology & Stroke, Eberhard-Karls Univ, Tuebingen, Germany
| | - Alfonso Ciccone
- Carlo Poma Hosp, Azienda Socio Sanitaria Territoriale di Mantova, Mantua, Italy
| | | | | | - Felix J Bode
- Neurology, Universitätsklinikum Bonn, Bonn, Germany
| | | | | | - Jiangang Duan
- Neurology, Xuanwu Hosp, Capital Med Univ, Beijing, China
| | | | | | | | | | | | | | - Jukka Putaala
- Helsinki Univ Hosp and Univ of Helsinki, Helsinki, Finland
| | - Mirjam Heldner
- Inselspital, Bern Univ Hosp, Univ of Bern, Bern, Switzerland
| | - Marcel Arnold
- Inselspital, Bern Univ Hosp, Univ of Bern, Bern, Switzerland
| | | | | | - Antonio Arauz
- Instituto Nacional de Neurologia, Mexico City, Mexico
| | | | - Jose M Ferro
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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25
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Dhoisne M, Puy L, Bretzner M, Bricout N, Behal H, Cordonnier C, Henon H. Early reocclusion after successful mechanical thrombectomy for large artery occlusion-related stroke. Int J Stroke 2023:17474930221148894. [PMID: 36537618 DOI: 10.1177/17474930221148894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Despite initial successful recanalization after mechanical thrombectomy (MT), some patients with large artery occlusion (LAO)-related stroke will experience an early reocclusion of the injured vessel which may worsen their prognosis. We aimed to investigate the prevalence, associated factors and prognosis of early reocclusion after successful MT in a large prospective cohort of stroke patients with LAO. METHODS We included patients from the Lille reperfusion registry with LAO-related stroke involving M1 segment, internal carotid artery terminus or tandem ICA-M1 occlusion, with successful recanalization after MT and available 24 h imaging follow-up. Early reocclusion was defined as internal carotid artery terminus or M1 occlusion on 24 h magnetic resonance imaging (MRI) or computed tomography (CT) vascular imaging. Multivariable logistic regression models were used to investigate factors associated with early reocclusion and its impact on outcomes. RESULTS Between 2015 and 2020, 62 of 1015 included patients experienced an early reocclusion (6.1%). Age (odds ratio (OR) per 15 years decrease: 1.38 (1.05-1.81)) antiplatelet use (OR: 0.41 (0.19-0.89)), several device passes (OR: 2.13 (1.18-3.83)), atherosclerosis cause (OR: 2.38 (1.19-4.78)), and early clinical worsening (OR: 2.45 (1.18-5.07)) were independently associated with early reocclusion. Early reocclusion was independently associated with poor prognosis (OR: 7.15 (3.49-14.65)) and mortality (OR: 2.05 (1.07-3.91)) at 3 months. CONCLUSION Six percent of patients with LAO-related stroke and initial successful recanalization experienced early reocclusion. This event is associated with a 7-fold increased risk of poor functional outcome and a 2-fold increased risk of mortality. Further efforts are warranted to refine early detection of patients at risk of reocclusion and to improve their management.
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Affiliation(s)
- Mathieu Dhoisne
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Laurent Puy
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Martin Bretzner
- Department of Interventional Neuroradiology, CHU Lille, University of Lille, Lille, France
| | - Nicolas Bricout
- Department of Interventional Neuroradiology, CHU Lille, University of Lille, Lille, France
| | - Helene Behal
- CHU Lille, ULR 2694-METRICS: Évaluation des technologies de santé et des pratiques médicales, University of Lille, Lille, France
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Hilde Henon
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
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26
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Raposo N, Zanon Zotin MC, Seiffge DJ, Li Q, Goeldlin MB, Charidimou A, Shoamanesh A, Jäger HR, Cordonnier C, Klijn CJM, Smith EE, Greenberg SM, Werring DJ, Viswanathan A. A Causal Classification System for Intracerebral Hemorrhage Subtypes. Ann Neurol 2023; 93:16-28. [PMID: 36197294 PMCID: PMC9839566 DOI: 10.1002/ana.26519] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Determining the underlying causes of intracerebral hemorrhage (ICH) is of major importance, because risk factors, prognosis, and management differ by ICH subtype. We developed a new causal CLASsification system for ICH Subtypes, termed CLAS-ICH, based on recent advances in neuroimaging. METHODS CLAS-ICH defines 5 ICH subtypes: arteriolosclerosis, cerebral amyloid angiopathy, mixed small vessel disease (SVD), other rare forms of SVD (genetic SVD and others), and secondary causes (macrovascular causes, tumor, and other rare causes). Every patient is scored in each category according to the level of diagnostic evidence: (1) well-defined ICH subtype; (2) possible underlying disease; and (0) no evidence of the disease. We evaluated CLAS-ICH in a derivation cohort of 113 patients with ICH from Massachusetts General Hospital, Boston, USA, and in a derivation cohort of 203 patients from Inselspital, Bern, Switzerland. RESULTS In the derivation cohort, a well-defined ICH subtype could be identified in 74 (65.5%) patients, including 24 (21.2%) with arteriolosclerosis, 23 (20.4%) with cerebral amyloid angiopathy, 18 (15.9%) with mixed SVD, and 9 (8.0%) with a secondary cause. One or more possible causes were identified in 42 (37.2%) patients. Interobserver agreement was excellent for each category (kappa value ranging from 0.86 to 1.00). Despite substantial differences in imaging modalities, we obtained similar results in the validation cohort. INTERPRETATION CLAS-ICH is a simple and reliable classification system for ICH subtyping, that captures overlap between causes and the level of diagnostic evidence. CLAS-ICH may guide clinicians to identify ICH causes, and improve ICH classification in multicenter studies. ANN NEUROL 2023;93:16-28.
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Affiliation(s)
- Nicolas Raposo
- Department of neurology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France,Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France
| | - Maria Clara Zanon Zotin
- Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Center for Imaging Sciences and Medical Physics, Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - David J. Seiffge
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Qi Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Martina B. Goeldlin
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland,Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Andreas Charidimou
- Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ashkan Shoamanesh
- Division of Neurology, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Hans Rolf Jäger
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France
| | - Catharina JM Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Eric E. Smith
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Steven M. Greenberg
- Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David J. Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Anand Viswanathan
- Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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27
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Theodorou A, Palaiodimou L, Malhotra K, Zompola C, Katsanos AH, Shoamanesh A, Boviatsis E, Dardiotis E, Spilioti M, Sacco S, Werring DJ, Cordonnier C, Alexandrov AV, Paraskevas GP, Tsivgoulis G. Clinical, Neuroimaging, and Genetic Markers in Cerebral Amyloid Angiopathy-Related Inflammation: A Systematic Review and Meta-Analysis. Stroke 2023; 54:178-188. [PMID: 36453271 DOI: 10.1161/strokeaha.122.040671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND There are limited data regarding the prevalence of distinct clinical, neuroimaging and genetic markers among patients diagnosed with cerebral amyloid angiopathy-related inflammation (CAA-ri). We sought to determine the prevalence of clinical, radiological, genetic and cerebrospinal fluid biomarker findings in patients with CAA-ri. METHODS A systematic review and meta-analysis of published studies including patients with CAA-ri was conducted to determine the prevalence of clinical, neuroimaging, genetic and cerebrospinal fluid biomarker findings. Subgroup analyses were performed based on (1) prospective or retrospective study design and (2) CAA-ri diagnosis with or without available biopsy. We pooled the prevalence rates using random-effects models and assessed the heterogeneity using Cochran-Q and I2-statistics. RESULTS We identified 4 prospective and 17 retrospective cohort studies comprising 378 patients with CAA-ri (mean age, 71.5 years; women, 52%). The pooled prevalence rates were as follows: cognitive decline at presentation 70% ([95% CI, 54%-84%]; I2=82%), focal neurological deficits 55% ([95% CI, 40%-70%]; I2=82%), encephalopathy 54% ([95% CI, 39%-68%]; I2=43%), seizures 37% ([95% CI, 27%-49%]; I2=65%), headache 31% ([95% CI, 22%-42%]; I2=58%), T2/fluid-attenuated inversion recovery-hyperintense white matter lesions 98% ([95% CI, 93%-100%]; I2=44%), lobar cerebral microbleeds 96% ([95% CI, 92%-99%]; I2=25%), gadolinium enhancing lesions 54% ([95% CI, 42%-66%]; I2=62%), cortical superficial siderosis 51% ([95% CI, 34%-68%]; I2=77%) and lobar macrohemorrhage 40% ([95% CI, 11%-73%]; I2=88%). The prevalence rate of the ApoE (Apolipoprotein E) ε4/ε4 genotype was 34% ([95% CI, 17%-53%]; I2=76%). Subgroup analyses demonstrated no differences in these prevalence rates based on study design and diagnostic strategy. CONCLUSIONS Cognitive decline was the most common clinical feature. Hyperintense T2/fluid-attenuated inversion recovery white matter lesions and lobar cerebral microbleeds were by far the most prevalent neuroimaging findings. Thirty-four percent of patients with CAA-ri have homozygous ApoE ε4/ε4 genotype and scarce data exist regarding the cerebrospinal fluid biomarkers and its significance in these patients.
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Affiliation(s)
- Aikaterini Theodorou
- Second Department of Neurology (A.T., L.P., C.Z., G.P.P., G.T.), National & Kapodistrian University of Athens, "Attikon" University Hospital, Greece
| | - Lina Palaiodimou
- Second Department of Neurology (A.T., L.P., C.Z., G.P.P., G.T.), National & Kapodistrian University of Athens, "Attikon" University Hospital, Greece
| | - Konark Malhotra
- Department of Neurology, Allegheny Health Network, Pittsburgh, PA (K.M.)
| | - Christina Zompola
- Second Department of Neurology (A.T., L.P., C.Z., G.P.P., G.T.), National & Kapodistrian University of Athens, "Attikon" University Hospital, Greece
| | - Aristeidis H Katsanos
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., A.S.)
| | - Ashkan Shoamanesh
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., A.S.)
| | - Efstathios Boviatsis
- Department of Neurosurgery (E.B.), National & Kapodistrian University of Athens, "Attikon" University Hospital, Greece
| | - Efthimios Dardiotis
- Neurology Department, University Hospital of Larissa, University of Thessaly, Greece (E.D.)
| | - Martha Spilioti
- First Department of Neurology, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece (M.S.)
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, via Vetoio, Italy (S.S.)
| | - David J Werring
- Stroke Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom (D.J.W.)
| | - Charlotte Cordonnier
- University Lille, Inserm, CHU Lille, U1172, LilNCog, Lille Neuroscience and Cognition, France (C.C.)
| | - Andrei V Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis (A.V.A., G.T.)
| | - George P Paraskevas
- Second Department of Neurology (A.T., L.P., C.Z., G.P.P., G.T.), National & Kapodistrian University of Athens, "Attikon" University Hospital, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology (A.T., L.P., C.Z., G.P.P., G.T.), National & Kapodistrian University of Athens, "Attikon" University Hospital, Greece.,Department of Neurology, University of Tennessee Health Science Center, Memphis (A.V.A., G.T.)
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28
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Scopelliti G, Karam A, Labreuche J, Bricout N, Marrama F, Diomedi M, Ben Hassen W, Leclerc X, Cordonnier C, Henon H, Casolla B. Internal carotid artery patency after mechanical thrombectomy for stroke due to occlusive dissection: Impact on outcome. Eur Stroke J 2022; 8:199-207. [PMID: 37021179 PMCID: PMC10069197 DOI: 10.1177/23969873221140649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/04/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction: Internal carotid artery dissection (ICAD) is a rare cause of acute ischemic stroke with large vessel occlusion (AIS-LVO). We aimed investigating the impact on outcome of internal carotid artery (ICA) patency after mechanical thrombectomy (MT) for AIS-LVO due to occlusive ICAD. Patients and methods: We included consecutive patients with AIS-LVO due to occlusive ICAD treated with MT from January 2015 to December 2020 in three European stroke centers. We excluded patients with unsuccessful intracranial reperfusion after MT (modified Thrombolysis in Cerebral Infarction (mTICI) score < 2b). We compared 3-month favorable clinical outcome rate, defined as a modified Rankin scale (mRS) score ⩽2, according to ICA status (patency vs occlusion) at the end of MT and at 24-h follow-up imaging, using univariate and multivariable models. Results: Among 70 included patients, ICA was patent in 54/70 (77%) at the end of MT, and in 36/66 (54.5%) patients with 24-h follow-up imaging. Among patients with ICA patency at the end of MT, 32% presented ICA occlusion at 24-h control imaging. Favorable 3-month outcome occurred in 41/54 (76%) patients with ICA patency post-MT and in 9/16 (56%) patients with occluded ICA post-MT ( p = 0.21). Rates of favorable outcome were significantly higher in patients with 24-h ICA patency compared to patients with 24-h ICA occlusion (32/36 [89%] vs 15/30 [50%]), with an adjusted odds ratio of 4.67 (95% CI: 1.26–17.25). Discussion and conclusion: Obtaining sustained (24-h) ICA patency after MT could be a therapeutic target for improving functional outcome in patients with AIS-LVO due to ICAD.
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Affiliation(s)
- Giuseppe Scopelliti
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Arnaud Karam
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
- Department of Neuroradiology, Roger Salengro Hospital, CHU Lille, University of Lille, Lille, France
| | | | - Nicolas Bricout
- Department of Neuroradiology, Roger Salengro Hospital, CHU Lille, University of Lille, Lille, France
| | - Federico Marrama
- Department of Systems Medicine, University of Tor Vergata, Rome, Italy
| | - Marina Diomedi
- Department of Systems Medicine, University of Tor Vergata, Rome, Italy
| | - Wagih Ben Hassen
- Department of Neuroradiology, GHU Paris, Université de Paris, INSERM UMR 1266, Paris, France
| | - Xavier Leclerc
- Department of Neuroradiology, Roger Salengro Hospital, CHU Lille, University of Lille, Lille, France
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Hilde Henon
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Barbara Casolla
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
- UR2CA-URRIS, Stroke Unit, CHU Pasteur 2, Nice Cote d’Azur University, Nice, France
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29
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Altersberger VL, Rusche N, Martinez-Majander N, Hametner C, Scheitz JF, Henon H, Dell’Acqua ML, Strambo D, Stolp J, Heldner MR, Grisendi I, Jovanovic DR, Bejot Y, Pezzini A, Leker RR, Kägi G, Wegener S, Cereda CW, Lindgren E, Ntaios G, Piot I, Polymeris AA, Lyrer PA, Räty S, Sibolt G, Tiainen M, Heyse M, Erdur H, Kaaouana O, Padjen V, Zedde M, Arnold M, Nederkoorn PJ, Michel P, Bigliardi G, Zini A, Cordonnier C, Nolte CH, Ringleb PA, Curtze S, Engelter ST, Gensicke H. Intravenous Thrombolysis in Patients With Ischemic Stroke Aged ≥90 Years: A Cohort Study From the TRISP Collaboration. Stroke 2022; 53:3557-3563. [DOI: 10.1161/strokeaha.122.039426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The probability to receive intravenous thrombolysis (IVT) for treatment of acute ischemic stroke declines with increasing age and is consequently the lowest in very elderly patients. Safety concerns likely influence individual IVT treatment decisions. Using data from a large IVT registry, we aimed to provide more evidence on safety of IVT in the very elderly.
Methods:
In this prospective multicenter study from the TRISP (Thrombolysis in Ischemic Stroke Patients) registry, we compared patients ≥90 years with those <90 years using symptomatic intracranial hemorrhage (ECASS [European Cooperative Acute Stroke Study]-II criteria), death, and poor functional outcome in survivors (modified Rankin Scale score 3–5 for patients with prestroke modified Rankin Scale score ≤2 and modified Rankin Scale score 4–5 for patients prestroke modified Rankin Scale ≥3) at 3 months as outcomes. We calculated adjusted odds ratio with 95% CI using logistic regression models.
Results:
Of 16 974 eligible patients, 976 (5.7%) were ≥90 years. Patients ≥90 years had higher median National Institutes of Health Stroke Scale on admission (12 versus 8) and were more often dependent prior to the index stroke (prestroke modified Rankin Scale score of ≥3; 45.2% versus 7.4%). Occurrence of symptomatic intracranial hemorrhage (5.7% versus 4.4%, odds ratio
adjusted
1.14 [0.83–1.57]) did not differ significantly between both groups. However, the probability of death (odds ratio
adjusted
3.77 [3.14–4.53]) and poor functional outcome (odds ratio
adjusted
2.63 [2.13–3.25]) was higher in patients aged ≥90 years. Results for the sample of centenarians (n=21) were similar.
Conclusions:
The probability of symptomatic intracranial hemorrhage after IVT in very elderly patients with stroke did not exceed that of their younger counterparts. The higher probability of death and poor functional outcome during follow-up in the very elderly seems not to be related to IVT treatment. Very high age itself should not be a reason to withhold IVT.
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Affiliation(s)
- Valerian L. Altersberger
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland (V.L.A., N.R., I.P., A.A.P., P.A.L., S.T.E., H.G.)
| | - Norman Rusche
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland (V.L.A., N.R., I.P., A.A.P., P.A.L., S.T.E., H.G.)
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Switzerland (N.R., S.T.E., H.G.)
| | - Nicolas Martinez-Majander
- Neurology, University of Helsinki and Helsinki University Hospital, Finland (N.M.-M., S.R., G.S., M.T., S.C.)
| | - Christian Hametner
- Department of Neurology, University Hospital Heidelberg, Germany C.H., M.H., P.A.R.)
| | - Jan F. Scheitz
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Klinik und Hochschulambulanz für Neurologie, Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Germany (J.F.S., H.E., C.H.N.)
| | - Hilde Henon
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France (H.H., O.K., C.C.)
| | - Maria Luisa Dell’Acqua
- Neurology - Stroke Unit, Department of Neuroscience, Ospedale Civile di Baggiovara, Modena University Hospital, Italy (M.L.D.A., G.B.)
| | - Davide Strambo
- Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland (D.S., P.M.)
| | - Jeffrey Stolp
- Amsterdam UMC location University of Amsterdam, Department of Neurology, the Netherlands (J.S., P.J.N.)
| | - Mirjam R. Heldner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland (M.R.H., G.K., M.A.)
| | - Ilaria Grisendi
- Neurology Unit-Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy (I.G., M.Z.)
| | - Dejana R. Jovanovic
- University of Belgrade, Faculty of Medicine, Neurology Clinic, University Clinical Centre of Serbia (D.R.J., V.P.)
| | - Yannick Bejot
- Department of Neurology, University Hospital Dijon, France (Y.B.)
| | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Italy (A.P.)
| | - Ronen R. Leker
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (R.R.L.)
| | - Georg Kägi
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland (M.R.H., G.K., M.A.)
- Department of Neurology, Kantonsspital St. Gallen, Switzerland (G.K.)
| | - Susanne Wegener
- Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland (S.W.)
| | - Carlo W. Cereda
- Stroke Center EOC, Neurology, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland (C.W.C.)
| | - Erik Lindgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.L.)
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece (G.N.)
| | - Ines Piot
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland (V.L.A., N.R., I.P., A.A.P., P.A.L., S.T.E., H.G.)
| | - Alexandros A. Polymeris
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland (V.L.A., N.R., I.P., A.A.P., P.A.L., S.T.E., H.G.)
| | - Philippe A. Lyrer
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland (V.L.A., N.R., I.P., A.A.P., P.A.L., S.T.E., H.G.)
| | - Silja Räty
- Neurology, University of Helsinki and Helsinki University Hospital, Finland (N.M.-M., S.R., G.S., M.T., S.C.)
| | - Gerli Sibolt
- Neurology, University of Helsinki and Helsinki University Hospital, Finland (N.M.-M., S.R., G.S., M.T., S.C.)
| | - Marjaana Tiainen
- Neurology, University of Helsinki and Helsinki University Hospital, Finland (N.M.-M., S.R., G.S., M.T., S.C.)
| | - Miriam Heyse
- Department of Neurology, University Hospital Heidelberg, Germany C.H., M.H., P.A.R.)
| | - Hebun Erdur
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Klinik und Hochschulambulanz für Neurologie, Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Germany (J.F.S., H.E., C.H.N.)
| | - Olfa Kaaouana
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France (H.H., O.K., C.C.)
| | - Visnja Padjen
- University of Belgrade, Faculty of Medicine, Neurology Clinic, University Clinical Centre of Serbia (D.R.J., V.P.)
| | - Marialuisa Zedde
- Neurology Unit-Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Italy (I.G., M.Z.)
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland (M.R.H., G.K., M.A.)
| | - Paul J. Nederkoorn
- Amsterdam UMC location University of Amsterdam, Department of Neurology, the Netherlands (J.S., P.J.N.)
| | - Patrik Michel
- Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland (D.S., P.M.)
| | - Guido Bigliardi
- Neurology - Stroke Unit, Department of Neuroscience, Ospedale Civile di Baggiovara, Modena University Hospital, Italy (M.L.D.A., G.B.)
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy (A.Z.)
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France (H.H., O.K., C.C.)
| | - Christian H. Nolte
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Klinik und Hochschulambulanz für Neurologie, Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Germany (J.F.S., H.E., C.H.N.)
| | - Peter A. Ringleb
- Department of Neurology, University Hospital Heidelberg, Germany C.H., M.H., P.A.R.)
| | - Sami Curtze
- Neurology, University of Helsinki and Helsinki University Hospital, Finland (N.M.-M., S.R., G.S., M.T., S.C.)
| | - Stefan T. Engelter
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland (V.L.A., N.R., I.P., A.A.P., P.A.L., S.T.E., H.G.)
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Switzerland (N.R., S.T.E., H.G.)
| | - Henrik Gensicke
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland (V.L.A., N.R., I.P., A.A.P., P.A.L., S.T.E., H.G.)
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Switzerland (N.R., S.T.E., H.G.)
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30
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van de Munckhof A, Lindgren E, Kleinig TJ, Field TS, Cordonnier C, Krzywicka K, Poli S, Sánchez van Kammen M, Borhani-Haghighi A, Lemmens R, Scutelnic A, Ciccone A, Gattringer T, Wittstock M, Dizonno V, Devroye A, Elkady A, Günther A, Cervera A, Mengel A, Chew BLA, Buck B, Zanferrari C, Garcia-Esperon C, Jacobi C, Soriano C, Michalski D, Zamani Z, Blacquiere D, Johansson E, Cuadrado-Godia E, Vuillier F, Bode FJ, Caparros F, Maier F, Tsivgoulis G, Katzberg HD, Duan J, Burrow J, Pelz J, Mbroh J, Oen J, Schouten J, Zimmermann J, Ng K, Garambois K, Petruzzellis M, Carvalho Dias M, Ghiasian M, Romoli M, Miranda M, Wronski M, Skjelland M, Almasi-Dooghaee M, Cuisenier P, Murphy S, Timsit S, Coutts SB, Schönenberger S, Nagel S, Hiltunen S, Chatterton S, Cox T, Bartsch T, Shaygannejad V, Mirzaasgari Z, Middeldorp S, Levi MM, Kremer Hovinga JA, Jood K, Tatlisumak T, Putaala J, Heldner MR, Arnold M, Aguiar de Sousa D, Ferro JM, Coutinho JM. Outcomes of Cerebral Venous Thrombosis due to Vaccine-Induced Immune Thrombotic Thrombocytopenia After the Acute Phase. Stroke 2022; 53:3206-3210. [PMID: 36082668 PMCID: PMC9508952 DOI: 10.1161/strokeaha.122.039575] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cerebral venous thrombosis (CVT) due to vaccine-induced immune thrombotic thrombocytopenia (VITT) is a severe condition, with high in-hospital mortality rates. Here, we report clinical outcomes of patients with CVT-VITT after SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) vaccination who survived initial hospitalization. METHODS We used data from an international registry of patients who developed CVT within 28 days of SARS-CoV-2 vaccination, collected until February 10, 2022. VITT diagnosis was classified based on the Pavord criteria. Outcomes were mortality, functional independence (modified Rankin Scale score 0-2), VITT relapse, new thrombosis, and bleeding events (all after discharge from initial hospitalization). RESULTS Of 107 CVT-VITT cases, 43 (40%) died during initial hospitalization. Of the remaining 64 patients, follow-up data were available for 60 (94%) patients (37 definite VITT, 9 probable VITT, and 14 possible VITT). Median age was 40 years and 45/60 (75%) patients were women. Median follow-up time was 150 days (interquartile range, 94-194). Two patients died during follow-up (3% [95% CI, 1%-11%). Functional independence was achieved by 53/60 (88% [95% CI, 78%-94%]) patients. No new venous or arterial thrombotic events were reported. One patient developed a major bleeding during follow-up (fatal intracerebral bleed). CONCLUSIONS In contrast to the high mortality of CVT-VITT in the acute phase, mortality among patients who survived the initial hospitalization was low, new thrombotic events did not occur, and bleeding events were rare. Approximately 9 out of 10 CVT-VITT patients who survived the acute phase were functionally independent at follow-up.
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Affiliation(s)
- Anita van de Munckhof
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands. (A.v.d.M., K.K., M.S.v.K., J.M.C.)
| | - Erik Lindgren
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.L., K.J., T.T.).,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden (E.L., K.J., T.T.)
| | - Timothy J Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia (T.J.K.)
| | - Thalia S Field
- Division of Neurology, Vancouver Stroke Program, University of British Columbia, Vancouver, Canada (T.S.F., V.D.)
| | - Charlotte Cordonnier
- University Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, France (C.C., F.C.)
| | - Katarzyna Krzywicka
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands. (A.v.d.M., K.K., M.S.v.K., J.M.C.)
| | - Sven Poli
- Department of Neurology and Stroke, University Hospital Tuebingen, Eberhard-Karls University, Germany. (S.P., A.M., J.M.).,Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Germany. (S.P., J.M.)
| | - Mayte Sánchez van Kammen
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands. (A.v.d.M., K.K., M.S.v.K., J.M.C.)
| | | | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Belgium (R.L., A.D.)
| | - Adrian Scutelnic
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland. (A.S., M.R.H., M.A.)
| | - Alfonso Ciccone
- Department of Neurology, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale di Mantova, Mantua, Italy (A. Ciccone)
| | | | - Matthias Wittstock
- Department of Neurology, University Hospital Rostock, Germany (M. Wittstock)
| | - Vanessa Dizonno
- Division of Neurology, Vancouver Stroke Program, University of British Columbia, Vancouver, Canada (T.S.F., V.D.)
| | - Annemie Devroye
- Department of Neurology, University Hospitals Leuven, Belgium (R.L., A.D.)
| | - Ahmed Elkady
- Department of Neurology, Saudi German Hospital, Jeddah, Saudi Arabia (A.E.)
| | - Albrecht Günther
- Department of Neurology, Jena University Hospital, Germany (A.G.)
| | - Alvaro Cervera
- Royal Darwin Hospital, Darwin, Northern Territory, Australia (A. Cervera)
| | - Annerose Mengel
- Department of Neurology and Stroke, University Hospital Tuebingen, Eberhard-Karls University, Germany. (S.P., A.M., J.M.)
| | - Beng Lim Alvin Chew
- Department of Neurology, John Hunter Hospital, Newcastle, Australia (B.L.A.C., C.G.-E.)
| | - Brian Buck
- Division of Neurology, University of Alberta Hospital, Edmonton, Canada (B.B.)
| | - Carla Zanferrari
- Department of Neurology, Azienda Ospedaliera di Melegnano e della Martesana, Italy (C.Z.)
| | - Carlos Garcia-Esperon
- Department of Neurology, John Hunter Hospital, Newcastle, Australia (B.L.A.C., C.G.-E.)
| | - Christian Jacobi
- Department of Neurology, Krankenhaus Nordwest, Frankfurt am Main, Germany (C.J.)
| | - Cristina Soriano
- Department of Neurology, Hospital General de Castellón, Castelló, Spain (C.S.)
| | - Dominik Michalski
- Department of Neurology, Leipzig University Hospital, Germany (D.M., J. Pelz)
| | - Zohreh Zamani
- Department of Neurology, Firoozabadi Hospital, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran. (Z.Z.)
| | | | - Elias Johansson
- Department Clinical Science, Wallenberg Center for Molecular Medicine (WCMM), Umeå University, Sweden (E.J.)
| | - Elisa Cuadrado-Godia
- Department of Neurology, University Hospital del Mar, Barcelona, Spain (E.C.-G.)
| | | | - Felix J Bode
- Department of Neurology, Universitätsklinikum Bonn, Germany (F.J.B., J.Z.)
| | - François Caparros
- University Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, France (C.C., F.C.)
| | - Frank Maier
- Department of Neurology, Caritas Hospital Saarbrücken, Germany (F.M.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Greece (G.T.)
| | - Hans D Katzberg
- Department of Neuromuscular Medicine, Toronto General Hospital, Canada (H.D.K.)
| | - Jiangang Duan
- Department of Neurology and Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China (J.D.)
| | - Jim Burrow
- Department of Neurology, Royal Darwin Hospital, Tiwi, Australia (J.B.)
| | - Johann Pelz
- Department of Neurology, Leipzig University Hospital, Germany (D.M., J. Pelz)
| | - Joshua Mbroh
- Department of Neurology and Stroke, University Hospital Tuebingen, Eberhard-Karls University, Germany. (S.P., A.M., J.M.).,Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Germany. (S.P., J.M.)
| | - Joyce Oen
- Department of Neurology, Antonius Ziekenhuis, Sneek, the Netherlands (J.O.)
| | - Judith Schouten
- Department of Neurology, Rijnstate Hospital Arnhem, the Netherlands (J.S.)
| | - Julian Zimmermann
- Department of Neurology, Universitätsklinikum Bonn, Germany (F.J.B., J.Z.)
| | - Karl Ng
- Department of Neurology, Royal North Shore Hospital, Sydney, Australia (K.N., M. Wronski, S.C.)
| | - Katia Garambois
- Department of Neurology, CHU Grenoble Alpes, France (K.G., P.C.)
| | - Marco Petruzzellis
- Department of Neurology, AOU Consorziale Policlinico di Bari, Italy (M.P.)
| | - Mariana Carvalho Dias
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte, University of Lisbon, Portugal (M.C.D.)
| | - Masoud Ghiasian
- Department of Neurology, Sina Hospital, Hamadan University of Medical Science, Iran (M.G.)
| | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy (M.R.)
| | - Miguel Miranda
- Department of Neurology, Hospital de Cascais Dr. José de Almeida, Cascais, Portugal (M.M.)
| | - Miriam Wronski
- Department of Neurology, Royal North Shore Hospital, Sydney, Australia (K.N., M. Wronski, S.C.)
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Norway (M.S.)
| | | | | | - Seán Murphy
- Acute Stroke Service, Mater Misericordiae University Hospital, UCD School of Medicine and RCSI Medical School, Dublin, Ireland (S. Murphy)
| | - Serge Timsit
- Department of Neurology, Stroke Unit, Hôpital de la Cavale Blanche, CHRU de Brest (University Hospital), Université de Bretagne Occidentale, Inserm 1078, Brest, France (S.T.)
| | - Shelagh B Coutts
- Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Foothills Medical Centre, Calgary, Canada (S.B.C.)
| | | | - Simon Nagel
- Department of Neurology, Heidelberg University Hospital, Germany (S.S., S.N.)
| | - Sini Hiltunen
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Finland (S.H., T.T., J. Putaala)
| | - Sophie Chatterton
- Department of Neurology, Royal North Shore Hospital, Sydney, Australia (K.N., M. Wronski, S.C.)
| | - Thomas Cox
- Department of Neurology, University Hospital Southampton NHS Foundation Trust, United Kingdom (T.C.)
| | - Thorsten Bartsch
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany (T.B.)
| | - Vahid Shaygannejad
- Isfahan University of Medical Sciences (IUMS), Isfahan Neurosciences Research Center (INRC), Iran (V.S.).,Department of Internal (INRC), Iran (V.S.)
| | - Zahra Mirzaasgari
- Department of Neurology, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran. (M.A.-D., Z.M.)
| | - Saskia Middeldorp
- Department of Internal Medicine and Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (S. Middeldorp)
| | - Marcel M Levi
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands. (M.M.L.).,National Institute for Health Research, University College London Hospitals (UCLH), Biomedical Research Centre, London, United Kingdom (M.M.L.)
| | - Johanna A Kremer Hovinga
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Switzerland. (J.A.K.H.)
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.L., K.J., T.T.).,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden (E.L., K.J., T.T.)
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.L., K.J., T.T.).,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden (E.L., K.J., T.T.).,Department of Neurology, Helsinki University Hospital, University of Helsinki, Finland (S.H., T.T., J. Putaala)
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Finland (S.H., T.T., J. Putaala)
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland. (A.S., M.R.H., M.A.)
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland. (A.S., M.R.H., M.A.)
| | - Diana Aguiar de Sousa
- Stroke Centre, Lisbon Central University Hospital Centre, Portugal (D.A.d.S.).,Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Portugal (D.A.d.S., J.M.F.)
| | - José M Ferro
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Portugal (D.A.d.S., J.M.F.)
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands. (A.v.d.M., K.K., M.S.v.K., J.M.C.)
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31
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Van Belle E, Debry N, Vincent F, Kuchcinski G, Cordonnier C, Rauch A, Robin E, Lassalle F, Pontana F, Delhaye C, Schurtz G, JeanPierre E, Rousse N, Casari C, Spillemaeker H, Porouchani S, Pamart T, Denimal T, Neiger X, Verdier B, Puy L, Cosenza A, Juthier F, Richardson M, Bretzner M, Dallongeville J, Labreuche J, Mazighi M, Dupont-Prado A, Staels B, Lenting PJ, Susen S. Cerebral Microbleeds During Transcatheter Aortic Valve Replacement: A Prospective Magnetic Resonance Imaging Cohort. Circulation 2022; 146:383-397. [PMID: 35722876 PMCID: PMC9345525 DOI: 10.1161/circulationaha.121.057145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cerebral microbleeds (CMBs) have been observed in healthy elderly people undergoing systematic brain magnetic resonance imaging. The potential role of acute triggers on the appearance of CMBs remains unknown. We aimed to describe the incidence of new CMBs after transcatheter aortic valve replacement (TAVR) and to identify clinical and procedural factors associated with new CMBs including hemostatic measures and anticoagulation management. METHODS We evaluated a prospective cohort of patients with symptomatic aortic stenosis referred for TAVR for CMBs (METHYSTROKE [Identification of Epigenetic Risk Factors for Ischemic Complication During the TAVR Procedure in the Elderly]). Standardized neurologic assessment, brain magnetic resonance imaging, and analysis of hemostatic measures including von Willebrand factor were performed before and after TAVR. Numbers and location of microbleeds on preprocedural magnetic resonance imaging and of new microbleeds on postprocedural magnetic resonance imaging were reported by 2 independent neuroradiologists blinded to clinical data. Measures associated with new microbleeds and postprocedural outcome including neurologic functional outcome at 6 months were also examined. RESULTS A total of 84 patients (47% men, 80.9±5.7 years of age) were included. On preprocedural magnetic resonance imaging, 22 patients (26% [95% CI, 17%-37%]) had at least 1 microbleed. After TAVR, new microbleeds were observed in 19 (23% [95% CI, 14%-33%]) patients. The occurrence of new microbleeds was independent of the presence of microbleeds at baseline and of diffusion-weighted imaging hypersignals. In univariable analysis, a previous history of bleeding (P=0.01), a higher total dose of heparin (P=0.02), a prolonged procedure (P=0.03), absence of protamine reversion (P=0.04), higher final activated partial thromboplastin time (P=0.05), lower final von Willebrand factor high-molecular-weight:multimer ratio (P=0.007), and lower final closure time with adenosine-diphosphate (P=0.02) were associated with the occurrence of new postprocedural microbleeds. In multivariable analysis, a prolonged procedure (odds ratio, 1.22 [95% CI, 1.03-1.73] for every 5 minutes of fluoroscopy time; P=0.02) and postprocedural acquired von Willebrand factor defect (odds ratio, 1.42 [95% CI, 1.08-1.89] for every lower 0.1 unit of high-molecular-weight:multimer ratio; P=0.004) were independently associated with the occurrence of new postprocedural microbleeds. New CMBs were not associated with changes in neurologic functional outcome or quality of life at 6 months. CONCLUSIONS One out of 4 patients undergoing TAVR has CMBs before the procedure and 1 out of 4 patients develops new CMBs. Procedural or antithrombotic management and persistence of acquired von Willebrand factor defect were associated with the occurrence of new CMBs. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02972008.
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Affiliation(s)
- Eric Van Belle
- Cardiology Department (E.V.B., N.D., F.V., C.D., G.S., H.S., S.P., T.P., T.D., X.N., B.V., M.R.), France.,INSERM Unité 1011 (E.V.B., N.D., F.V., A.R., E.J., A.D.-P., B.S., S.S.), Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France
| | - Nicolas Debry
- Cardiology Department (E.V.B., N.D., F.V., C.D., G.S., H.S., S.P., T.P., T.D., X.N., B.V., M.R.), France.,INSERM Unité 1011 (E.V.B., N.D., F.V., A.R., E.J., A.D.-P., B.S., S.S.), Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France
| | - Flavien Vincent
- Cardiology Department (E.V.B., N.D., F.V., C.D., G.S., H.S., S.P., T.P., T.D., X.N., B.V., M.R.), France.,INSERM Unité 1011 (E.V.B., N.D., F.V., A.R., E.J., A.D.-P., B.S., S.S.), Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France
| | | | - Charlotte Cordonnier
- Degenerative and Vascular Cognitive Disorders, Department of Neurology (C. Cordonnier, L.P.), France.,(C. Cordonnier, L.P.), Université Lille, France
| | - Antoine Rauch
- Hematology and Transfusion Department (A.R., F.L., E.J., A.D.-P., S.S.), France.,INSERM Unité 1011 (E.V.B., N.D., F.V., A.R., E.J., A.D.-P., B.S., S.S.), Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France
| | | | - Fanny Lassalle
- Hematology and Transfusion Department (A.R., F.L., E.J., A.D.-P., S.S.), France
| | | | - Cédric Delhaye
- Cardiology Department (E.V.B., N.D., F.V., C.D., G.S., H.S., S.P., T.P., T.D., X.N., B.V., M.R.), France
| | - Guillaume Schurtz
- Cardiology Department (E.V.B., N.D., F.V., C.D., G.S., H.S., S.P., T.P., T.D., X.N., B.V., M.R.), France
| | - Emmanuelle JeanPierre
- Hematology and Transfusion Department (A.R., F.L., E.J., A.D.-P., S.S.), France.,INSERM Unité 1011 (E.V.B., N.D., F.V., A.R., E.J., A.D.-P., B.S., S.S.), Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France
| | | | - Caterina Casari
- INSERM UMR_S 1176 (C. Casari, P.J.L.), Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Hugues Spillemaeker
- Cardiology Department (E.V.B., N.D., F.V., C.D., G.S., H.S., S.P., T.P., T.D., X.N., B.V., M.R.), France
| | - Sina Porouchani
- Cardiology Department (E.V.B., N.D., F.V., C.D., G.S., H.S., S.P., T.P., T.D., X.N., B.V., M.R.), France
| | - Thibault Pamart
- Cardiology Department (E.V.B., N.D., F.V., C.D., G.S., H.S., S.P., T.P., T.D., X.N., B.V., M.R.), France
| | - Tom Denimal
- Cardiology Department (E.V.B., N.D., F.V., C.D., G.S., H.S., S.P., T.P., T.D., X.N., B.V., M.R.), France
| | - Xavier Neiger
- Cardiology Department (E.V.B., N.D., F.V., C.D., G.S., H.S., S.P., T.P., T.D., X.N., B.V., M.R.), France
| | - Basile Verdier
- Cardiology Department (E.V.B., N.D., F.V., C.D., G.S., H.S., S.P., T.P., T.D., X.N., B.V., M.R.), France
| | - Laurent Puy
- Degenerative and Vascular Cognitive Disorders, Department of Neurology (C. Cordonnier, L.P.), France.,(C. Cordonnier, L.P.), Université Lille, France
| | - Alessandro Cosenza
- Cardiology Department (E.V.B., N.D., F.V., C.D., G.S., H.S., S.P., T.P., T.D., X.N., B.V., M.R.), France
| | | | - Marjorie Richardson
- Cardiology Department (E.V.B., N.D., F.V., C.D., G.S., H.S., S.P., T.P., T.D., X.N., B.V., M.R.), France
| | | | | | - Julien Labreuche
- CHU Lille (J.L.), France.,EA 2694–Santé Publique: Épidémiologie et Qualité des Soins (J.L.), Université Lille, France
| | - Mikael Mazighi
- Department of Neurology, Hôpital Laribosière, APHP-NORD (M.M.), Université de Paris, France.,Department of Interventional Neuroradiology, Fondation Adolphe de Rothschild, FHU NeuroVasc, INSERM U 1148 (M.M.), Université de Paris, France
| | - Annabelle Dupont-Prado
- Hematology and Transfusion Department (A.R., F.L., E.J., A.D.-P., S.S.), France.,INSERM Unité 1011 (E.V.B., N.D., F.V., A.R., E.J., A.D.-P., B.S., S.S.), Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France
| | - Bart Staels
- INSERM Unité 1011 (E.V.B., N.D., F.V., A.R., E.J., A.D.-P., B.S., S.S.), Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France
| | - Peter J. Lenting
- INSERM UMR_S 1176 (C. Casari, P.J.L.), Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Sophie Susen
- Hematology and Transfusion Department (A.R., F.L., E.J., A.D.-P., S.S.), France.,INSERM Unité 1011 (E.V.B., N.D., F.V., A.R., E.J., A.D.-P., B.S., S.S.), Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France
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32
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Charidimou A, Boulouis G, Frosch MP, Baron JC, Pasi M, Albucher JF, Banerjee G, Barbato C, Bonneville F, Brandner S, Calviere L, Caparros F, Casolla B, Cordonnier C, Delisle MB, Deramecourt V, Dichgans M, Gokcal E, Herms J, Hernandez-Guillamon M, Jäger HR, Jaunmuktane Z, Linn J, Martinez-Ramirez S, Martínez-Sáez E, Mawrin C, Montaner J, Moulin S, Olivot JM, Piazza F, Puy L, Raposo N, Rodrigues MA, Roeber S, Romero JR, Samarasekera N, Schneider JA, Schreiber S, Schreiber F, Schwall C, Smith C, Szalardy L, Varlet P, Viguier A, Wardlaw JM, Warren A, Wollenweber FA, Zedde M, van Buchem MA, Gurol ME, Viswanathan A, Al-Shahi Salman R, Smith EE, Werring DJ, Greenberg SM. The Boston criteria version 2.0 for cerebral amyloid angiopathy: a multicentre, retrospective, MRI-neuropathology diagnostic accuracy study. Lancet Neurol 2022; 21:714-725. [PMID: 35841910 PMCID: PMC9389452 DOI: 10.1016/s1474-4422(22)00208-3] [Citation(s) in RCA: 151] [Impact Index Per Article: 75.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/11/2022] [Accepted: 05/06/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cerebral amyloid angiopathy (CAA) is an age-related small vessel disease, characterised pathologically by progressive deposition of amyloid β in the cerebrovascular wall. The Boston criteria are used worldwide for the in-vivo diagnosis of CAA but have not been updated since 2010, before the emergence of additional MRI markers. We report an international collaborative study aiming to update and externally validate the Boston diagnostic criteria across the full spectrum of clinical CAA presentations. METHODS In this multicentre, hospital-based, retrospective, MRI and neuropathology diagnostic accuracy study, we did a retrospective analysis of clinical, radiological, and histopathological data available to sites participating in the International CAA Association to formulate updated Boston criteria and establish their diagnostic accuracy across different populations and clinical presentations. Ten North American and European academic medical centres identified patients aged 50 years and older with potential CAA-related clinical presentations (ie, spontaneous intracerebral haemorrhage, cognitive impairment, or transient focal neurological episodes), available brain MRI, and histopathological assessment for CAA diagnosis. MRI scans were centrally rated at Massachusetts General Hospital (Boston, MA, USA) for haemorrhagic and non-haemorrhagic CAA markers, and brain tissue samples were rated by neuropathologists at the contributing sites. We derived the Boston criteria version 2.0 (v2.0) by selecting MRI features to optimise diagnostic specificity and sensitivity in a prespecified derivation cohort (Boston cases 1994-2012, n=159), then externally validated the criteria in a prespecified temporal validation cohort (Boston cases 2012-18, n=59) and a geographical validation cohort (non-Boston cases 2004-18; n=123), comparing accuracy of the new criteria to the currently used modified Boston criteria with histopathological assessment of CAA as the diagnostic standard. We also assessed performance of the v2.0 criteria in patients across all cohorts who had the diagnostic gold standard of brain autopsy. FINDINGS The study protocol was finalised on Jan 15, 2017, patient identification was completed on Dec 31, 2018, and imaging analyses were completed on Sept 30, 2019. Of 401 potentially eligible patients presenting to Massachusetts General Hospital, 218 were eligible to be included in the analysis; of 160 patient datasets from other centres, 123 were included. Using the derivation cohort, we derived provisional criteria for probable CAA requiring the presence of at least two strictly lobar haemorrhagic lesions (ie, intracerebral haemorrhages, cerebral microbleeds, or foci of cortical superficial siderosis) or at least one strictly lobar haemorrhagic lesion and at least one white matter characteristic (ie, severe visible perivascular spaces in centrum semiovale or white matter hyperintensities in a multispot pattern). The sensitivity and specificity of these criteria were 74·8% (95% CI 65·4-82·7) and 84·6% (71·9-93·1) in the derivation cohort, 92·5% (79·6-98·4) and 89·5% (66·9-98·7) in the temporal validation cohort, 80·2% (70·8-87·6) and 81·5% (61·9-93·7) in the geographical validation cohort, and 74·5% (65·4-82·4) and 95·0% (83·1-99·4) in all patients who had autopsy as the diagnostic standard. The area under the receiver operating characteristic curve (AUC) was 0·797 (0·732-0·861) in the derivation cohort, 0·910 (0·828-0·992) in the temporal validation cohort, 0·808 (0·724-0·893) in the geographical validation cohort, and 0·848 (0·794-0·901) in patients who had autopsy as the diagnostic standard. The v2.0 Boston criteria for probable CAA had superior accuracy to the current Boston criteria (sensitivity 64·5% [54·9-73·4]; specificity 95·0% [83·1-99·4]; AUC 0·798 [0·741-0854]; p=0·0005 for comparison of AUC) across all individuals who had autopsy as the diagnostic standard. INTERPRETATION The Boston criteria v2.0 incorporate emerging MRI markers of CAA to enhance sensitivity without compromising their specificity in our cohorts of patients aged 50 years and older presenting with spontaneous intracerebral haemorrhage, cognitive impairment, or transient focal neurological episodes. Future studies will be needed to determine generalisability of the v.2.0 criteria across the full range of patients and clinical presentations. FUNDING US National Institutes of Health (R01 AG26484).
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Affiliation(s)
- Andreas Charidimou
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
| | - Gregoire Boulouis
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR-S1266, Université Paris Cité, Paris, France
| | - Matthew P Frosch
- C S Kubik Laboratory of Neuropathology, Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Jean-Claude Baron
- Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR-S1266, Université Paris Cité, Paris, France; GHU Psychiatrie et Neurosciences, site Sainte-Anne, Paris, France
| | - Marco Pasi
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Jean Francois Albucher
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Gargi Banerjee
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Carmen Barbato
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Fabrice Bonneville
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Sebastian Brandner
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Lionel Calviere
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - François Caparros
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Barbara Casolla
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Charlotte Cordonnier
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Marie-Bernadette Delisle
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Vincent Deramecourt
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Ludwig-Maximilians University Munich, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy) and German Center for Neurodegenerative Diseases, Munich, Germany
| | - Elif Gokcal
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Jochen Herms
- Center for Neuropathology and Prion Research, Ludwig-Maximilians University Munich, Munich, Germany
| | - Mar Hernandez-Guillamon
- Neurovascular Research Laboratory, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Hans Rolf Jäger
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Zane Jaunmuktane
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Jennifer Linn
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital, Dresden, Germany
| | - Sergi Martinez-Ramirez
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Framingham Heart Study and Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Elena Martínez-Sáez
- Neurovascular Research Laboratory, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Christian Mawrin
- Departments of Neuropathology, Neurosurgery, and Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Joan Montaner
- Neurovascular Research Laboratory, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Institute of Biomedicine of Seville, Hospital Universitario Virgen Macarena, Consejo Superior de Investigaciones Científicas, University of Seville, Spain
| | - Solene Moulin
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Jean-Marc Olivot
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Fabrizio Piazza
- CAA and AD Translational Research and Biomarkers Laboratory, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Laurent Puy
- Université Lille, INSERM, Centre Hospitalier Universitaire (CHU) Lille, U1172-Lille Neuroscience and Cognition, Lille, France
| | - Nicolas Raposo
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Mark A Rodrigues
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Sigrun Roeber
- Center for Neuropathology and Prion Research, Ludwig-Maximilians University Munich, Munich, Germany
| | - Jose Rafael Romero
- Framingham Heart Study and Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | | | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Stefanie Schreiber
- Departments of Neuropathology, Neurosurgery, and Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Frank Schreiber
- Departments of Neuropathology, Neurosurgery, and Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Corentin Schwall
- Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR-S1266, Université Paris Cité, Paris, France; GHU Psychiatrie et Neurosciences, site Sainte-Anne, Paris, France
| | - Colin Smith
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Levente Szalardy
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Pascale Varlet
- Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Institut de Psychiatrie et Neurosciences de Paris, INSERM UMR-S1266, Université Paris Cité, Paris, France; GHU Psychiatrie et Neurosciences, site Sainte-Anne, Paris, France
| | - Alain Viguier
- Departments of Neurology, Neuroradiology, and Pathology, Hôpital Pierre-Paul Riquet, CHU Toulouse, Toulouse Neuroimaging Centre, Universite da Toulouse, INSERM UPS, France
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Andrew Warren
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Frank A Wollenweber
- Institute for Stroke and Dementia Research, Ludwig-Maximilians University Munich, Munich, Germany; Helios Dr Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Marialuisa Zedde
- Neurology Unit-Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - M Edip Gurol
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Anand Viswanathan
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Rustam Al-Shahi Salman
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Eric E Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Steven M Greenberg
- Hemorrhagic Stroke Research Program, J Philip Kistler Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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Puy L, Forman R, Cordonnier C, Sheth KN. Protecting the Brain, From the Heart: Safely Mitigating the Consequences of Thrombosis in Intracerebral Hemorrhage Survivors With Atrial Fibrillation. Stroke 2022; 53:2152-2160. [PMID: 35759545 DOI: 10.1161/strokeaha.122.036888] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Optimal antithrombotic management after intracerebral hemorrhage remains one of the central unresolved issues for patients who survive, especially for those patients with atrial fibrillation. Given the observational nature of the studies regarding anticoagulation resumption after intracerebral hemorrhage, there is uncertainty regarding resumption of oral anticoagulation therapy and its timing. There is limited high-quality evidence to guide clinical practice, leading to significant practice variation and uncertainty for patients and providers. Here, we aim to provide the key elements to guide clinicians in their individual decision: whether or not to start or resume anticoagulation in patients with a history of intracerebral hemorrhage.
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Puy L, Leboullenger C, Auger F, Bordet R, Cordonnier C, Bérézowski V. Intracerebral Hemorrhage-Induced Cognitive Impairment in Rats Is Associated With Brain Atrophy, Hypometabolism, and Network Dysconnectivity. Front Neurosci 2022; 16:882996. [PMID: 35844211 PMCID: PMC9280302 DOI: 10.3389/fnins.2022.882996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/10/2022] [Indexed: 11/17/2022] Open
Abstract
The mechanisms underlying intracerebral hemorrhage (ICH)-related cognitive impairment (CI) remain unclear. Long-term structural and functional changes were investigated in the brains of healthy male and female Wistar rats after experimental ICH. Following double injection of autologous blood, rats underwent short-term (onset, 3 and 7 days) and long-term (3 and 6 months) radiological assessment and behavioral tests exploring spontaneous locomotion, anxiety-like behavior and working memory, spatial recognition memory and visual recognition memory. Volumetric and metabolic changes in brain areas were examined by 7Tesla-MRI and [18F] FDG-PET, respectively. Brain connectomic disorders and maladaptive processes were seeked through brain metabolic connectivity analysis and atrophy-related network analysis. From an initial hematoma mean volume of 23.35 ± 9.50 mm3, we found early spontaneous locomotor recovery and significant spontaneous blood resorption (≈ 40% of the initial lesion) from days 0 to 7. After 3 and 6 months, ICH rats exhibited CI in several domains as compared to the sham group (working memory: 58.1 ± 1.2 vs. 70.7 ± 1.2%, p < 0.001; spatial recognition memory: 48.7 ± 1.9 vs. 64 ± 1.8%, p < 0.001 and visual recognition memory: 0.14 ± 0.05 vs. 0.33 ± 0.04, p = 0.013, in female only). Rats that experienced ICH had remote and concomitant cerebral atrophy and hypometabolism of ipsilateral striatum, thalamus, limbic system and cortical areas (temporal and parietal lobes). Interestingly, both structural and metabolic deterioration was found in the limbic system connected to the affected site, but remotely from the initial insult. On the other hand, increased activity and functional connectivity occurred in the contralateral hemisphere. These connectomics results showed that both maladaptative and compensation processes coexist in the rat brain following ICH, even at young age and in a disease-free setting. These radiological findings deepen our understanding of ICH-related CI and may serve as biomarkers in the view of future therapeutic intervention.
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Affiliation(s)
- Laurent Puy
- Univ. Lille, Inserm, CHU Lille, UMR-S1172 – LilNCog - Lille Neuroscience and Cognition, Lille, France
| | - Clémence Leboullenger
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, US 41 - UMS 2014 - PLBS, Lille, France
| | - Florent Auger
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, US 41 - UMS 2014 - PLBS, Lille, France
| | - Régis Bordet
- Univ. Lille, Inserm, CHU Lille, UMR-S1172 – LilNCog - Lille Neuroscience and Cognition, Lille, France
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, UMR-S1172 – LilNCog - Lille Neuroscience and Cognition, Lille, France
- *Correspondence: Charlotte Cordonnier,
| | - Vincent Bérézowski
- Univ. Lille, Inserm, CHU Lille, UMR-S1172 – LilNCog - Lille Neuroscience and Cognition, Lille, France
- UArtois, Lens, France
- Vincent Bérézowski,
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35
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Scutelnic A, Krzywicka K, Mbroh J, van de Munckhof A, van Kammen MS, de Sousa DA, Lindgren E, Jood K, Günther A, Hiltunen S, Putaala J, Tiede A, Maier F, Kern R, Bartsch T, Althaus K, Ciccone A, Wiedmann M, Skjelland M, Medina A, Cuadrado-Godia E, Cox T, Aujayeb A, Raposo N, Garambois K, Payen JF, Vuillier F, Franchineau G, Timsit S, Bougon D, Dubois MC, Tawa A, Tracol C, De Maistre E, Bonneville F, Vayne C, Mengel A, Michalski D, Pelz J, Wittstock M, Bode F, Zimmermann J, Schouten J, Buture A, Murphy S, Palma V, Negro A, Gutschalk A, Nagel S, Schoenenberger S, Frisullo G, Zanferrari C, Grillo F, Giammello F, Martin MM, Cervera A, Burrow J, Esperon CG, Chew BLA, Kleinig TJ, Soriano C, Zimatore DS, Petruzzellis M, Elkady A, Miranda MS, Fernandes J, Vogel ÅH, Johansson E, Philip AP, Coutts SB, Bal S, Buck B, Legault C, Blacquiere D, Katzberg HD, Field TS, Dizonno V, Gattringer T, Jacobi C, Devroye A, Lemmens R, Kristoffersen ES, di Poggio MB, Ghiasian M, Karapanayiotides T, Chatterton S, Wronski M, Ng K, Kahnis R, Geeraerts T, Reiner P, Cordonnier C, Middeldorp S, Levi M, van Gorp ECM, van de Beek D, Brodard J, Kremer Hovinga JA, Kruip MJHA, Tatlisumak T, Ferro JM, Coutinho JM, Arnold M, Poli S, Heldner MR. Management of Cerebral Venous Thrombosis Due to Adenoviral COVID-19 Vaccination. Ann Neurol 2022; 92:562-573. [PMID: 35689346 PMCID: PMC9349982 DOI: 10.1002/ana.26431] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/21/2022] [Accepted: 05/27/2022] [Indexed: 01/01/2023]
Abstract
Objective Cerebral venous thrombosis (CVT) caused by vaccine‐induced immune thrombotic thrombocytopenia (VITT) is a rare adverse effect of adenovirus‐based severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2) vaccines. In March 2021, after autoimmune pathogenesis of VITT was discovered, treatment recommendations were developed. These comprised immunomodulation, non‐heparin anticoagulants, and avoidance of platelet transfusion. The aim of this study was to evaluate adherence to these recommendations and its association with mortality. Methods We used data from an international prospective registry of patients with CVT after the adenovirus‐based SARS‐CoV‐2 vaccination. We analyzed possible, probable, or definite VITT‐CVT cases included until January 18, 2022. Immunomodulation entailed administration of intravenous immunoglobulins and/or plasmapheresis. Results Ninety‐nine patients with VITT‐CVT from 71 hospitals in 17 countries were analyzed. Five of 38 (13%), 11 of 24 (46%), and 28 of 37 (76%) of the patients diagnosed in March, April, and from May onward, respectively, were treated in‐line with VITT recommendations (p < 0.001). Overall, treatment according to recommendations had no statistically significant influence on mortality (14/44 [32%] vs 29/55 [52%], adjusted odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.16–1.19). However, patients who received immunomodulation had lower mortality (19/65 [29%] vs 24/34 [70%], adjusted OR = 0.19, 95% CI = 0.06–0.58). Treatment with non‐heparin anticoagulants instead of heparins was not associated with lower mortality (17/51 [33%] vs 13/35 [37%], adjusted OR = 0.70, 95% CI = 0.24–2.04). Mortality was also not significantly influenced by platelet transfusion (17/27 [63%] vs 26/72 [36%], adjusted OR = 2.19, 95% CI = 0.74–6.54). Conclusions In patients with VITT‐CVT, adherence to VITT treatment recommendations improved over time. Immunomodulation seems crucial for reducing mortality of VITT‐CVT. ANN NEUROL 2022;92:562–573
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Affiliation(s)
- Adrian Scutelnic
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Katarzyna Krzywicka
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Joshua Mbroh
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tuebingen, Germany.,Department of Neurology & Stroke, Eberhard-Karls University, Tuebingen, Germany
| | - Anita van de Munckhof
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Mayte Sánchez van Kammen
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Diana Aguiar de Sousa
- CEEM and Institute of Anatomy, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Erik Lindgren
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Albrecht Günther
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Sini Hiltunen
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Andreas Tiede
- Clinic for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Frank Maier
- Department of Neurology, Caritas Hospital Saarbrücken, Saarbrücken, Germany
| | - Rolf Kern
- Department of Neurology, Kempten Hospital, Kempten, Germany
| | - Thorsten Bartsch
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | | | - Alfonso Ciccone
- Department of Neurology, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale di Mantova, Mantua, Italy
| | - Markus Wiedmann
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Mona Skjelland
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Antonio Medina
- Department of Neurology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Thomas Cox
- Department of Neurology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Avinash Aujayeb
- Respiratory Department, Northumbria Healthcare NHS Foundation Trust, Cramlington, UK
| | - Nicolas Raposo
- Department of Neurology, Toulouse University Hospital, Toulouse, France
| | - Katia Garambois
- Stroke Unit, University Hospital of Grenoble, Grenoble, France
| | | | | | - Guillaume Franchineau
- Department of Intensive Care, Centre Hospitalier Intercommunal de Poissy Saint Germain en Laye, Poissy, France
| | - Serge Timsit
- Neurology and Stroke Unit, Centre Hospitalier Universitaire de Brest, CHU Brest, Brest, France
| | - David Bougon
- Department of Critical Care, Annecy Genevois Hospital, Annecy, France
| | - Marie-Cécile Dubois
- Department of Anesthesia and Intensive Care, University Hospital of Poitiers, Poitiers, France
| | - Audrey Tawa
- Department of Anesthesia and Intensive Care, University Hospital of Rennes, Rennes, France
| | | | | | - Fabrice Bonneville
- Department of Neuroradiology, Toulouse University Hospital, Toulouse, France
| | - Caroline Vayne
- Department of Hematology and Hemostasis, Tours University Hospital, Tours, France
| | - Annerose Mengel
- Department of Neurology and Stroke, Eberhard-Karls University, Tuebingen, Germany
| | - Dominik Michalski
- Department of Neurology, Leipzig University Hospital, Leipzig, Germany
| | - Johann Pelz
- Department of Neurology, Leipzig University Hospital, Leipzig, Germany
| | | | - Felix Bode
- Department of Neurology, Universitätsklinikum Bonn, Bonn, Germany
| | | | - Judith Schouten
- Department of Neurology, Rijnstate Hospital Arnhem, Arnhem, The Netherlands
| | - Alina Buture
- Acute Stroke Service, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sean Murphy
- Acute Stroke Service, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Vincenzo Palma
- Department of Neuroradiology, Ospedale del Mare, Naples, Italy
| | - Alberto Negro
- Department of Neuroradiology, Ospedale del Mare, Naples, Italy
| | - Alexander Gutschalk
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Simon Nagel
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Giovanni Frisullo
- Department of Neurology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carla Zanferrari
- Department of Neurology, Azienda Ospedaliera di Melegnano e della Martesana, Melegnano, Italy
| | - Francesco Grillo
- Stroke Unit, Department of Clinical and Experimental Medicine, University Hospital G. Martino, Messina, Italy
| | - Fabrizio Giammello
- Translational Molecular Medicine and Surgery, XXXV Cycle, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Mar Morin Martin
- Department of Neurology, Hospital Complex of Toledo, Toledo, Spain
| | - Alvaro Cervera
- Department of Neurology, Royal Darwin Hospital, Tiwi, Northern Territory, Australia
| | - Jim Burrow
- Department of Neurology, Royal Darwin Hospital, Tiwi, Northern Territory, Australia
| | - Carlos Garcia Esperon
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Beng Lim Alvin Chew
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Timothy J Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Cristina Soriano
- Department of Neurology, Hospital General de Castellón, Castelló, Spain
| | | | - Marco Petruzzellis
- Department of Neurology, AOU Consorziale Policlinico di Bari, Bari, Italy
| | - Ahmed Elkady
- Department of Neurology, Saudi German Hospital, Jeddah, Saudi Arabia
| | - Miguel S Miranda
- Department of Neurology, Hospital de Cascais Dr José de Almeida, Cascais, Portugal
| | - João Fernandes
- Department of Neurology, Norra Älvsborgs Länssjukhus, Trollhattan, Sweden
| | | | - Elias Johansson
- Clinical Science, Neurosciences, Umeå University, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine, Umeå, Sweden
| | | | - Shelagh B Coutts
- Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Simerpreet Bal
- Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Brian Buck
- Division of Neurology, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Catherine Legault
- Department of Neurology and Neurosurgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Dylan Blacquiere
- Division of Neurology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Hans D Katzberg
- Department of Neuromuscular Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - Thalia S Field
- Division of Neurology, University of British Columbia, Vancouver Stroke Program, Vancouver, British Columbia, Canada
| | - Vanessa Dizonno
- Division of Neurology, University of British Columbia, Vancouver Stroke Program, Vancouver, British Columbia, Canada
| | | | - Christian Jacobi
- Department of Neurology, Nordwest Hospital, Frankfurt am Main, Germany
| | - Annemie Devroye
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Masoud Ghiasian
- Department of Neurology, Sina Hospital, Hamadan University of Medical Science, Hamadan, Iran
| | | | - Sophie Chatterton
- Department of Neurology, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - Miriam Wronski
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Karl Ng
- Department of Neurology and Clinical Neurophysiology, Royal North Shore Hospital and The University of Sydney, Sydney, New South Wales, Australia
| | - Robert Kahnis
- Department of Neurology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | - Thomas Geeraerts
- Department of Anaesthesiology and Critical Care, University Toulouse 3-Paul-Sabatier, University Hospital of Toulouse, Hôpital Pierre-Paul Riquet, CHU Toulouse-Purpan, Toulouse, France
| | - Peggy Reiner
- Service de neurologie, hôpital Lariboisière Université Paris-7, AP-HP, Paris Cedex 10, France
| | - Charlotte Cordonnier
- University of Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Saskia Middeldorp
- Department of Internal Medicine & Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel Levi
- National Institute for Health Research University College London Hospitals (UCLH) Biomedical Research Centre, London, UK.,Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric C M van Gorp
- Department of Viroscience, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Diederik van de Beek
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Justine Brodard
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johanna A Kremer Hovinga
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marieke J H A Kruip
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Turgut Tatlisumak
- Department of Neurology & Stroke, Eberhard-Karls University, Tuebingen, Germany
| | - José M Ferro
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Poli
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tuebingen, Germany.,Department of Neurology & Stroke, Eberhard-Karls University, Tuebingen, Germany
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Aspegren O, Staessens S, Vandelanotte S, Desender L, Cordonnier C, Puy L, Bricout N, De Meyer SF, Andersson T, Arnberg F. Unusual Histopathological Findings in Mechanically Removed Stroke Thrombi - A Multicenter Experience. Front Neurol 2022; 13:846293. [PMID: 35665052 PMCID: PMC9157388 DOI: 10.3389/fneur.2022.846293] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/20/2022] [Indexed: 11/20/2022] Open
Abstract
Background Several studies have investigated the histopathology of mechanically retrieved thrombi from stroke patients. Thrombi with unusual components constitute about 1–2% of all stroke thrombi in clinical practice. Knowledge about these rare components is limited. Objectives To characterize the histopathology of unusual stroke thrombi from a real-world setting with relation to clinical presentation, patient characteristics and procedural aspects of mechanical thrombectomy. Methods One-thousand and eight thrombi retrieved from stroke patients with mechanical thrombectomy at three different hospitals were retrospectively reviewed for unusual histological components. Fifteen thrombi were included in the study for further histopathological analysis. Clinical data and data on procedural aspects were collected. Results We identified six cases with large amounts of extracellular DNA, of which three were calcified. All six cases except one received anticoagulant therapy. We describe two types of calcifications that differ with respect to general calcification morphology, von Kossa staining pattern, macrophage immunophenotype and presence of multinucleated giant cells. Cholesterol-rich (n = 3), adipocyte-like pattern-rich (n = 2), collagen-rich (n = 2) and myxomatous (n = 1) thrombi were also identified and are discussed with regard to pathogenesis and clinical and intervention characteristics. Finally, a thrombus with parts of a vascular wall is described. Suggestions for future studies are made and clinical and technical aspects of the management for these rare but important patients are discussed. Conclusion In our retrospective multicenter study, we characterized stroke thrombi histopathologically and found subgroups of thrombi defined by presence of rarely seen components. These defined subgroups showed relation to underlying cardiovascular disease, patient characteristics, and mechanical thrombectomy technique. Knowledge about these components may increase our understanding of stroke pathophysiology and influence interventional procedures.
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Affiliation(s)
- Oskar Aspegren
- Department of Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Senna Staessens
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Sarah Vandelanotte
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Linda Desender
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Charlotte Cordonnier
- University of Lille, INSERM, CHU Lille, U1172-Lille Neuroscience & Cognition (LilNCog), Lille, France
| | - Laurent Puy
- University of Lille, INSERM, CHU Lille, U1172-Lille Neuroscience & Cognition (LilNCog), Lille, France
| | - Nicolas Bricout
- Department of Interventional Neuroradiology, CHU Lille, Lille, France
| | - Simon F De Meyer
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Tommy Andersson
- Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Fabian Arnberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
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Greenberg SM, Ziai WC, Cordonnier C, Dowlatshahi D, Francis B, Goldstein JN, Hemphill JC, Johnson R, Keigher KM, Mack WJ, Mocco J, Newton EJ, Ruff IM, Sansing LH, Schulman S, Selim MH, Sheth KN, Sprigg N, Sunnerhagen KS. 2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association. Stroke 2022; 53:e282-e361. [PMID: 35579034 DOI: 10.1161/str.0000000000000407] [Citation(s) in RCA: 275] [Impact Index Per Article: 137.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - William J Mack
- AHA Stroke Council Scientific Statement Oversight Committee on Clinical Practice Guideline liaison
| | | | | | - Ilana M Ruff
- AHA Stroke Council Stroke Performance Measures Oversight Committee liaison
| | | | | | | | - Kevin N Sheth
- AHA Stroke Council Scientific Statement Oversight Committee on Clinical Practice Guideline liaison.,AAN representative
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Duloquin G, Henon H, Pasi M, Dequatre N, Della Schiava L, Kuchcinski G, Leclerc X, Cordonnier C, Casolla B. Challenging the diagnosis of a posterior circulation dissecting aneurysm. Neurol Sci 2022; 43:3415-3417. [DOI: 10.1007/s10072-022-05923-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/27/2022] [Indexed: 10/19/2022]
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39
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Puy L, Perbet R, Figeac M, Duchêne B, Deramecourt V, Cordonnier C, Bérézowski V. Brain Peri-Hematomal Area, a Strategic Interface for Blood Clearance: A Human Neuropathological and Transcriptomic Study. Stroke 2022; 53:2026-2035. [DOI: 10.1161/strokeaha.121.037751] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Enhancing the blood clearance process is a promising therapeutic strategy for intracerebral hemorrhage (ICH). We aimed to investigate the kinetic of this process after ICH in human brain tissue through the monocyte-macrophage scavenger receptor (CD163)/HO-1 (hemoxygenase-1) pathway.
Methods:
We led a cross-sectional post-mortem study including 22 consecutive ICH cases (2005–2019) from the Lille Neurobank. Cases were grouped according to the time of death: ≤72 hours, 4 to 7 days, 8 to 15 days, 16 to 90 days, and >90 days after ICH onset. Paraffin-embedded tissue was extracted from 4 strategic areas, including hematoma core and peri-hematomal area to perform histological investigations. Additionally, we extracted RNA from the peri-hematomal area of 6 cases to perform transcriptomic analysis.
Results:
We included 19 ICH cases (median age: 79 [71–89] years; median delay ICH-death: 13 [5–41] days). The peri-hematomal area concentrated most of reactive microglia, CD163/HO-1 and iron deposits as compared with other brain areas. We found a surge in the blood clearance process from day 8 to day 15 after ICH onset. Transcriptomic analysis showed that HO-1 was the most upregulated gene (2.81±0.39, adjusted
P
=1.11×10
–10
) and CD163 the sixth (1.49±0.29, adjusted
P
=1.68×10
–
5
). We also identified several upregulated genes that exert a beneficial role in terminating inflammation and enhancing tissue repair.
Conclusions:
We provide histological and transcriptomic-based evidence in humans for the key role of peri-hematomal area in endogenous blood clearance process through the CD163/HO-1 pathway, especially from day 8 after ICH and favored by an anti-inflammatory environment. Our findings contribute to identify innovative therapeutic strategies for ICH.
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Affiliation(s)
- Laurent Puy
- Univ. Lille, Inserm, CHU-Lille, Lille Neuroscience & Cognition research Center UMR-S1172, Degenerative and Vascular Cognitive Disorders, France (L.P., R.P., V.D., C.C., V.B.)
| | - Romain Perbet
- Univ. Lille, Inserm, CHU-Lille, Lille Neuroscience & Cognition research Center UMR-S1172, Degenerative and Vascular Cognitive Disorders, France (L.P., R.P., V.D., C.C., V.B.)
- Alzheimer Research Unit, Department of Neurology, Massachusetts General Hospital, Charlestown (R.P.)
- Harvard Medical School, Boston, MA (R.P.)
| | - Martin Figeac
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, US 41 - UMS 2014 - PLBS, France (M.F.)
| | - Bélinda Duchêne
- Univ. Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, Lille, France (B.D.)
| | - Vincent Deramecourt
- Univ. Lille, Inserm, CHU-Lille, Lille Neuroscience & Cognition research Center UMR-S1172, Degenerative and Vascular Cognitive Disorders, France (L.P., R.P., V.D., C.C., V.B.)
- Université d’Artois, Lens, France (V.B.)
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU-Lille, Lille Neuroscience & Cognition research Center UMR-S1172, Degenerative and Vascular Cognitive Disorders, France (L.P., R.P., V.D., C.C., V.B.)
| | - Vincent Bérézowski
- Univ. Lille, Inserm, CHU-Lille, Lille Neuroscience & Cognition research Center UMR-S1172, Degenerative and Vascular Cognitive Disorders, France (L.P., R.P., V.D., C.C., V.B.)
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Abstract
The past decade has seen significant advances in stroke prevention. These advances include new antithrombotic agents, new options for dyslipidemia treatment, and novel techniques for surgical stroke prevention. In addition, there is greater recognition of the benefits of multifaceted interventions, including the role of physical activity and dietary modification. Despite these advances, the aging of the population and the high prevalence of key vascular risk factors pose challenges to reducing the burden of stroke. Using a cause-based framework, current approaches to prevention of cardioembolic, cryptogenic, atherosclerotic, and small vessel disease stroke are outlined in this paper. Special emphasis is given to recent trials of antithrombotic agents, including studies that have tested combination treatments and responses according to genetic factors.
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Affiliation(s)
| | | | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France
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41
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Vayne C, Palankar R, Billy S, Handtke S, Thiele T, Cordonnier C, Pouplard C, Greinacher A, Gruel Y, Rollin J. The deglycosylated form of 1E12 inhibits platelet activation and prothrombotic effects induced by VITT antibodies. Haematologica 2022; 107:2445-2453. [PMID: 35385923 PMCID: PMC9521230 DOI: 10.3324/haematol.2021.280251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Indexed: 11/09/2022] Open
Abstract
In order to improve the safety of COVID-19 vaccines, there is an urgent need to unravel the pathogenesis of vaccine-induced immune thrombotic thrombocytopenia (VITT), a severe complication of recombinant adenoviral vector vaccines used to prevent COVID-19, and likely due to anti-platelet factor 4 (PF4) IgG antibodies. In this study, we demonstrated that 1E12, a chimeric anti-PF4 antibody with a human Fc fragment, fully mimics the effects of human VITT antibodies, as it activates platelets to a similar level in the presence of platelet factor 4 (PF4). Incubated with neutrophils, platelets and PF4, 1E12 also strongly induces NETosis, and in a microfluidic model of whole blood thrombosis, it triggers the formation of large platelet/leukocyte thrombi containing fibrin(ogen). In addition, a deglycosylated form of 1E12 (DG-1E12), which still binds PF4 but no longer interacts with Fcγ receptors, inhibits platelet, granulocyte and clotting activation induced by human anti-PF4 VITT antibodies. This strongly supports that 1E12 and VITT antibodies recognize overlapping epitopes on PF4. In conclusion, 1E12 is a potentially important tool to study the pathophysiology of VITT, and for establishing mouse models. On the other hand, DG-1E12 may help the development of a new drug that specifically neutralizes the pathogenic effect of autoimmune anti-PF4 antibodies, such as those associated with VITT.
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Affiliation(s)
- Caroline Vayne
- Regional University Hospital Centre Tours, Department of Hemostasis, Tours, France; University of Tours, EA7501 GICC, Tours
| | - Raghavendra Palankar
- University Medicine Greifswald, Institute for Immunology and Transfusion Medicine, Greifswald
| | | | - Stefan Handtke
- University Medicine Greifswald, Institute for Immunology and Transfusion Medicine, Greifswald
| | - Thomas Thiele
- University Medicine Greifswald, Institute for Immunology and Transfusion Medicine, Greifswald
| | - Charlotte Cordonnier
- University of Lille, Inserm, Lille University Hospital Center, U1172-LilNCog-LilleNeuroscience and Cognition, Lille
| | - Claire Pouplard
- Regional University Hospital Centre Tours, Department of Hemostasis, Tours, France; University of Tours, EA7501 GICC, Tours
| | - Andreas Greinacher
- University Medicine Greifswald, Institute for Immunology and Transfusion Medicine, Greifswald
| | - Yves Gruel
- Regional University Hospital Centre Tours, Department of Hemostasis, Tours, France; University of Tours, EA7501 GICC, Tours.
| | - Jérôme Rollin
- Regional University Hospital Centre Tours, Department of Hemostasis, Tours, France; University of Tours, EA7501 GICC, Tours.
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Marchal A, Bretzner M, Casolla B, Kyheng M, Labreuche J, Personnic T, Cordonnier C, Henon H, Bricout N. Endovascular Thrombectomy for Distal Medium Vessel Occlusions of the Middle Cerebral Artery: A Safe and Effective Procedure. World Neurosurg 2022; 160:e234-e241. [PMID: 34995827 DOI: 10.1016/j.wneu.2021.12.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Distal medium vessel occlusions (DMVOs) are increasingly recognized as a next target for endovascular thrombectomy (EVT). Our objective was to investigate safety and clinical outcomes of EVT for DMVO of the middle cerebral artery (MCA). METHODS We analyzed data of the Lille Reperfusion Registry from January 2017 to September 2020. Patients with a primary or secondary DMVO of the MCA seen on pretreatment angiogram were included. Only patients with a eTICI score 2b50-2b67 on initial angiogram were considered. Baseline characteristics, angiographic clinical, and safety outcomes were compared between patients treated with EVT or standard medical treatment (no-EVT). RESULTS Of the 171 patients included, 96 received EVT (46.9% male, 68.7 ± 15.8 years) and 75 received standard medical treatment (44% male, 73.9 ± 13.1 years). EVT patients had a better improvement of the NIHSS score at discharge (adjusted mean difference: 3.71; 95% CI: 1.18-6.24). In the distal M2 occlusions subgroup, EVT was significantly associated with a higher rate of early neurologic improvement (adjusted OR: 3.62 95% CI: 1.31-10.03), NIHSS improvement at discharge (adjusted mean difference: 5.23; 95% CI: 2.18-8.29), and improved modified Rankin Scale score at 3 months (adjusted common OR for 1 point improvement: 3.06; 95% CI: 1.30 to 7.23). Symptomatic intracranial hemorrhage occurred in 3.1% in the EVT group and in 9.5% in the no-EVT group. CONCLUSIONS EVT for DMVO of the MCA appears to be safe and may lead to improved clinical outcomes. This effect was especially pronounced in patients with distal M2 occlusions, warranting randomized trials to validate this result.
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Affiliation(s)
- Adrien Marchal
- Department of Interventional Neuroradiology, CHU Lille, Lille, France
| | - Martin Bretzner
- Department of Interventional Neuroradiology, CHU Lille, Lille, France; J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Barbara Casolla
- Department of Neurology, Stroke Unit, University of Lille, Inserm U1172, CHU Lille, Lille, France; Department of Neurology, Stroke Unit, University Côte d'Azur (UCA), CHU Nice, Nice, France
| | - Maeva Kyheng
- METRICS: évaluation des technologies de santé et des pratiques médicales, University of Lille, CHU Lille, Lille, France; Department of Biostatistics, CHU Lille, Lille, France
| | - Julien Labreuche
- METRICS: évaluation des technologies de santé et des pratiques médicales, University of Lille, CHU Lille, Lille, France; Department of Biostatistics, CHU Lille, Lille, France
| | - Thomas Personnic
- Department of Interventional Neuroradiology, CHU Lille, Lille, France
| | - Charlotte Cordonnier
- Department of Neurology, Stroke Unit, University of Lille, Inserm U1172, CHU Lille, Lille, France
| | - Hilde Henon
- Department of Neurology, Stroke Unit, University of Lille, Inserm U1172, CHU Lille, Lille, France
| | - Nicolas Bricout
- Department of Interventional Neuroradiology, CHU Lille, Lille, France.
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Malhotra K, Theodorou A, Katsanos AH, Zompola C, Shoamanesh A, Boviatsis E, Paraskevas GP, Spilioti M, Cordonnier C, Werring DJ, Alexandrov AV, Tsivgoulis G. Prevalence of Clinical and Neuroimaging Markers in Cerebral Amyloid Angiopathy: A Systematic Review and Meta-Analysis. Stroke 2022; 53:1944-1953. [PMID: 35264008 DOI: 10.1161/strokeaha.121.035836] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited data exist regarding the prevalence of clinical and neuroimaging manifestations among patients diagnosed with cerebral amyloid angiopathy (CAA). We sought to determine the prevalence of clinical phenotypes and radiological markers in patients with CAA. METHODS Systematic review and meta-analysis of studies including patients with CAA was conducted to primarily assess the prevalence of clinical phenotypes and neuroimaging markers as available in the included studies. Sensitivity analyses were performed based on the (1) retrospective or prospective study design and (2) probable or unspecified CAA status. We pooled the prevalence rates using random-effects models and assessed the heterogeneity using the Cochran Q and I2 statistics. RESULTS We identified 12 prospective and 34 retrospective studies including 7159 patients with CAA. The pooled prevalence rates were cerebral microbleeds (52% [95% CI, 43%-60%]; I2=93%), cortical superficial siderosis (49% [95% CI, 38%-59%]; I2=95%), dementia or mild cognitive impairment (50% [95% CI, 35%-65%]; I2=97%), intracerebral hemorrhage (ICH; 44% [95% CI, 27%-61%]; I2=98%), transient focal neurological episodes (48%; 10 studies [95% CI, 29%-67%]; I2=97%), lacunar infarcts (30% [95% CI, 25%-36%]; I2=78%), high grades of perivascular spaces located in centrum semiovale (56% [95% CI, 44%-67%]; I2=88%) and basal ganglia (21% [95% CI, 2%-51%]; I2=98%), and white matter hyperintensities with moderate or severe Fazekas score (53% [95% CI, 40%-65%]; I2=91%). The only neuroimaging marker that was associated with higher odds of recurrent ICH was cortical superficial siderosis (odds ratio, 1.57 [95% CI, 1.01-2.46]; I2=47%). Sensitivity analyses demonstrated a higher prevalence of ICH (53% versus 16%; P=0.03) and transient focal neurological episodes (57% versus 17%; P=0.03) among retrospective studies compared with prospective studies. No difference was documented between the prevalence rates based on the CAA status. CONCLUSIONS Approximately one-half of hospital-based cohort of CAA patients was observed to have cerebral microbleeds, cortical superficial siderosis, mild cognitive impairment, dementia, ICH, or transient focal neurological episodes. Cortical superficial siderosis was the only neuroimaging marker that was associated with higher odds of ICH recurrence. Future population-based studies among well-defined CAA cohorts are warranted to corroborate our findings.
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Affiliation(s)
- Konark Malhotra
- Department of Neurology, Allegheny Health Network, Pittsburgh, PA (K.M.)
| | - Aikaterini Theodorou
- Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Greece. (A.T., A.H.K., C.Z., G.P.P., G.T.)
| | - Aristeidis H Katsanos
- Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Greece. (A.T., A.H.K., C.Z., G.P.P., G.T.).,Department of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., A.S.)
| | - Christina Zompola
- Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Greece. (A.T., A.H.K., C.Z., G.P.P., G.T.)
| | - Ashkan Shoamanesh
- Department of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., A.S.)
| | - Efstathios Boviatsis
- Department of Neurosurgery, National and Kapodistrian University of Athens, "Attikon" University Hospital, Greece. (E.B.)
| | - George P Paraskevas
- Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Greece. (A.T., A.H.K., C.Z., G.P.P., G.T.)
| | - Martha Spilioti
- First Department of Neurology, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece (M.S.)
| | - Charlotte Cordonnier
- University Lille, Inserm, CHU Lille, U1172, LilNCog, Lille Neuroscience and Cognition, France (C.C.)
| | - David J Werring
- Stroke Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom (D.J.W.)
| | - Andrei V Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis (A.V.A., G.T.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Greece. (A.T., A.H.K., C.Z., G.P.P., G.T.).,Department of Neurology, University of Tennessee Health Science Center, Memphis (A.V.A., G.T.)
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44
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Scopelliti G, Casolla B, Boulouis G, Kuchcinski G, Moulin S, Leys D, Henon H, Cordonnier C, Pasi M. Long-term neuropsychiatric symptoms in spontaneous intracerebral haemorrhage survivors. J Neurol Neurosurg Psychiatry 2022; 93:232-237. [PMID: 34728587 DOI: 10.1136/jnnp-2021-327557] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/13/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Neuropsychiatric (NP) symptoms are prominent features of cognitive decline, but they have been understudied in patients with spontaneous intracerebral haemorrhage (ICH). In ICH survivors, we aimed at assessing NP symptoms prevalence and profiles, and their influence on long-term outcomes. METHODS We analysed data from consecutive 6-month ICH survivors enrolled in the Prognosis of Intracerebral Haemorrhage study. We performed NP evaluation using the Neuropsychiatric Inventory Questionnaire. Patients underwent long-term clinical follow-up after ICH (median follow-up time 7.2 years, IQR 4.8-8.2). RESULTS Out of 560 patients with ICH, 265 survived at 6 months. NP evaluation 6 months after ICH was feasible in 202 patients. NP symptoms were present in 112 patients (55%), and in 36 out of 48 patients (75%) with post-ICH dementia. Affective symptoms were present in 77 patients (38%), followed by vegetative symptoms (52 patients, 26%) and hyperactivity (47 patients, 23%). Apathy and hyperactivity were associated with post-ICH dementia and cerebral amyloid angiopathy MRI profile (all p<0.05). Apathy and hyperactivity prevailing over affective symptoms at 6-month follow-up were associated with higher risks of developing new-onset dementia (HR 5.40; 95% CI 2.27 to 12.84), while presence or severity of NP symptoms were not. CONCLUSION NP symptoms were present in more than half of 6-month ICH survivors, with higher prevalence and severity in patients with post-ICH dementia. Distinctive NP profile might be associated to cognitive status and inform on long-term dementia risk.
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Affiliation(s)
- Giuseppe Scopelliti
- Department of Neurology, Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille, Lille, France
| | - Barbara Casolla
- Department of Neurology, Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille, Lille, France
| | - Grégoire Boulouis
- Department of Neuroradiology, Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille, Lille, France
| | - Gregory Kuchcinski
- Department of Neuroradiology, Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille, Lille, France
| | - Solène Moulin
- Department of Neurology, Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille, Lille, France
| | - Didier Leys
- Department of Neurology, Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille, Lille, France
| | - Hilde Henon
- Department of Neurology, Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille, Lille, France
| | - Charlotte Cordonnier
- Department of Neurology, Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille, Lille, France
| | - Marco Pasi
- Department of Neurology, Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille, Lille, France
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45
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Mateos M, Staessens S, Bretzner M, Corseaux D, Cordonnier C, Casolla B, Pruvo JP, Leclerc X, Boulleaux E, Desender L, Vandenbulcke A, De Meyer S, Susen S, Kuchcinski G. Prédiction de la concentration en globules rouges des caillots d'avc en combinant l'irm t2* et des données cliniques et biologiques simples. J Neuroradiol 2022. [DOI: 10.1016/j.neurad.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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46
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FORESTIER G, Agbonon R, Bricout N, Benhassen W, Turc G, Bretzner M, Pasi M, Benzakoun J, Seners P, Personnic T, Legrand L, Trystram D, Rordiguez-Regent C, Charidimou A, Rost NS, Bracard S, Clarençon F, Eker OF, Nighoghossian N, Cordonnier C, Oppenheim C, Naggara O, Henon H, Boulouis G. Small vessel disease and collaterals in ischemic stroke patients treated with thrombectomy. J Neuroradiol 2022. [DOI: 10.1016/j.neurad.2022.01.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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47
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Duloquin G, Ferrigno M, Hassen WB, Kyheng M, Bricout N, Boulouis G, Seners P, Labreuche J, Turc G, Naggara O, Cordonnier C, Henon H, Pasi M. Pre-treatment lesional volume in older stroke patients treated with endovascular treatment. Int J Stroke 2022; 17:1085-1092. [PMID: 35225745 DOI: 10.1177/17474930211068657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent studies in the general stroke population treated with endovascular treatment (EVT) reported that higher pre-treatment lesional volumes were independently associated with poor neurological outcome and functional dependence after stroke. However, it has been not evaluated in older patients. AIM We test the association between the pre-treatment lesional volume on diffusion-weighted magnetic resonance imaging and relevant outcome measures in older adults with stroke treated with EVT. METHODS We included consecutive older adults with stroke (⩾80 years old) treated with EVT in two academic comprehensive stroke centers. The association between pre-treatment lesional volume and relevant outcome measures (poor outcome (modified Rankin scale 4-6), 3-month mortality and symptomatic intracerebral hemorrhage (sICH)) was evaluated using univariate and multivariable models. RESULTS Five hundred seventy-nine patients were included (mean age: 85.6 ± 4.1, median lesional volume was 10 ml; interquartile range: 3-30 ml). Pre-treatment lesional volume was associated with poor functional outcome (adjusted odds ratio (aOR): 1.87, 95% confidence interval (CI): 1.60-2.20, for +1 logarithmic increase of lesional volume), 3-month mortality (aOR: 1.50, CI: 1.28-1.76), and sICH (aOR: 1.67, CI: 1.27-2.20). A threshold lesional volume >35 ml predicted 90% of patients with poor functional outcome and a cut-off >51 ml predicted 90% of patients dead at 3 months. CONCLUSIONS Pre-treatment lesional volume might contribute, in association with other relevant clinical features, to the selection of older stroke patients who will benefit from EVT.
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Affiliation(s)
- Gauthier Duloquin
- EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, Dijon, France
| | - Marc Ferrigno
- University of Lille, Inserm, CHU Lille, U1172-Lille Neuroscience & Cognition (LilNCog), Lille, France
| | - Wagih Ben Hassen
- Department of Neuroradiology, Paris University, Inserm U1266, GHU Paris, Saint-Anne Hospital, Paris, France
| | - Maéva Kyheng
- Département de Biostatistiques, CHU Lille, Lille, France.,University of Lille, CHU Lille, ULR 2694-METRICS: évaluation des technologies de santé et des pratiques médicales, Lille, France
| | | | - Grégoire Boulouis
- Department of Neuroradiology, Paris University, Inserm U1266, GHU Paris, Saint-Anne Hospital, Paris, France
| | - Pierre Seners
- Université de Paris, Inserm U1266, GHU Paris Psychiatrie et Neurosciences (Department of Neurology), FHU NeuroVasc, Paris, France
| | | | - Guillaume Turc
- Université de Paris, Inserm U1266, GHU Paris Psychiatrie et Neurosciences (Department of Neurology), FHU NeuroVasc, Paris, France
| | - Olivier Naggara
- Department of Neuroradiology, Paris University, Inserm U1266, GHU Paris, Saint-Anne Hospital, Paris, France
| | - Charlotte Cordonnier
- University of Lille, Inserm, CHU Lille, U1172-Lille Neuroscience & Cognition (LilNCog), Lille, France
| | - Hilde Henon
- University of Lille, Inserm, CHU Lille, U1172-Lille Neuroscience & Cognition (LilNCog), Lille, France
| | - Marco Pasi
- University of Lille, Inserm, CHU Lille, U1172-Lille Neuroscience & Cognition (LilNCog), Lille, France
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Scopelliti G, Casolla B, Boulouis G, Kuchcinski G, Moulin S, Leys D, Hénon H, Cordonnier C, Pasi M. Long-term anxiety in spontaneous intracerebral haemorrhage survivors. Int J Stroke 2022; 17:1093-1099. [DOI: 10.1177/17474930221085443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Although anxiety is common in several neurological conditions, it has been poorly investigated after spontaneous intracerebral haemorrhage (ICH). Aims. In consecutive ICH survivors, we assessed the long-term prevalence of anxiety and its clinical and radiological determinants. Methods. Using the Hospital Anxiety and Depression scale (HADS), we evaluated ICH survivors enrolled in the prospective, single-centre Prognosis of Intracerebral Hemorrhage (PITCH) study. The prevalence of anxiety (defined as a HADS-anxiety subscale score > 7) was evaluated at three time points (1-2, 3-5, and 6-8 years after ICH), along with neurological symptoms severity, functional disability, and cognitive impairment scores. Clinical and radiological characteristics associated with anxiety were evaluated in univariate and multivariable models. Results. Of 560 patients with spontaneous ICH, 255 were alive 1 year later, 179 of whom completed the HADS questionnaire and were included in the study. Thirty-one patients (17%; 95% confidence interval [CI] 12-23) had anxiety 1-2 years, 38 (27%; 95% CI 19-34) 3-5 years, and 18 (21%; 95% CI 12-30) 6-8 years after ICH. In patients with anxiety, the prevalence of associated depressive symptoms was 48.4% 1-2 years, 60.5% 3-5 years, and 55.5% 6-8 years after ICH. Among clinical and radiological baseline characteristics, only lobar ICH location was significantly associated with anxiety 1-2 years after ICH (odds ratio 2.8; 95% CI 1.2-6.5). Anxiety was not associated with concomitant neurological symptoms severity, functional disability, or cognitive impairment. Conclusions. Anxiety is frequent in ICH survivors, often in association with depressive symptoms, even many years after the index event.
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Affiliation(s)
- Giuseppe Scopelliti
- Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille (Department of Neurology), F-59000 Lille, France
| | - Barbara Casolla
- Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille (Department of Neurology), F-59000 Lille, France
| | - Grégoire Boulouis
- Inserm UMR 1266, GHU Paris Psychiatrie et Neurosciences, Department of Neuroradiology, Centre Hospitalier Sainte-Anne, Paris University, Paris, France
| | - Grégory Kuchcinski
- Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille (Department of Neuroradiology), F-59000 Lille, France
| | - Solène Moulin
- Department of Neurology, Centre Hospitalier Universitaire Reims, Hôpital Maison Blanche, Reims, France
| | - Didier Leys
- Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille (Department of Neurology), F-59000 Lille, France
| | - Hilde Hénon
- Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille (Department of Neurology), F-59000 Lille, France
| | - Charlotte Cordonnier
- Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille (Department of Neurology), F-59000 Lille, France
| | - Marco Pasi
- Univ. Lille, Inserm U1172 - LilNCog - Lille Neuroscience & Cognition, CHU Lille (Department of Neurology), F-59000 Lille, France
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Leys D, Casolla B, Cordonnier C. Low-Density Lipoprotein Cholesterol Level After a Stroke-Reducing It by Any Means. JAMA Neurol 2022; 79:329-330. [PMID: 35188953 DOI: 10.1001/jamaneurol.2021.5586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Didier Leys
- University of Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience & Cognition, Lille, France
| | - Barbara Casolla
- Stroke Unit, Hôpital Pasteur 2, URRIS-UR2CA, Unité de Recherche Clinique Cote d'Azur, Cote d'Azur University, Nice, France
| | - Charlotte Cordonnier
- University of Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience & Cognition, Lille, France
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Jacob MA, Ekker MS, Allach Y, Cai M, Aarnio K, Arauz A, Arnold M, Bae HJ, Bandeo L, Barboza MA, Bolognese M, Bonardo P, Brouns R, Chuluun B, Chuluunbatar E, Cordonnier C, Dagvajantsan B, Debette S, Don A, Enzinger C, Ekizoglu E, Fandler-Höfler S, Fazekas F, Fromm A, Gattringer T, Hora TF, Jern C, Jood K, Kim YS, Kittner S, Kleinig T, Klijn CJ, Kõrv J, Kumar V, Lee KJ, Lee TH, Maaijwee NA, Martinez-Majander N, Marto JP, Mehndiratta MM, Mifsud V, Montanaro V, Pacio G, Patel VB, Phillips MC, Piechowski-Jozwiak B, Pikula A, Ruiz-Sandoval J, von Sarnowski B, Swartz RH, Tan KS, Tanne D, Tatlisumak T, Thijs V, Viana-Baptista M, Vibo R, Wu TY, Yesilot N, Waje-Andreassen U, Pezzini A, Putaala J, Tuladhar AM, de Leeuw FE. Global Differences in Risk Factors, Etiology, and Outcome of Ischemic Stroke in Young Adults-A Worldwide Meta-analysis: The GOAL Initiative. Neurology 2022; 98:e573-e588. [PMID: 34906974 PMCID: PMC8829964 DOI: 10.1212/wnl.0000000000013195] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 11/16/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There is a worldwide increase in the incidence of stroke in young adults, with major regional and ethnic differences. Advancing knowledge of ethnic and regional variation in causes and outcomes will be beneficial in implementation of regional health care services. We studied the global distribution of risk factors, causes, and 3-month mortality of young patients with ischemic stroke, by performing a patient data meta-analysis from different cohorts worldwide. METHODS We performed a pooled analysis of individual patient data from cohort studies that included consecutive patients with ischemic stroke aged 18-50 years. We studied differences in prevalence of risk factors and causes of ischemic stroke between different ethnic and racial groups, geographic regions, and countries with different income levels. We investigated differences in 3-month mortality by mixed-effects multivariable logistic regression. RESULTS We included 17,663 patients from 32 cohorts in 29 countries. Hypertension and diabetes were most prevalent in Black (hypertension, 52.1%; diabetes, 20.7%) and Asian patients (hypertension 46.1%, diabetes, 20.9%). Large vessel atherosclerosis and small vessel disease were more often the cause of stroke in high-income countries (HICs; both p < 0.001), whereas "other determined stroke" and "undetermined stroke" were higher in low and middle-income countries (LMICs; both p < 0.001). Patients in LMICs were younger, had less vascular risk factors, and despite this, more often died within 3 months than those from HICs (odds ratio 2.49; 95% confidence interval 1.42-4.36). DISCUSSION Ethnoracial and regional differences in risk factors and causes of stroke at young age provide an understanding of ethnic and racial and regional differences in incidence of ischemic stroke. Our results also highlight the dissimilarities in outcome after stroke in young adults that exist between LMICs and HICs, which should serve as call to action to improve health care facilities in LMICs.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Keon-Joo Lee
- From Donders Institute for Brain, Cognition and Behaviour (M.A.J., M.S.E., Y.A., M.C., C.J.M.K., A.M.T., F.-E.d.L.), Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands; Neurology (K.A., N.M.-M., T.T., J.P.), Helsinki University Hospital and University of Helsinki, Finland; National Institute of Neurology and Neurosurgery of Mexico (A.A.), Manuel Velasco Suárez, Mexico City; Department of Neurology (M.A.), Inselspital, University Hospital, University of Bern, Switzerland; Cerebrovascular Disease Center (H.-J.B., K.-J.L.), Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea; Neurology Department (L.B., P.B., G.P.), Hospital Británico de Buenos Aires, Argentina; Neurosciences Department (M.A.B.), Hospital Dr. Rafael A. Calderon Guardia, CCSS, San Jose, Costa Rica; Neurocenter (M.B., N.A.M.M.), Department of Neurology and Neurorehabilitation, Lucerne Cantonal Hospital, Luzern, Switzerland; The Faculty of Medicine and Pharmacy (R.B.), Vrije Universiteit Brussel, Jette, Belgium; Department of Neurology (R.B.), ZorgSaam Hospital, Terneuzen, the Netherlands; International School of Traditional Medicine (B.C.) and Department of Neurology, School of Medicine (B.D.), Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia; Department of Global Health (E.C.), School of Public Health, Taipei Medical University, Taiwan; U1172-LilNCog-Lille Neuroscience & Cognition (C.C.), Univ Lille, Inserm, CHU Lille; Team VINTAGE (S.D.), Bordeaux Population Health Research Center, Inserm, University of Bordeaux, France; School of Medicine (A.D.) and Department of Epidemiology and Preventive Medicine, School of Public Health (D.T.), Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Neurology (C.E., S.F.-H., F.F., T.G.) and Division of Neuroradiology, Department of Radiology (C.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.E., N.Y.), Istanbul University, Istanbul Faculty of Medicine, Turkey; Center for Neurovascular Diseases, Department of Neurology (A.F., U.W.-A.), Haukeland University Hospital, Bergen, Norway; SARAH Hospital of Rehabilitation (T.F.H., V. Montanaro), Brasilia, Brazil; Department of Laboratory Medicine, Institute of Biomedicine (C.J.), and Institute of Neuroscience and Physiology (K.J.), the Sahlgrenska Academy, University of Gothenburg; Departments of Clinical Genetics and Genomics (C.J.) and Neurology (K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Neurology (K.Y.S.), College of Medicine, Hanyang University, Seoul, South Korea; Department of Neurology (S.K.), Veterans Affairs Maryland Health Care System, University of Maryland School of Medicine, Baltimore; Department of Neurology (T.K.), Royal Adelaide Hospital, Australia; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; Neurological Institute (V.K., V. Mifsud, B.P.-J.), Cleveland Clinic Abu Dhabi, United Arab Emirates; Department of Neurology (T.-H.L.), Chang Gung Memorial Hospital, Linkou Medical Center; College of Medicine (T.-H.L.), Chang Gung University, Guishan, Taoyuan, Taiwan; Department of Neurology (J.P.M., M.V.-B.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental and CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal; Department of Neurology (M.M.M.), G.B. Pant Institute of Medical Education and Research (GIPMER), New Delhi, India; Department of Neurology (V.B.P.), Nelson R. Mandela School of Medicine, Inkosi Albert Luthuli Central Hospital, Mayville, South Africa; Department of Neurology (M.C.P.), Waikato Hospital, Hamilton, New Zealand; Department of Medicine (Neurology), University Health Network (A. Pikula), and Department of Medicine (Neurology) (R.H.S.), Sunnybrook Health Sciences Center, University of Toronto, Canada; Department of Neurology (J.R.-S.), Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico; Department of Neurology (B.v.S.), University Medicine, Greifswald, Germany; Department of Medicine (K.-S.T.), University of Malaya, Kuala Lumpur; Rambam Healthcare Campus (D.T.), Haifa, Israel; Stroke Theme (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne; Department of Neurology (V.T.), Austin Health, Melbourne, Victoria, Australia; Department of Neurology (T.Y.W.), Christchurch Hospital, New Zealand; and Department of Clinical and Experimental Sciences (A. Pezzini), Neurology Clinic, University of Brescia, Italy.
| | - Tsong-Hai Lee
- From Donders Institute for Brain, Cognition and Behaviour (M.A.J., M.S.E., Y.A., M.C., C.J.M.K., A.M.T., F.-E.d.L.), Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands; Neurology (K.A., N.M.-M., T.T., J.P.), Helsinki University Hospital and University of Helsinki, Finland; National Institute of Neurology and Neurosurgery of Mexico (A.A.), Manuel Velasco Suárez, Mexico City; Department of Neurology (M.A.), Inselspital, University Hospital, University of Bern, Switzerland; Cerebrovascular Disease Center (H.-J.B., K.-J.L.), Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea; Neurology Department (L.B., P.B., G.P.), Hospital Británico de Buenos Aires, Argentina; Neurosciences Department (M.A.B.), Hospital Dr. Rafael A. Calderon Guardia, CCSS, San Jose, Costa Rica; Neurocenter (M.B., N.A.M.M.), Department of Neurology and Neurorehabilitation, Lucerne Cantonal Hospital, Luzern, Switzerland; The Faculty of Medicine and Pharmacy (R.B.), Vrije Universiteit Brussel, Jette, Belgium; Department of Neurology (R.B.), ZorgSaam Hospital, Terneuzen, the Netherlands; International School of Traditional Medicine (B.C.) and Department of Neurology, School of Medicine (B.D.), Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia; Department of Global Health (E.C.), School of Public Health, Taipei Medical University, Taiwan; U1172-LilNCog-Lille Neuroscience & Cognition (C.C.), Univ Lille, Inserm, CHU Lille; Team VINTAGE (S.D.), Bordeaux Population Health Research Center, Inserm, University of Bordeaux, France; School of Medicine (A.D.) and Department of Epidemiology and Preventive Medicine, School of Public Health (D.T.), Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Neurology (C.E., S.F.-H., F.F., T.G.) and Division of Neuroradiology, Department of Radiology (C.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.E., N.Y.), Istanbul University, Istanbul Faculty of Medicine, Turkey; Center for Neurovascular Diseases, Department of Neurology (A.F., U.W.-A.), Haukeland University Hospital, Bergen, Norway; SARAH Hospital of Rehabilitation (T.F.H., V. Montanaro), Brasilia, Brazil; Department of Laboratory Medicine, Institute of Biomedicine (C.J.), and Institute of Neuroscience and Physiology (K.J.), the Sahlgrenska Academy, University of Gothenburg; Departments of Clinical Genetics and Genomics (C.J.) and Neurology (K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Neurology (K.Y.S.), College of Medicine, Hanyang University, Seoul, South Korea; Department of Neurology (S.K.), Veterans Affairs Maryland Health Care System, University of Maryland School of Medicine, Baltimore; Department of Neurology (T.K.), Royal Adelaide Hospital, Australia; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; Neurological Institute (V.K., V. Mifsud, B.P.-J.), Cleveland Clinic Abu Dhabi, United Arab Emirates; Department of Neurology (T.-H.L.), Chang Gung Memorial Hospital, Linkou Medical Center; College of Medicine (T.-H.L.), Chang Gung University, Guishan, Taoyuan, Taiwan; Department of Neurology (J.P.M., M.V.-B.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental and CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal; Department of Neurology (M.M.M.), G.B. Pant Institute of Medical Education and Research (GIPMER), New Delhi, India; Department of Neurology (V.B.P.), Nelson R. Mandela School of Medicine, Inkosi Albert Luthuli Central Hospital, Mayville, South Africa; Department of Neurology (M.C.P.), Waikato Hospital, Hamilton, New Zealand; Department of Medicine (Neurology), University Health Network (A. Pikula), and Department of Medicine (Neurology) (R.H.S.), Sunnybrook Health Sciences Center, University of Toronto, Canada; Department of Neurology (J.R.-S.), Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico; Department of Neurology (B.v.S.), University Medicine, Greifswald, Germany; Department of Medicine (K.-S.T.), University of Malaya, Kuala Lumpur; Rambam Healthcare Campus (D.T.), Haifa, Israel; Stroke Theme (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne; Department of Neurology (V.T.), Austin Health, Melbourne, Victoria, Australia; Department of Neurology (T.Y.W.), Christchurch Hospital, New Zealand; and Department of Clinical and Experimental Sciences (A. Pezzini), Neurology Clinic, University of Brescia, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Frank-Erik de Leeuw
- From Donders Institute for Brain, Cognition and Behaviour (M.A.J., M.S.E., Y.A., M.C., C.J.M.K., A.M.T., F.-E.d.L.), Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands; Neurology (K.A., N.M.-M., T.T., J.P.), Helsinki University Hospital and University of Helsinki, Finland; National Institute of Neurology and Neurosurgery of Mexico (A.A.), Manuel Velasco Suárez, Mexico City; Department of Neurology (M.A.), Inselspital, University Hospital, University of Bern, Switzerland; Cerebrovascular Disease Center (H.-J.B., K.-J.L.), Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea; Neurology Department (L.B., P.B., G.P.), Hospital Británico de Buenos Aires, Argentina; Neurosciences Department (M.A.B.), Hospital Dr. Rafael A. Calderon Guardia, CCSS, San Jose, Costa Rica; Neurocenter (M.B., N.A.M.M.), Department of Neurology and Neurorehabilitation, Lucerne Cantonal Hospital, Luzern, Switzerland; The Faculty of Medicine and Pharmacy (R.B.), Vrije Universiteit Brussel, Jette, Belgium; Department of Neurology (R.B.), ZorgSaam Hospital, Terneuzen, the Netherlands; International School of Traditional Medicine (B.C.) and Department of Neurology, School of Medicine (B.D.), Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia; Department of Global Health (E.C.), School of Public Health, Taipei Medical University, Taiwan; U1172-LilNCog-Lille Neuroscience & Cognition (C.C.), Univ Lille, Inserm, CHU Lille; Team VINTAGE (S.D.), Bordeaux Population Health Research Center, Inserm, University of Bordeaux, France; School of Medicine (A.D.) and Department of Epidemiology and Preventive Medicine, School of Public Health (D.T.), Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Neurology (C.E., S.F.-H., F.F., T.G.) and Division of Neuroradiology, Department of Radiology (C.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.E., N.Y.), Istanbul University, Istanbul Faculty of Medicine, Turkey; Center for Neurovascular Diseases, Department of Neurology (A.F., U.W.-A.), Haukeland University Hospital, Bergen, Norway; SARAH Hospital of Rehabilitation (T.F.H., V. Montanaro), Brasilia, Brazil; Department of Laboratory Medicine, Institute of Biomedicine (C.J.), and Institute of Neuroscience and Physiology (K.J.), the Sahlgrenska Academy, University of Gothenburg; Departments of Clinical Genetics and Genomics (C.J.) and Neurology (K.J.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Neurology (K.Y.S.), College of Medicine, Hanyang University, Seoul, South Korea; Department of Neurology (S.K.), Veterans Affairs Maryland Health Care System, University of Maryland School of Medicine, Baltimore; Department of Neurology (T.K.), Royal Adelaide Hospital, Australia; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; Neurological Institute (V.K., V. Mifsud, B.P.-J.), Cleveland Clinic Abu Dhabi, United Arab Emirates; Department of Neurology (T.-H.L.), Chang Gung Memorial Hospital, Linkou Medical Center; College of Medicine (T.-H.L.), Chang Gung University, Guishan, Taoyuan, Taiwan; Department of Neurology (J.P.M., M.V.-B.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental and CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal; Department of Neurology (M.M.M.), G.B. Pant Institute of Medical Education and Research (GIPMER), New Delhi, India; Department of Neurology (V.B.P.), Nelson R. Mandela School of Medicine, Inkosi Albert Luthuli Central Hospital, Mayville, South Africa; Department of Neurology (M.C.P.), Waikato Hospital, Hamilton, New Zealand; Department of Medicine (Neurology), University Health Network (A. Pikula), and Department of Medicine (Neurology) (R.H.S.), Sunnybrook Health Sciences Center, University of Toronto, Canada; Department of Neurology (J.R.-S.), Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico; Department of Neurology (B.v.S.), University Medicine, Greifswald, Germany; Department of Medicine (K.-S.T.), University of Malaya, Kuala Lumpur; Rambam Healthcare Campus (D.T.), Haifa, Israel; Stroke Theme (V.T.), Florey Institute of Neuroscience and Mental Health, University of Melbourne; Department of Neurology (V.T.), Austin Health, Melbourne, Victoria, Australia; Department of Neurology (T.Y.W.), Christchurch Hospital, New Zealand; and Department of Clinical and Experimental Sciences (A. Pezzini), Neurology Clinic, University of Brescia, Italy.
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