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Lavallée PC, Charles H, Albers GW, Caplan LR, Donnan GA, Ferro JM, Hennerici MG, Labreuche J, Molina C, Rothwell PM, Steg PG, Touboul PJ, Uchiyama S, Vicaut É, Wong LKS, Amarenco P. Underlying Causes of TIA and Minor Ischemic Stroke and Risk of Major Vascular Events. JAMA Neurol 2023; 80:1199-1208. [PMID: 37782494 PMCID: PMC10546292 DOI: 10.1001/jamaneurol.2023.3344] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 04/07/2023] [Accepted: 07/16/2023] [Indexed: 10/03/2023]
Abstract
Importance The coexistence of underlying causes in patients with transient ischemic attack (TIA) or minor ischemic stroke as well as their associated 5-year risks are not well known. Objective To apply the ASCOD (atherosclerosis, small vessel disease, cardiac pathology, other cause, or dissection) grading system to assess coexistence of underlying causes of TIA and minor ischemic stroke and the 5-year risk for major vascular events. Design, Setting, and Participants This international registry cohort (TIAregistry.org) study enrolled 4789 patients from June 1, 2009, to December 31, 2011, with 1- to 5-year follow-up at 61 sites in 21 countries. Eligible patients had a TIA or minor stroke (with modified Rankin Scale score of 0 or 1) within the last 7 days. Among these, 3847 patients completed the 5-year follow-up by December 31, 2016. Data were analyzed from October 1, 2022, to June 15, 2023. Exposure Five-year follow-up. Main Outcomes and Measures Estimated 5-year risk of the composite outcome of stroke, acute coronary syndrome, or cardiovascular death. Results A total of 3847 patients (mean [SD] age, 66.4 [13.2] years; 2295 men [59.7%]) in 42 sites were enrolled and participated in the 5-year follow-up cohort (median percentage of 5-year follow-up per center was 92.3% [IQR, 83.4%-97.8%]). In 998 patients with probable or possible causal atherosclerotic disease, 489 (49.0%) had some form of small vessel disease (SVD), including 110 (11.0%) in whom a lacunar stroke was also probably or possibly causal, and 504 (50.5%) had no SVD; 275 (27.6%) had some cardiac findings, including 225 (22.6%) in whom cardiac pathology was also probably or possibly causal, and 702 (70.3%) had no cardiac findings. Compared with patients with none of the 5 ASCOD categories of disease (n = 484), the 5-year rate of major vascular events was almost 5 times higher (hazard ratio [HR], 4.86 [95% CI, 3.07-7.72]; P < .001) in patients with causal atherosclerosis, 2.5 times higher (HR, 2.57 [95% CI, 1.58-4.20]; P < .001) in patients with causal lacunar stroke or lacunar syndrome, and 4 times higher (HR, 4.01 [95% CI, 2.50-6.44]; P < .001) in patients with causal cardiac pathology. Conclusion and Relevance The findings of this cohort study suggest that in patients with TIA and minor ischemic stroke, the coexistence of atherosclerosis, SVD, cardiac pathology, dissection, or other causes is substantial, and the 5-year risk of a major vascular event varies considerably across the 5 categories of underlying diseases. These findings further suggest the need for secondary prevention strategies based on pathophysiology rather than a one-size-fits-all approach.
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Affiliation(s)
- Philippa C. Lavallée
- Department of Neurology and Stroke Center, Bichat Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Institut National de la Santé et de la Recherche Médicale (INSERM) Laboratory for Vascular Translational Science (LVTS)–U1148, University Paris-Cité, Paris, France
| | - Hugo Charles
- Department of Neurology and Stroke Center, Bichat Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Institut National de la Santé et de la Recherche Médicale (INSERM) Laboratory for Vascular Translational Science (LVTS)–U1148, University Paris-Cité, Paris, France
| | - Gregory W. Albers
- Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, California
| | - Louis R. Caplan
- Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts
| | - Geoffrey A. Donnan
- Melbourne Brain Centre, Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia
| | - José M. Ferro
- Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisbon, Portugal
| | - Michael G. Hennerici
- Department of Neurology, Universitäts Medizin Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Julien Labreuche
- Department of Neurology and Stroke Center, Bichat Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Institut National de la Santé et de la Recherche Médicale (INSERM) Laboratory for Vascular Translational Science (LVTS)–U1148, University Paris-Cité, Paris, France
- Department of Biostatistics, Centre Hospitalier Universitaire Lille, Lille, France
| | - Carlos Molina
- Stroke Unit, Department of Neurology, Vall d’Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Peter M. Rothwell
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom
| | - Philippe Gabriel Steg
- Department of Cardiology, Hôpital Bichat, Université Paris Cité, AP-HP, INSERM LVTS-U1148, Institut Universitaire de France, Paris, France
| | - Pierre-Jean Touboul
- Department of Neurology and Stroke Center, Bichat Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Institut National de la Santé et de la Recherche Médicale (INSERM) Laboratory for Vascular Translational Science (LVTS)–U1148, University Paris-Cité, Paris, France
| | - Shinichiro Uchiyama
- Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, International University of Health and Welfare, Tokyo, Japan
| | - Éric Vicaut
- Department of Biostatistics, Fernand Widal Hospital, AP-HP, Université Paris-Cité, Paris, France
| | - Lawrence K. S. Wong
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
| | - Pierre Amarenco
- Department of Neurology and Stroke Center, Bichat Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Institut National de la Santé et de la Recherche Médicale (INSERM) Laboratory for Vascular Translational Science (LVTS)–U1148, University Paris-Cité, Paris, France
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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Lavallée PC, Charles H, Albers GW, Caplan LR, Donnan GA, Ferro JM, Hennerici MG, Labreuche J, Molina C, Rothwell PM, Steg PG, Touboul PJ, Uchiyama S, Vicaut É, Wong LKS, Amarenco P. Effect of atherosclerosis on 5-year risk of major vascular events in patients with transient ischaemic attack or minor ischaemic stroke: an international prospective cohort study. Lancet Neurol 2023; 22:320-329. [PMID: 36931807 DOI: 10.1016/s1474-4422(23)00067-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 10/11/2022] [Revised: 02/02/2023] [Accepted: 02/22/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND The prevalence of atherosclerosis and the long-term risk of major vascular events in people who have had a transient ischaemic attack or minor ischaemic stroke, regardless of the causal relationship between the index event and atherosclerosis, are not well known. In this analysis, we applied the ASCOD (atherosclerosis, small vessel disease, cardiac pathology, other causes, and dissection) grading system to estimate the 5-year risk of major vascular events according to whether there was a causal relationship between atherosclerosis and the index event (ASCOD grade A1 and A2), no causal relationship (A3), and with or without a causal relationship (A1, A2, and A3). We also aimed to estimate the prevalence of different grades of atherosclerosis and identify associated risk factors. METHODS We analysed patient data from TIAregistry.org, which is an international, prospective, observational registry of patients with a recent (within the previous 7 days) transient ischaemic attack or minor ischaemic stroke (modified Rankin Scale score of 0-1) from 61 specialised centres in 21 countries in Europe, Asia, the Middle East, and Latin America. Using data from case report forms, we applied the ASCOD grading system to categorise the degree of atherosclerosis in our population (A0: no atherosclerosis; A1 or A2: atherosclerosis with stenosis ipsilateral to the cerebral ischaemic area; A3: atherosclerosis in vascular beds not related to the ischaemic area or ipsilateral plaques without stenosis; and A9: atherosclerosis not assessed). The primary outcome was a composite of non-fatal stroke, non-fatal acute coronary syndrome, or cardiovascular death within 5 years. FINDINGS Between June 1, 2009, and Dec 29, 2011, 4789 patients were enrolled to TIAregistry.org, of whom 3847 people from 42 centres participated in the 5-year follow-up; 3383 (87·9%) patients had a 5-year follow-up visit (median 92·3% [IQR 83·4-97·8] per centre). 1406 (36·5%) of 3847 patients had no atherosclerosis (ASCOD grade A0), 998 (25·9%) had causal atherosclerosis (grade A1 or A2), and 1108 (28·8%) had atherosclerosis that was unlikely to be causal (grade A3); in 335 (8·7%) patients, atherosclerosis was not assessed (grade A9). The 5-year event rate of the primary composite outcome was 7·7% (95% CI 6·3-9·2; 101 events) in patients categorised with grade A0 atherosclerosis, 19·8% (17·4-22·4; 189 events) in those with grade A1 or A2, and 13·8% (11·8-16·0; 144 events) in patients with grade A3. Compared with patients with grade A0 atherosclerosis, patients categorised as grade A1 or A2 had an increased risk of the primary composite outcome (hazard ratio 2·77, 95% CI 2·18-3·53; p<0·0001), as did patients with grade A3 (1·87, 1·45-2·42; p<0·0001). Except for age, male sex, and multiple infarctions on neuroimaging, most of the risk factors that were identified as being associated with grade A1 or A2 atherosclerosis were modifiable risk factors (ie, hypertension, dyslipidaemia, overweight, smoking cigarettes, and low physical activity; all p values <0·025). INTERPRETATION In patients with transient ischaemic attack or minor ischaemic stroke, those with atherosclerosis have a much higher risk of major vascular events within 5 years than do those without atherosclerosis. Preventive strategies addressing complications of atherosclerosis should focus on individuals with atherosclerosis rather than grouping together all people who have had a transient ischaemic attack or minor ischaemic stroke (including those without atherosclerosis). FUNDING AstraZeneca, Sanofi, Bristol Myers Squibb, SOS Attaque Cérébrale Association.
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Affiliation(s)
- Philippa C Lavallée
- Department of Neurology and Stroke Center, APHP, Bichat Hospital, INSERM LVTS-U1148, DHU FIRE, University of Paris-Cité, Paris, France
| | - Hugo Charles
- Department of Neurology and Stroke Center, APHP, Bichat Hospital, INSERM LVTS-U1148, DHU FIRE, University of Paris-Cité, Paris, France
| | - Gregory W Albers
- Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA, USA
| | - Louis R Caplan
- Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
| | - Geoffrey A Donnan
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - José M Ferro
- Instituto de Medicina Molecular João Lobo Antunes, Universidade de Lisboa, Lisbon, Portugal
| | - Michael G Hennerici
- Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg, Germany
| | - Julien Labreuche
- Department of Neurology and Stroke Center, APHP, Bichat Hospital, INSERM LVTS-U1148, DHU FIRE, University of Paris-Cité, Paris, France; Department of Biostatistics, CHU Lille, Lille, France
| | - Carlos Molina
- Department of Neurology, Stroke Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Peter M Rothwell
- Nuffield Department of Clinical Neuroscience, Wolfson Centre for Prevention of Stroke and Dementia, University of Oxford, Oxford, UK
| | - Philippe Gabriel Steg
- Department of Cardiology, APHP, INSERM LVTS-U1148, DHU FIRE, Université Paris-Diderot, Université Paris Cité, Paris, France; Institut Universitaire de France, Paris, France
| | - Pierre-Jean Touboul
- Department of Neurology and Stroke Center, APHP, Bichat Hospital, INSERM LVTS-U1148, DHU FIRE, University of Paris-Cité, Paris, France
| | - Shinichiro Uchiyama
- Center for Brain and Cerebral Vessels, International University of Health and Welfare, Sanno Hospital and Sanno Medical Center, Tokyo, Japan
| | - Éric Vicaut
- Department of Biostatistics, APHP, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital, Paris, France
| | - Lawrence K S Wong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Pierre Amarenco
- Department of Neurology and Stroke Center, APHP, Bichat Hospital, INSERM LVTS-U1148, DHU FIRE, University of Paris-Cité, Paris, France; Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
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Hoshino T, Uchiyama S, Wong LKS, Kitagawa K, Charles H, Labreuche J, Lavallée PC, Albers GW, Caplan LR, Donnan GA, Ferro JM, Hennerici MG, Molina C, Rothwell PM, Steg PG, Touboul PJ, Vicaut É, Amarenco P. Five-Year Prognosis After TIA or Minor Ischemic Stroke in Asian and Non-Asian Populations. Neurology 2020; 96:e54-e66. [PMID: 33046613 DOI: 10.1212/wnl.0000000000010995] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 08/24/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine long-term vascular outcomes of Asian patients who experienced TIA or minor ischemic stroke and to compare the outcomes of Asian patients with those of non-Asian patients, in the context of modern guideline-based prevention strategies. METHODS This is a subanalysis of the TIAregistry.org project, in which 3,847 patients (882 from Asian and 2,965 from non-Asian countries) with a recent TIA or minor ischemic stroke were assessed and treated by specialists at 42 dedicated units from 14 countries and followed for 5 years. The primary outcome was a composite of cardiovascular death, nonfatal stroke, and nonfatal acute coronary syndrome. RESULTS No differences were observed in the 5-year risk of the primary outcome (14.0% vs 11.7%; hazard ratio [HR], 1.10; 95% confidence interval [CI], 0.88-1.37; p = 0.41) and stroke (10.7% vs 8.5%; HR, 1.17; 95% CI, 0.90-1.51; p = 0.24) between Asian and non-Asian patients. Asian participants were at higher risk of intracranial hemorrhage (1.8% vs 0.8%; HR, 2.23; 95% CI, 1.09-4.57; p = 0.029). Multivariable analysis showed that the presence of multiple acute infarctions on initial brain imaging was an independent predictor of primary outcome and modified Rankin Scale score of >1 in both Asian (HR, 1.91; 95% CI, 1.11-3.29; p = 0.020) and non-Asian (HR, 1.39; 95% CI, 1.02-1.90; p = 0.037) patients. CONCLUSION The long-term risk of vascular events in Asian patients was as low as that in non-Asian patients, while Asian participants had a 2.2-fold higher intracranial hemorrhage risk. Multiple acute infarctions were independently associated with future disability in both groups. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that among people who experienced TIA or minor stroke, Asian patients have a similar 5-year risk of cardiovascular death, stroke, and acute coronary syndrome as non-Asian patients.
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Affiliation(s)
- Takao Hoshino
- From the Department of Neurology and Stroke Center (T.H., H.C., J.L., P.C.L., P.-J.T., P.A.), Bichat Hospital, AP-HP and INSERM LVTS-U1148, DHU FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, France; Center for Brain and Cerebral Vessels (S.U.), Sanno Hospital and Sanno Medical Center, International University of Health and Welfare, Tokyo, Japan; Department of Medicine and Therapeutics (L.K.S.W.), Chinese University of Hong Kong, Prince of Wales Hospital; Department of Neurology (T.H., K.K.), Tokyo Women's Medical University, Japan; Université Lille (J.L.), Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille, France; Stanford Stroke Center (G.W.A.), Department of Neurology and Neurological Sciences, Stanford University Medical Center, CA; Cerebrovascular Disease Service (L.R.C.), Beth Israel Deaconess Medical Center, Harvard University, Boston, MA; Melbourne Brain Centre (G.A.D.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurosciences (J.M.F.), Service of Neurology, Hospital Santa Maria, University of Lisbon, Portugal; Department of Neurology (M.G.H.), Universitäts Medizin Mannheim, Heidelberg University, Germany; Stroke Unit, Department of Neurology (C.M.), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; Stroke Prevention Research Unit (P.M.R.), Nuffield Department of Clinical Neuroscience, University of Oxford, UK; Department of Cardiology (P.G.S.), Bichat Hospital, AP-HP, Paris, France; National Heart and Lung Institute Imperial College (P.G.S.), Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London, UK; Department of Biostatistics (É.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital, AP-HP, Paris, France
| | - Shinichiro Uchiyama
- From the Department of Neurology and Stroke Center (T.H., H.C., J.L., P.C.L., P.-J.T., P.A.), Bichat Hospital, AP-HP and INSERM LVTS-U1148, DHU FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, France; Center for Brain and Cerebral Vessels (S.U.), Sanno Hospital and Sanno Medical Center, International University of Health and Welfare, Tokyo, Japan; Department of Medicine and Therapeutics (L.K.S.W.), Chinese University of Hong Kong, Prince of Wales Hospital; Department of Neurology (T.H., K.K.), Tokyo Women's Medical University, Japan; Université Lille (J.L.), Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille, France; Stanford Stroke Center (G.W.A.), Department of Neurology and Neurological Sciences, Stanford University Medical Center, CA; Cerebrovascular Disease Service (L.R.C.), Beth Israel Deaconess Medical Center, Harvard University, Boston, MA; Melbourne Brain Centre (G.A.D.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurosciences (J.M.F.), Service of Neurology, Hospital Santa Maria, University of Lisbon, Portugal; Department of Neurology (M.G.H.), Universitäts Medizin Mannheim, Heidelberg University, Germany; Stroke Unit, Department of Neurology (C.M.), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; Stroke Prevention Research Unit (P.M.R.), Nuffield Department of Clinical Neuroscience, University of Oxford, UK; Department of Cardiology (P.G.S.), Bichat Hospital, AP-HP, Paris, France; National Heart and Lung Institute Imperial College (P.G.S.), Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London, UK; Department of Biostatistics (É.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital, AP-HP, Paris, France
| | - Lawrence K S Wong
- From the Department of Neurology and Stroke Center (T.H., H.C., J.L., P.C.L., P.-J.T., P.A.), Bichat Hospital, AP-HP and INSERM LVTS-U1148, DHU FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, France; Center for Brain and Cerebral Vessels (S.U.), Sanno Hospital and Sanno Medical Center, International University of Health and Welfare, Tokyo, Japan; Department of Medicine and Therapeutics (L.K.S.W.), Chinese University of Hong Kong, Prince of Wales Hospital; Department of Neurology (T.H., K.K.), Tokyo Women's Medical University, Japan; Université Lille (J.L.), Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille, France; Stanford Stroke Center (G.W.A.), Department of Neurology and Neurological Sciences, Stanford University Medical Center, CA; Cerebrovascular Disease Service (L.R.C.), Beth Israel Deaconess Medical Center, Harvard University, Boston, MA; Melbourne Brain Centre (G.A.D.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurosciences (J.M.F.), Service of Neurology, Hospital Santa Maria, University of Lisbon, Portugal; Department of Neurology (M.G.H.), Universitäts Medizin Mannheim, Heidelberg University, Germany; Stroke Unit, Department of Neurology (C.M.), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; Stroke Prevention Research Unit (P.M.R.), Nuffield Department of Clinical Neuroscience, University of Oxford, UK; Department of Cardiology (P.G.S.), Bichat Hospital, AP-HP, Paris, France; National Heart and Lung Institute Imperial College (P.G.S.), Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London, UK; Department of Biostatistics (É.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital, AP-HP, Paris, France
| | - Kazuo Kitagawa
- From the Department of Neurology and Stroke Center (T.H., H.C., J.L., P.C.L., P.-J.T., P.A.), Bichat Hospital, AP-HP and INSERM LVTS-U1148, DHU FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, France; Center for Brain and Cerebral Vessels (S.U.), Sanno Hospital and Sanno Medical Center, International University of Health and Welfare, Tokyo, Japan; Department of Medicine and Therapeutics (L.K.S.W.), Chinese University of Hong Kong, Prince of Wales Hospital; Department of Neurology (T.H., K.K.), Tokyo Women's Medical University, Japan; Université Lille (J.L.), Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille, France; Stanford Stroke Center (G.W.A.), Department of Neurology and Neurological Sciences, Stanford University Medical Center, CA; Cerebrovascular Disease Service (L.R.C.), Beth Israel Deaconess Medical Center, Harvard University, Boston, MA; Melbourne Brain Centre (G.A.D.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurosciences (J.M.F.), Service of Neurology, Hospital Santa Maria, University of Lisbon, Portugal; Department of Neurology (M.G.H.), Universitäts Medizin Mannheim, Heidelberg University, Germany; Stroke Unit, Department of Neurology (C.M.), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; Stroke Prevention Research Unit (P.M.R.), Nuffield Department of Clinical Neuroscience, University of Oxford, UK; Department of Cardiology (P.G.S.), Bichat Hospital, AP-HP, Paris, France; National Heart and Lung Institute Imperial College (P.G.S.), Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London, UK; Department of Biostatistics (É.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital, AP-HP, Paris, France
| | - Hugo Charles
- From the Department of Neurology and Stroke Center (T.H., H.C., J.L., P.C.L., P.-J.T., P.A.), Bichat Hospital, AP-HP and INSERM LVTS-U1148, DHU FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, France; Center for Brain and Cerebral Vessels (S.U.), Sanno Hospital and Sanno Medical Center, International University of Health and Welfare, Tokyo, Japan; Department of Medicine and Therapeutics (L.K.S.W.), Chinese University of Hong Kong, Prince of Wales Hospital; Department of Neurology (T.H., K.K.), Tokyo Women's Medical University, Japan; Université Lille (J.L.), Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille, France; Stanford Stroke Center (G.W.A.), Department of Neurology and Neurological Sciences, Stanford University Medical Center, CA; Cerebrovascular Disease Service (L.R.C.), Beth Israel Deaconess Medical Center, Harvard University, Boston, MA; Melbourne Brain Centre (G.A.D.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurosciences (J.M.F.), Service of Neurology, Hospital Santa Maria, University of Lisbon, Portugal; Department of Neurology (M.G.H.), Universitäts Medizin Mannheim, Heidelberg University, Germany; Stroke Unit, Department of Neurology (C.M.), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; Stroke Prevention Research Unit (P.M.R.), Nuffield Department of Clinical Neuroscience, University of Oxford, UK; Department of Cardiology (P.G.S.), Bichat Hospital, AP-HP, Paris, France; National Heart and Lung Institute Imperial College (P.G.S.), Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London, UK; Department of Biostatistics (É.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital, AP-HP, Paris, France
| | - Julien Labreuche
- From the Department of Neurology and Stroke Center (T.H., H.C., J.L., P.C.L., P.-J.T., P.A.), Bichat Hospital, AP-HP and INSERM LVTS-U1148, DHU FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, France; Center for Brain and Cerebral Vessels (S.U.), Sanno Hospital and Sanno Medical Center, International University of Health and Welfare, Tokyo, Japan; Department of Medicine and Therapeutics (L.K.S.W.), Chinese University of Hong Kong, Prince of Wales Hospital; Department of Neurology (T.H., K.K.), Tokyo Women's Medical University, Japan; Université Lille (J.L.), Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille, France; Stanford Stroke Center (G.W.A.), Department of Neurology and Neurological Sciences, Stanford University Medical Center, CA; Cerebrovascular Disease Service (L.R.C.), Beth Israel Deaconess Medical Center, Harvard University, Boston, MA; Melbourne Brain Centre (G.A.D.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurosciences (J.M.F.), Service of Neurology, Hospital Santa Maria, University of Lisbon, Portugal; Department of Neurology (M.G.H.), Universitäts Medizin Mannheim, Heidelberg University, Germany; Stroke Unit, Department of Neurology (C.M.), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; Stroke Prevention Research Unit (P.M.R.), Nuffield Department of Clinical Neuroscience, University of Oxford, UK; Department of Cardiology (P.G.S.), Bichat Hospital, AP-HP, Paris, France; National Heart and Lung Institute Imperial College (P.G.S.), Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London, UK; Department of Biostatistics (É.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital, AP-HP, Paris, France
| | - Philippa C Lavallée
- From the Department of Neurology and Stroke Center (T.H., H.C., J.L., P.C.L., P.-J.T., P.A.), Bichat Hospital, AP-HP and INSERM LVTS-U1148, DHU FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, France; Center for Brain and Cerebral Vessels (S.U.), Sanno Hospital and Sanno Medical Center, International University of Health and Welfare, Tokyo, Japan; Department of Medicine and Therapeutics (L.K.S.W.), Chinese University of Hong Kong, Prince of Wales Hospital; Department of Neurology (T.H., K.K.), Tokyo Women's Medical University, Japan; Université Lille (J.L.), Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille, France; Stanford Stroke Center (G.W.A.), Department of Neurology and Neurological Sciences, Stanford University Medical Center, CA; Cerebrovascular Disease Service (L.R.C.), Beth Israel Deaconess Medical Center, Harvard University, Boston, MA; Melbourne Brain Centre (G.A.D.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurosciences (J.M.F.), Service of Neurology, Hospital Santa Maria, University of Lisbon, Portugal; Department of Neurology (M.G.H.), Universitäts Medizin Mannheim, Heidelberg University, Germany; Stroke Unit, Department of Neurology (C.M.), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; Stroke Prevention Research Unit (P.M.R.), Nuffield Department of Clinical Neuroscience, University of Oxford, UK; Department of Cardiology (P.G.S.), Bichat Hospital, AP-HP, Paris, France; National Heart and Lung Institute Imperial College (P.G.S.), Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London, UK; Department of Biostatistics (É.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital, AP-HP, Paris, France
| | - Gregory W Albers
- From the Department of Neurology and Stroke Center (T.H., H.C., J.L., P.C.L., P.-J.T., P.A.), Bichat Hospital, AP-HP and INSERM LVTS-U1148, DHU FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, France; Center for Brain and Cerebral Vessels (S.U.), Sanno Hospital and Sanno Medical Center, International University of Health and Welfare, Tokyo, Japan; Department of Medicine and Therapeutics (L.K.S.W.), Chinese University of Hong Kong, Prince of Wales Hospital; Department of Neurology (T.H., K.K.), Tokyo Women's Medical University, Japan; Université Lille (J.L.), Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille, France; Stanford Stroke Center (G.W.A.), Department of Neurology and Neurological Sciences, Stanford University Medical Center, CA; Cerebrovascular Disease Service (L.R.C.), Beth Israel Deaconess Medical Center, Harvard University, Boston, MA; Melbourne Brain Centre (G.A.D.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurosciences (J.M.F.), Service of Neurology, Hospital Santa Maria, University of Lisbon, Portugal; Department of Neurology (M.G.H.), Universitäts Medizin Mannheim, Heidelberg University, Germany; Stroke Unit, Department of Neurology (C.M.), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; Stroke Prevention Research Unit (P.M.R.), Nuffield Department of Clinical Neuroscience, University of Oxford, UK; Department of Cardiology (P.G.S.), Bichat Hospital, AP-HP, Paris, France; National Heart and Lung Institute Imperial College (P.G.S.), Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London, UK; Department of Biostatistics (É.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital, AP-HP, Paris, France
| | - Louis R Caplan
- From the Department of Neurology and Stroke Center (T.H., H.C., J.L., P.C.L., P.-J.T., P.A.), Bichat Hospital, AP-HP and INSERM LVTS-U1148, DHU FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, France; Center for Brain and Cerebral Vessels (S.U.), Sanno Hospital and Sanno Medical Center, International University of Health and Welfare, Tokyo, Japan; Department of Medicine and Therapeutics (L.K.S.W.), Chinese University of Hong Kong, Prince of Wales Hospital; Department of Neurology (T.H., K.K.), Tokyo Women's Medical University, Japan; Université Lille (J.L.), Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille, France; Stanford Stroke Center (G.W.A.), Department of Neurology and Neurological Sciences, Stanford University Medical Center, CA; Cerebrovascular Disease Service (L.R.C.), Beth Israel Deaconess Medical Center, Harvard University, Boston, MA; Melbourne Brain Centre (G.A.D.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurosciences (J.M.F.), Service of Neurology, Hospital Santa Maria, University of Lisbon, Portugal; Department of Neurology (M.G.H.), Universitäts Medizin Mannheim, Heidelberg University, Germany; Stroke Unit, Department of Neurology (C.M.), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; Stroke Prevention Research Unit (P.M.R.), Nuffield Department of Clinical Neuroscience, University of Oxford, UK; Department of Cardiology (P.G.S.), Bichat Hospital, AP-HP, Paris, France; National Heart and Lung Institute Imperial College (P.G.S.), Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London, UK; Department of Biostatistics (É.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital, AP-HP, Paris, France
| | - Geoffrey A Donnan
- From the Department of Neurology and Stroke Center (T.H., H.C., J.L., P.C.L., P.-J.T., P.A.), Bichat Hospital, AP-HP and INSERM LVTS-U1148, DHU FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, France; Center for Brain and Cerebral Vessels (S.U.), Sanno Hospital and Sanno Medical Center, International University of Health and Welfare, Tokyo, Japan; Department of Medicine and Therapeutics (L.K.S.W.), Chinese University of Hong Kong, Prince of Wales Hospital; Department of Neurology (T.H., K.K.), Tokyo Women's Medical University, Japan; Université Lille (J.L.), Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille, France; Stanford Stroke Center (G.W.A.), Department of Neurology and Neurological Sciences, Stanford University Medical Center, CA; Cerebrovascular Disease Service (L.R.C.), Beth Israel Deaconess Medical Center, Harvard University, Boston, MA; Melbourne Brain Centre (G.A.D.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurosciences (J.M.F.), Service of Neurology, Hospital Santa Maria, University of Lisbon, Portugal; Department of Neurology (M.G.H.), Universitäts Medizin Mannheim, Heidelberg University, Germany; Stroke Unit, Department of Neurology (C.M.), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; Stroke Prevention Research Unit (P.M.R.), Nuffield Department of Clinical Neuroscience, University of Oxford, UK; Department of Cardiology (P.G.S.), Bichat Hospital, AP-HP, Paris, France; National Heart and Lung Institute Imperial College (P.G.S.), Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London, UK; Department of Biostatistics (É.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital, AP-HP, Paris, France
| | - José M Ferro
- From the Department of Neurology and Stroke Center (T.H., H.C., J.L., P.C.L., P.-J.T., P.A.), Bichat Hospital, AP-HP and INSERM LVTS-U1148, DHU FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, France; Center for Brain and Cerebral Vessels (S.U.), Sanno Hospital and Sanno Medical Center, International University of Health and Welfare, Tokyo, Japan; Department of Medicine and Therapeutics (L.K.S.W.), Chinese University of Hong Kong, Prince of Wales Hospital; Department of Neurology (T.H., K.K.), Tokyo Women's Medical University, Japan; Université Lille (J.L.), Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille, France; Stanford Stroke Center (G.W.A.), Department of Neurology and Neurological Sciences, Stanford University Medical Center, CA; Cerebrovascular Disease Service (L.R.C.), Beth Israel Deaconess Medical Center, Harvard University, Boston, MA; Melbourne Brain Centre (G.A.D.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurosciences (J.M.F.), Service of Neurology, Hospital Santa Maria, University of Lisbon, Portugal; Department of Neurology (M.G.H.), Universitäts Medizin Mannheim, Heidelberg University, Germany; Stroke Unit, Department of Neurology (C.M.), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; Stroke Prevention Research Unit (P.M.R.), Nuffield Department of Clinical Neuroscience, University of Oxford, UK; Department of Cardiology (P.G.S.), Bichat Hospital, AP-HP, Paris, France; National Heart and Lung Institute Imperial College (P.G.S.), Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London, UK; Department of Biostatistics (É.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital, AP-HP, Paris, France
| | - Michael G Hennerici
- From the Department of Neurology and Stroke Center (T.H., H.C., J.L., P.C.L., P.-J.T., P.A.), Bichat Hospital, AP-HP and INSERM LVTS-U1148, DHU FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, France; Center for Brain and Cerebral Vessels (S.U.), Sanno Hospital and Sanno Medical Center, International University of Health and Welfare, Tokyo, Japan; Department of Medicine and Therapeutics (L.K.S.W.), Chinese University of Hong Kong, Prince of Wales Hospital; Department of Neurology (T.H., K.K.), Tokyo Women's Medical University, Japan; Université Lille (J.L.), Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille, France; Stanford Stroke Center (G.W.A.), Department of Neurology and Neurological Sciences, Stanford University Medical Center, CA; Cerebrovascular Disease Service (L.R.C.), Beth Israel Deaconess Medical Center, Harvard University, Boston, MA; Melbourne Brain Centre (G.A.D.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurosciences (J.M.F.), Service of Neurology, Hospital Santa Maria, University of Lisbon, Portugal; Department of Neurology (M.G.H.), Universitäts Medizin Mannheim, Heidelberg University, Germany; Stroke Unit, Department of Neurology (C.M.), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; Stroke Prevention Research Unit (P.M.R.), Nuffield Department of Clinical Neuroscience, University of Oxford, UK; Department of Cardiology (P.G.S.), Bichat Hospital, AP-HP, Paris, France; National Heart and Lung Institute Imperial College (P.G.S.), Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London, UK; Department of Biostatistics (É.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital, AP-HP, Paris, France
| | - Carlos Molina
- From the Department of Neurology and Stroke Center (T.H., H.C., J.L., P.C.L., P.-J.T., P.A.), Bichat Hospital, AP-HP and INSERM LVTS-U1148, DHU FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, France; Center for Brain and Cerebral Vessels (S.U.), Sanno Hospital and Sanno Medical Center, International University of Health and Welfare, Tokyo, Japan; Department of Medicine and Therapeutics (L.K.S.W.), Chinese University of Hong Kong, Prince of Wales Hospital; Department of Neurology (T.H., K.K.), Tokyo Women's Medical University, Japan; Université Lille (J.L.), Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille, France; Stanford Stroke Center (G.W.A.), Department of Neurology and Neurological Sciences, Stanford University Medical Center, CA; Cerebrovascular Disease Service (L.R.C.), Beth Israel Deaconess Medical Center, Harvard University, Boston, MA; Melbourne Brain Centre (G.A.D.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurosciences (J.M.F.), Service of Neurology, Hospital Santa Maria, University of Lisbon, Portugal; Department of Neurology (M.G.H.), Universitäts Medizin Mannheim, Heidelberg University, Germany; Stroke Unit, Department of Neurology (C.M.), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; Stroke Prevention Research Unit (P.M.R.), Nuffield Department of Clinical Neuroscience, University of Oxford, UK; Department of Cardiology (P.G.S.), Bichat Hospital, AP-HP, Paris, France; National Heart and Lung Institute Imperial College (P.G.S.), Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London, UK; Department of Biostatistics (É.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital, AP-HP, Paris, France
| | - Peter M Rothwell
- From the Department of Neurology and Stroke Center (T.H., H.C., J.L., P.C.L., P.-J.T., P.A.), Bichat Hospital, AP-HP and INSERM LVTS-U1148, DHU FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, France; Center for Brain and Cerebral Vessels (S.U.), Sanno Hospital and Sanno Medical Center, International University of Health and Welfare, Tokyo, Japan; Department of Medicine and Therapeutics (L.K.S.W.), Chinese University of Hong Kong, Prince of Wales Hospital; Department of Neurology (T.H., K.K.), Tokyo Women's Medical University, Japan; Université Lille (J.L.), Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille, France; Stanford Stroke Center (G.W.A.), Department of Neurology and Neurological Sciences, Stanford University Medical Center, CA; Cerebrovascular Disease Service (L.R.C.), Beth Israel Deaconess Medical Center, Harvard University, Boston, MA; Melbourne Brain Centre (G.A.D.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurosciences (J.M.F.), Service of Neurology, Hospital Santa Maria, University of Lisbon, Portugal; Department of Neurology (M.G.H.), Universitäts Medizin Mannheim, Heidelberg University, Germany; Stroke Unit, Department of Neurology (C.M.), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; Stroke Prevention Research Unit (P.M.R.), Nuffield Department of Clinical Neuroscience, University of Oxford, UK; Department of Cardiology (P.G.S.), Bichat Hospital, AP-HP, Paris, France; National Heart and Lung Institute Imperial College (P.G.S.), Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London, UK; Department of Biostatistics (É.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital, AP-HP, Paris, France
| | - P Gabriel Steg
- From the Department of Neurology and Stroke Center (T.H., H.C., J.L., P.C.L., P.-J.T., P.A.), Bichat Hospital, AP-HP and INSERM LVTS-U1148, DHU FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, France; Center for Brain and Cerebral Vessels (S.U.), Sanno Hospital and Sanno Medical Center, International University of Health and Welfare, Tokyo, Japan; Department of Medicine and Therapeutics (L.K.S.W.), Chinese University of Hong Kong, Prince of Wales Hospital; Department of Neurology (T.H., K.K.), Tokyo Women's Medical University, Japan; Université Lille (J.L.), Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille, France; Stanford Stroke Center (G.W.A.), Department of Neurology and Neurological Sciences, Stanford University Medical Center, CA; Cerebrovascular Disease Service (L.R.C.), Beth Israel Deaconess Medical Center, Harvard University, Boston, MA; Melbourne Brain Centre (G.A.D.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurosciences (J.M.F.), Service of Neurology, Hospital Santa Maria, University of Lisbon, Portugal; Department of Neurology (M.G.H.), Universitäts Medizin Mannheim, Heidelberg University, Germany; Stroke Unit, Department of Neurology (C.M.), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; Stroke Prevention Research Unit (P.M.R.), Nuffield Department of Clinical Neuroscience, University of Oxford, UK; Department of Cardiology (P.G.S.), Bichat Hospital, AP-HP, Paris, France; National Heart and Lung Institute Imperial College (P.G.S.), Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London, UK; Department of Biostatistics (É.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital, AP-HP, Paris, France
| | - Pierre-Jean Touboul
- From the Department of Neurology and Stroke Center (T.H., H.C., J.L., P.C.L., P.-J.T., P.A.), Bichat Hospital, AP-HP and INSERM LVTS-U1148, DHU FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, France; Center for Brain and Cerebral Vessels (S.U.), Sanno Hospital and Sanno Medical Center, International University of Health and Welfare, Tokyo, Japan; Department of Medicine and Therapeutics (L.K.S.W.), Chinese University of Hong Kong, Prince of Wales Hospital; Department of Neurology (T.H., K.K.), Tokyo Women's Medical University, Japan; Université Lille (J.L.), Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille, France; Stanford Stroke Center (G.W.A.), Department of Neurology and Neurological Sciences, Stanford University Medical Center, CA; Cerebrovascular Disease Service (L.R.C.), Beth Israel Deaconess Medical Center, Harvard University, Boston, MA; Melbourne Brain Centre (G.A.D.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurosciences (J.M.F.), Service of Neurology, Hospital Santa Maria, University of Lisbon, Portugal; Department of Neurology (M.G.H.), Universitäts Medizin Mannheim, Heidelberg University, Germany; Stroke Unit, Department of Neurology (C.M.), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; Stroke Prevention Research Unit (P.M.R.), Nuffield Department of Clinical Neuroscience, University of Oxford, UK; Department of Cardiology (P.G.S.), Bichat Hospital, AP-HP, Paris, France; National Heart and Lung Institute Imperial College (P.G.S.), Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London, UK; Department of Biostatistics (É.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital, AP-HP, Paris, France
| | - Éric Vicaut
- From the Department of Neurology and Stroke Center (T.H., H.C., J.L., P.C.L., P.-J.T., P.A.), Bichat Hospital, AP-HP and INSERM LVTS-U1148, DHU FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, France; Center for Brain and Cerebral Vessels (S.U.), Sanno Hospital and Sanno Medical Center, International University of Health and Welfare, Tokyo, Japan; Department of Medicine and Therapeutics (L.K.S.W.), Chinese University of Hong Kong, Prince of Wales Hospital; Department of Neurology (T.H., K.K.), Tokyo Women's Medical University, Japan; Université Lille (J.L.), Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille, France; Stanford Stroke Center (G.W.A.), Department of Neurology and Neurological Sciences, Stanford University Medical Center, CA; Cerebrovascular Disease Service (L.R.C.), Beth Israel Deaconess Medical Center, Harvard University, Boston, MA; Melbourne Brain Centre (G.A.D.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurosciences (J.M.F.), Service of Neurology, Hospital Santa Maria, University of Lisbon, Portugal; Department of Neurology (M.G.H.), Universitäts Medizin Mannheim, Heidelberg University, Germany; Stroke Unit, Department of Neurology (C.M.), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; Stroke Prevention Research Unit (P.M.R.), Nuffield Department of Clinical Neuroscience, University of Oxford, UK; Department of Cardiology (P.G.S.), Bichat Hospital, AP-HP, Paris, France; National Heart and Lung Institute Imperial College (P.G.S.), Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London, UK; Department of Biostatistics (É.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital, AP-HP, Paris, France
| | - Pierre Amarenco
- From the Department of Neurology and Stroke Center (T.H., H.C., J.L., P.C.L., P.-J.T., P.A.), Bichat Hospital, AP-HP and INSERM LVTS-U1148, DHU FIRE, Université Paris-Diderot, Sorbonne-Paris Cité, France; Center for Brain and Cerebral Vessels (S.U.), Sanno Hospital and Sanno Medical Center, International University of Health and Welfare, Tokyo, Japan; Department of Medicine and Therapeutics (L.K.S.W.), Chinese University of Hong Kong, Prince of Wales Hospital; Department of Neurology (T.H., K.K.), Tokyo Women's Medical University, Japan; Université Lille (J.L.), Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille, France; Stanford Stroke Center (G.W.A.), Department of Neurology and Neurological Sciences, Stanford University Medical Center, CA; Cerebrovascular Disease Service (L.R.C.), Beth Israel Deaconess Medical Center, Harvard University, Boston, MA; Melbourne Brain Centre (G.A.D.), Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Department of Neurosciences (J.M.F.), Service of Neurology, Hospital Santa Maria, University of Lisbon, Portugal; Department of Neurology (M.G.H.), Universitäts Medizin Mannheim, Heidelberg University, Germany; Stroke Unit, Department of Neurology (C.M.), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; Stroke Prevention Research Unit (P.M.R.), Nuffield Department of Clinical Neuroscience, University of Oxford, UK; Department of Cardiology (P.G.S.), Bichat Hospital, AP-HP, Paris, France; National Heart and Lung Institute Imperial College (P.G.S.), Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London, UK; Department of Biostatistics (É.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital, AP-HP, Paris, France.
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Kim BJ, Kwon SU, Park JH, Kim YJ, Hong KS, Wong LKS, Yu S, Hwang YH, Lee JS, Lee J, Rha JH, Heo SH, Ahn SH, Seo WK, Park JM, Lee JH, Kwon JH, Sohn SI, Jung JM, Navarro JC, Kim HY, Kim EG, Kim S, Cha JK, Park MS, Nam HS, Kang DW. Cilostazol Versus Aspirin in Ischemic Stroke Patients With High-Risk Cerebral Hemorrhage: Subgroup Analysis of the PICASSO Trial. Stroke 2019; 51:931-937. [PMID: 31856691 DOI: 10.1161/strokeaha.119.023855] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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 and Purpose- Although cilostazol has shown less hemorrhagic events than aspirin, only marginal difference was observed in hemorrhagic stroke events among patients at high risk for cerebral hemorrhage. To identify patients who would most benefit from cilostazol, this study analyzed interactions between treatment and subgroups of the PICASSO trial (Prevention of Cardiovascular Events in Asian Ischemic Stroke Patients With High Risk of Cerebral Hemorrhage). Methods- Ischemic stroke patients with a previous intracerebral hemorrhage or multiple microbleeds were randomized to treatment with cilostazol or aspirin and followed up for a mean 1.8 years. Efficacy, defined as the composite of any stroke, myocardial infarction, and vascular death, and safety, defined as the incidence of hemorrhagic stroke, were analyzed in the 2 groups. Interactions between treatment and age, sex, presence of hypertension and diabetes mellitus, index of high-risk cerebral hemorrhage, and white matter lesion burden were analyzed for primary and key secondary outcomes. Changes in vital signs and laboratory results were compared in the 2 groups. Results- Among all 1534 patients enrolled, a significant interaction between treatment group and index of high risk for cerebral hemorrhage on hemorrhagic stroke (P for interaction, 0.03) was observed. Hemorrhagic stroke was less frequent in the cilostazol than in the aspirin group in patients with multiple microbleeds (1 versus 13 events; hazard ratio, 0.08 [95% CI, 0.01-0.61]; P=0.01). A marginal interaction between treatment group and white matter change on any stroke (P for interaction, 0.08) was observed. Cilostazol reduced any stroke significantly in patients with mild (5 versus 16 events; hazard ratio, 0.36 [95% CI, 0.13-0.97]; P=0.04)-to-moderate (16 versus 32 events; hazard ratio, 0.50 [95% CI, 0.29-0.92]; P=0.03) white matter changes. Heart rate and HDL (high-density lipoprotein) cholesterol level were significantly higher in the cilostazol group than in the aspirin group at follow-up. Conclusions- Cilostazol may be more beneficial for ischemic stroke patients with multiple cerebral microbleeds and before white matter changes are extensive. Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT01013532.
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Affiliation(s)
- Bum Joon Kim
- From the Department of Neurology, Kyung Hee University Medical Center, Seoul, Korea (B.J.K., S.H.H.)
| | - Sun U Kwon
- Department of Neurology (S.U.K., D.-W.K.), Asan Medical Center, Ulsan University, Seoul, Korea
| | - Joung-Ho Park
- Department of Neurology, Hanyang University, Myongji Hospital, Seoul, Korea (J.-H.P.)
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul (Y.-J.K.)
| | - Keun-Sik Hong
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea (K.-S.H.)
| | - Lawrence K S Wong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong (L.K.S.W.)
| | - Sungwook Yu
- Department of Neurology, Anam Hospital (S.Y.), Korea University, Seoul
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, Daegu, Korea (Y.-H.H.)
| | - Ji Sung Lee
- Clinical Research Center (J.S.L.), Asan Medical Center, Ulsan University, Seoul, Korea
| | - Juneyoung Lee
- Department of Biostatistics (J.L.), Korea University, Seoul
| | - Jong-Ho Rha
- Department of Neurology, Inha University Hospital, Incheon, Korea (J.-H.R.)
| | - Sung Hyuk Heo
- From the Department of Neurology, Kyung Hee University Medical Center, Seoul, Korea (B.J.K., S.H.H.)
| | - Seong Hwan Ahn
- Department of Neurology, Chosun University Hospital, Gwangju, Korea (S.H.A.)
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea (W.-K.S.)
| | - Jong-Moo Park
- Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Korea (J.-M.P.)
| | - Ju-Hun Lee
- Department of Neurology, Sacred Heart Hospital, Hallym University, Seoul, Korea (J.-H.L.)
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan University Hospital, Ulsan University, Korea (J.-H.K.)
| | - Sung-Il Sohn
- Department of Neurology, Dongsan Medical Center, Keimyung University, Daegu, Korea (S.-I.S.)
| | - Jin-Man Jung
- Department of Neurology, Ansan Hospital (J.-M.J.), Korea University, Seoul
| | - Jose C Navarro
- Department of Neurology and Psychiatry, University of Santo Tomas Hospital, Manila, Philippines (J.C.N.)
| | - Hahn Young Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea (H.Y.K.)
| | - Eung-Gyu Kim
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea (E.-G.K.)
| | - Seongheon Kim
- Department of Neurology, Kangwon National University Hospital, Chuncheon, Korea (S.K.)
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, Korea (J.-K.C.)
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea (M.-S.P.)
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University Severance Hospital, Seoul, Korea (H.S.N.)
| | - Dong-Wha Kang
- Department of Neurology (S.U.K., D.-W.K.), Asan Medical Center, Ulsan University, Seoul, Korea
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Yu SCH, Lau TWW, Wong SSM, Lee KT, Wong LKS, Leung TWH. Long-Term Evolutionary Change in the Lumen of Intracranial Atherosclerotic Stenosis Following Angioplasty and Stenting. Oper Neurosurg (Hagerstown) 2019. [PMID: 28637237 DOI: 10.1093/ons/opx097] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Angioplasty and stenting is a recognized treatment option for patients with intracranial atherosclerosis. OBJECTIVE To evaluate the long-term evolutionary luminal changes of intracranial atherosclerosis after angioplasty and stenting. METHODS This was a retrospective study with patient consent. Eighty-two patients presenting with acute and minor cerebral ischemia due to stenosis ≥70%, who had received medical therapy with or without stenting (Wingspan), were invited. Luminal imaging was provided using 3-dimensional rotational angiography (3-DRA) at baseline and 12 mo, and cone-beam computed tomography angiography with intravenous contrast (CBCT) was provided at follow-up (median 82.4 mo [interquartile range 61.9-96.9 mo]). RESULTS Thirty-six patients in the stenting group and 26 patients in the medical group were recruited and completed the study. There was no statistically significant difference in demographics between the 2 patient groups. The luminal gain at 12 or 80 mo as compared to baseline in the stenting group was significantly greater than that in the medical group (12 mo: median gain 30% vs 7.2%, P < .001; 80 mo: median gain 42.9% vs 7.2%, P < .0001). Luminal loss or unchanged lumen was correlated with recurrent ischemic event. The differences in the stenosis degree assessment between CBCT and 3-DRA in the same 10 patients with or without stenting were 1.2 ± 0.6% or 0.2 ± 0.06%, respectively. There was a correlation between recurrent ischemic events and luminal loss. CONCLUSION Arterial lumen after angioplasty and stenting can probably be well maintained and delayed luminal gain does occur, long-term luminal loss is associated with recurrent ischemic events, CBCT might be useful as a less-invasive means for long-term assessment.
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Affiliation(s)
- Simon C H Yu
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China.,Vascular and Interventional Radiology Foundation Clinical Science Center, the Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Tiffany W W Lau
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Simon S M Wong
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Kwok T Lee
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Lawrence K S Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Thomas W H Leung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
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Soo YO, Abrigo J, Chu W, Leung KT, Fong WC, Li SH, Li R, Ng PW, Wong KK, Wong LKS, Leung TWH. Risk of intracerebral haemorrhage in patients with cerebral microbleeds taking warfarin for atrial fibrillation: a prospective study. Hong Kong Med J 2019; 25 Suppl 5:6-8. [PMID: 31416977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Affiliation(s)
- Y O Soo
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - J Abrigo
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - W Chu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - K T Leung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - W C Fong
- Department of Medicine, Queen Elizabeth Hospital
| | - S H Li
- Department of Medicine, North District Hospital
| | - R Li
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital
| | - P W Ng
- Department of Medicine and Geriatrics, United Christian Hospital
| | - K K Wong
- Department of Medicine, Yan Chai Hospital
| | - L K S Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - T W H Leung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong
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Leung TWH, Fan SY, Ip HL, Lau AYL, Siu DYW, Dai EYL, Wong LKS, Liebeskind DS. Effects of collateral circulation on haemodynamic flow status in intracranial artery stenosis depicted by computational fluid dynamics. Hong Kong Med J 2019; 25 Suppl 5:18-21. [PMID: 31416981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Affiliation(s)
- T W H Leung
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - S Y Fan
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - H L Ip
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - A Y L Lau
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - D Y W Siu
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - E Y L Dai
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - L K S Wong
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong
| | - D S Liebeskind
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong
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Xiong L, Tian G, Leung HW, Chen XY, Lin WH, Leung TWH, Soo YO, Siu DYW, Wong LKS. Autonomic dysfunction as measured by Ewing battery test to predict poor outcome after acute ischaemic stroke. Hong Kong Med J 2019; 25 Suppl 5:9-11. [PMID: 31416978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Affiliation(s)
- L Xiong
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong
| | - G Tian
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong
| | - H W Leung
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong
| | - X Y Chen
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong
| | - W H Lin
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong
| | - T W H Leung
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong
| | - Y O Soo
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong
| | - D Y W Siu
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong
| | - L K S Wong
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong
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Amarenco P, Lavallée PC, Monteiro Tavares L, Labreuche J, Albers GW, Abboud H, Anticoli S, Audebert H, Bornstein NM, Caplan LR, Correia M, Donnan GA, Ferro JM, Gongora-Rivera F, Heide W, Hennerici MG, Kelly PJ, Král M, Lin HF, Molina C, Park JM, Purroy F, Rothwell PM, Segura T, Školoudík D, Steg PG, Touboul PJ, Uchiyama S, Vicaut É, Wang Y, Wong LKS. Five-Year Risk of Stroke after TIA or Minor Ischemic Stroke. N Engl J Med 2018; 378:2182-2190. [PMID: 29766771 DOI: 10.1056/nejmoa1802712] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND After a transient ischemic attack (TIA) or minor stroke, the long-term risk of stroke and other vascular events is not well known. In this follow-up to a report on 1-year outcomes from a registry of TIA clinics in 21 countries that enrolled 4789 patients with a TIA or minor ischemic stroke from 2009 through 2011, we examined the 5-year risk of stroke and vascular events. METHODS We evaluated patients who had had a TIA or minor stroke within 7 days before enrollment in the registry. Among 61 sites that participated in the 1-year outcome study, we selected 42 sites that had follow-up data on more than 50% of their enrolled patients at 5 years. The primary outcome was a composite of stroke, acute coronary syndrome, or death from cardiovascular causes (whichever occurred first), with an emphasis on events that occurred in the second through fifth years. In calculating the cumulative incidence of the primary outcome and secondary outcomes (except death from any cause), we treated death as a competing risk. RESULTS A total of 3847 patients were included in the 5-year follow-up study; the median percentage of patients with 5-year follow-up data per center was 92.3% (interquartile range, 83.4 to 97.8). The composite primary outcome occurred in 469 patients (estimated cumulative rate, 12.9%; 95% confidence interval [CI], 11.8 to 14.1), with 235 events (50.1%) occurring in the second through fifth years. At 5 years, strokes had occurred in 345 patients (estimated cumulative rate, 9.5%; 95% CI, 8.5 to 10.5), with 149 of these patients (43.2%) having had a stroke during the second through fifth years. Rates of death from any cause, death from cardiovascular causes, intracranial hemorrhage, and major bleeding were 10.6%, 2.7%, 1.1%, and 1.5%, respectively, at 5 years. In multivariable analyses, ipsilateral large-artery atherosclerosis, cardioembolism, and a baseline ABCD2 score for the risk of stroke (range, 0 to 7, with higher scores indicating greater risk) of 4 or more were each associated with an increased risk of subsequent stroke. CONCLUSIONS In a follow-up to a 1-year study involving patients who had a TIA or minor stroke, the rate of cardiovascular events including stroke in a selected cohort was 6.4% in the first year and 6.4% in the second through fifth years. (Funded by AstraZeneca and others.).
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Affiliation(s)
- Pierre Amarenco
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - Philippa C Lavallée
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - Linsay Monteiro Tavares
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - Julien Labreuche
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - Gregory W Albers
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - Halim Abboud
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - Sabrina Anticoli
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - Heinrich Audebert
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - Natan M Bornstein
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - Louis R Caplan
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - Manuel Correia
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - Geoffrey A Donnan
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - José M Ferro
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - Fernando Gongora-Rivera
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - Wolfgang Heide
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - Michael G Hennerici
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - Peter J Kelly
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - Michal Král
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - Hsiu-Fen Lin
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - Carlos Molina
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - Jong Moo Park
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - Francisco Purroy
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - Peter M Rothwell
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - Tomas Segura
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - David Školoudík
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - P Gabriel Steg
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - Pierre-Jean Touboul
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - Shinichiro Uchiyama
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - Éric Vicaut
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - Yongjun Wang
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
| | - Lawrence K S Wong
- From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.)
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Kim BJ, Lee EJ, Kwon SU, Park JH, Kim YJ, Hong KS, Wong LKS, Yu S, Hwang YH, Lee JS, Lee J, Rha JH, Heo SH, Ahn SH, Seo WK, Park JM, Lee JH, Kwon JH, Sohn SI, Jung JM, Navarro JC, Kang DW, Kwon SU, Lee J, Kang DW, Rha JH, Park JM, Lee YS, Lee JH, Kim YJ, Hong KS, Yu KH, Sohn SI, Ahn SH, Cha JK, Park MS, Kim JS, Yoon BW, Lee BC, Nam CM, Koo JS, Nam HS, Park KY, Park JM, Lee JH, Kim DH, Rha JH, Nah HW, Lee YS, Cho YJ, Kim DE, Han MK, Lee KB, Heo SH, Heo JH, Kim BJ, Cho KH, Kim HY, Kim YD, Cho AH, Lee KY, Lee JS, Park JH, Seo WK, Kim EG, Koh IS, Choi NC, Kwon JH, Lee J, Hwang YH, Song HJ, Shin BS, Kim JT, Lee SJ, Chung PW, Kim SH, Lee JH, Shin DI, Do JK, Lee SB, Lee YB, Yoo BG, Sung SM, Jung JM, Park JW, Lee TK, Navarro JC, San Jos MCZ, Roxas A, Mallarl-Alvarez RJ, Collantes MEV, WONG LK, Fong WC, Tsoi TH, Ng PW, Lee EJ, Lee JS. Prevention of cardiovascular events in Asian patients with ischaemic stroke at high risk of cerebral haemorrhage (PICASSO): a multicentre, randomised controlled trial. Lancet Neurol 2018; 17:509-518. [DOI: 10.1016/s1474-4422(18)30128-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 12/18/2022]
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Wong A, Black SE, Yiu SYP, Au LWC, Lau AYL, Soo YOY, Chan AYY, Leung TWH, Wong LKS, Kwok TCY, Cheung TCK, Leung KT, Lam BYK, Kwan JSK, Mok VCT. Converting MMSE to MoCA and MoCA 5-minute protocol in an educationally heterogeneous sample with stroke or transient ischemic attack. Int J Geriatr Psychiatry 2018; 33:729-734. [PMID: 29292529 DOI: 10.1002/gps.4846] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 08/17/2017] [Accepted: 11/21/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Montreal Cognitive Assessment (MoCA) is psychometrically superior over the Mini-mental State Examination (MMSE) for cognitive screening in stroke or transient ischemic attack (TIA). It is free for clinical and research use. The objective of this study is to convert scores from the MMSE to MoCA and MoCA-5-minute protocol (MoCA-5 min) and to examine the ability of the converted scores in detecting cognitive impairment after stroke or TIA. METHODS A total of 904 patients were randomly divided into training (n = 623) and validation (n = 281) samples matched for demography and cognition. MMSE scores were converted to MoCA and MoCA-5 min using (1) equipercentile method with log-linear smoothing and (2) Poisson regression adjusting for age and education. Receiver operating characteristics curve analysis was used to examine the ability of the converted scores in differentiating patients with cognitive impairment. RESULTS The mean education was 5.8 (SD = 4.6; ranged 0-20) years. The entire spectrum of MMSE scores was converted to MoCA and MoCA-5 min using equipercentile method. Relationship between MMSE and MoCA scores was confounded by age and education, and a conversion equation with adjustment for age and education was derived. In the validation sample, the converted scores differentiated cognitively impaired patients with area under receiver operating characteristics curve 0.826 to 0.859. CONCLUSION We provided 2 methods to convert scores from the MMSE to MoCA and MoCA-5 min based on a large sample of patients with stroke or TIA having a wide range of education and cognitive levels. The converted scores differentiated patients with cognitive impairment after stroke or TIA with high accuracy.
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Affiliation(s)
- Adrian Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong
| | | | - Stanley Y P Yiu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Lisa W C Au
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong.,Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Alexander Y L Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Yannie O Y Soo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Anne Y Y Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Thomas W H Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Lawrence K S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Timothy C Y Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong
| | - Theodore C K Cheung
- Department of Clinical Psychology, Haven of Hope Hospital, Hong Kong.,Department of Psychology, University of Toronto at Scarborough, Canada
| | - Kam-Tat Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Bonnie Y K Lam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Joseph S K Kwan
- Department of Medicine, The University of Hong Kong, Hong Kong
| | - Vincent C T Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong.,Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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Charidimou A, Karayiannis C, Song TJ, Orken DN, Thijs V, Lemmens R, Kim J, Goh SM, Phan TG, Soufan C, Chandra RV, Slater LA, Haji S, Mok V, Horstmann S, Leung KT, Kawamura Y, Sato N, Hasebe N, Saito T, Wong LKS, Soo Y, Veltkamp R, Flemming KD, Imaizumi T, Srikanth V, Heo JH. Brain microbleeds, anticoagulation, and hemorrhage risk: Meta-analysis in stroke patients with AF. Neurology 2017; 89:2317-2326. [PMID: 29117953 DOI: 10.1212/wnl.0000000000004704] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 09/18/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To assess the association between cerebral microbleeds (CMBs) and future spontaneous intracerebral hemorrhage (ICH) risk in ischemic stroke patients with nonvalvular atrial fibrillation (AF) taking oral anticoagulants. METHODS This was a meta-analysis of cohort studies with >50 patients with recent ischemic stroke and documented AF, brain MRI at baseline, long-term oral anticoagulation treatment, and ≥6 months of follow-up. Authors provided summary-level data on stroke outcomes stratified by CMB status. We estimated pooled annualized ICH and ischemic stroke rates from Poisson regression. We calculated odds ratios (ORs) of ICH by CMB presence/absence, ≥5 CMBs, and CMB topography (strictly lobar, mixed, and strictly deep) using random-effects models. RESULTS We established an international collaboration and pooled data from 8 centers including 1,552 patients. The crude CMB prevalence was 30% and 7% for ≥5 CMBs. Baseline CMB presence (vs no CMB) was associated with ICH during follow-up (OR 2.68, 95% confidence interval [CI] 1.19-6.01, p = 0.017). Presence of ≥5 CMB was related to higher future ICH risk (OR 5.50, 95% CI 2.07-14.66, p = 0.001). The pooled annual ICH incidence increased from 0.30% (95% CI 0.04-0.55) among CMB-negative patients to 0.81% (95% CI 0.17-1.45) in CMB-positive patients (p = 0.01) and 2.48% (95% CI 1.2-6.2) in patients with ≥5 CMBs (p = 0.001). There was no association between CMBs and recurrent ischemic stroke. CONCLUSIONS The presence of CMB on MRI and the dichotomized cutoff of ≥5 CMBs might identify subgroups of ischemic stroke patients with AF with high ICH risk and after further validation could help in risk stratification, in anticoagulation decisions, and in guiding randomized trials and ongoing large observational studies.
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Affiliation(s)
- Andreas Charidimou
- From the J. Philip Kistler Stroke Research Center (A.C.), Department of Neurology, Massachusetts General Hospital; Harvard Medical School (A.C.), Boston, MA; META-MICROBLEEDS Initiative/Consortium (A.C.); Stroke and Ageing Research Centre (C.K., S.M.G., T.G.P., R.V.C., V.S.), Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Sisli Hamidiye Etfal Education and Research Hospital (D.N.O.), Department of Neurology, Istanbul, Turkey; Department of Neurology (V.T.), Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Neurology (J.K.), CHA Bundang Medical Centre, CHA University, Seongnam, Korea; Stroke Unit (T.G.P., V.S.), Neurosciences, and Neuroradiology Service (C.S., R.V.C., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Australia; Department of Neurology (S.H.), Mayo Clinic, Rochester, MN; Department of Medicine and Therapeutics (V.M., K.T.L., L.K.S.W., Y.S.), Chinese University of Hong Kong; Department of Neurology (S.H., R.V., T.I.), University of Heidelberg, Germany; Department of Internal Medicine (Y.K., N.S., N.H., T.S.), Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London, UK; Department of Neurosurgery (K.D.F.), Kushiro City General Hospital, Hokkaido, Japan; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology; University Hospitals Leuven (R.L.), Department of Neurology, Belgium; and Department of Neurology (T.-J.S.), College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Korea.
| | - Christopher Karayiannis
- From the J. Philip Kistler Stroke Research Center (A.C.), Department of Neurology, Massachusetts General Hospital; Harvard Medical School (A.C.), Boston, MA; META-MICROBLEEDS Initiative/Consortium (A.C.); Stroke and Ageing Research Centre (C.K., S.M.G., T.G.P., R.V.C., V.S.), Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Sisli Hamidiye Etfal Education and Research Hospital (D.N.O.), Department of Neurology, Istanbul, Turkey; Department of Neurology (V.T.), Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Neurology (J.K.), CHA Bundang Medical Centre, CHA University, Seongnam, Korea; Stroke Unit (T.G.P., V.S.), Neurosciences, and Neuroradiology Service (C.S., R.V.C., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Australia; Department of Neurology (S.H.), Mayo Clinic, Rochester, MN; Department of Medicine and Therapeutics (V.M., K.T.L., L.K.S.W., Y.S.), Chinese University of Hong Kong; Department of Neurology (S.H., R.V., T.I.), University of Heidelberg, Germany; Department of Internal Medicine (Y.K., N.S., N.H., T.S.), Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London, UK; Department of Neurosurgery (K.D.F.), Kushiro City General Hospital, Hokkaido, Japan; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology; University Hospitals Leuven (R.L.), Department of Neurology, Belgium; and Department of Neurology (T.-J.S.), College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Korea
| | - Tae-Jin Song
- From the J. Philip Kistler Stroke Research Center (A.C.), Department of Neurology, Massachusetts General Hospital; Harvard Medical School (A.C.), Boston, MA; META-MICROBLEEDS Initiative/Consortium (A.C.); Stroke and Ageing Research Centre (C.K., S.M.G., T.G.P., R.V.C., V.S.), Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Sisli Hamidiye Etfal Education and Research Hospital (D.N.O.), Department of Neurology, Istanbul, Turkey; Department of Neurology (V.T.), Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Neurology (J.K.), CHA Bundang Medical Centre, CHA University, Seongnam, Korea; Stroke Unit (T.G.P., V.S.), Neurosciences, and Neuroradiology Service (C.S., R.V.C., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Australia; Department of Neurology (S.H.), Mayo Clinic, Rochester, MN; Department of Medicine and Therapeutics (V.M., K.T.L., L.K.S.W., Y.S.), Chinese University of Hong Kong; Department of Neurology (S.H., R.V., T.I.), University of Heidelberg, Germany; Department of Internal Medicine (Y.K., N.S., N.H., T.S.), Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London, UK; Department of Neurosurgery (K.D.F.), Kushiro City General Hospital, Hokkaido, Japan; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology; University Hospitals Leuven (R.L.), Department of Neurology, Belgium; and Department of Neurology (T.-J.S.), College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Korea
| | - Dilek Necioglu Orken
- From the J. Philip Kistler Stroke Research Center (A.C.), Department of Neurology, Massachusetts General Hospital; Harvard Medical School (A.C.), Boston, MA; META-MICROBLEEDS Initiative/Consortium (A.C.); Stroke and Ageing Research Centre (C.K., S.M.G., T.G.P., R.V.C., V.S.), Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Sisli Hamidiye Etfal Education and Research Hospital (D.N.O.), Department of Neurology, Istanbul, Turkey; Department of Neurology (V.T.), Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Neurology (J.K.), CHA Bundang Medical Centre, CHA University, Seongnam, Korea; Stroke Unit (T.G.P., V.S.), Neurosciences, and Neuroradiology Service (C.S., R.V.C., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Australia; Department of Neurology (S.H.), Mayo Clinic, Rochester, MN; Department of Medicine and Therapeutics (V.M., K.T.L., L.K.S.W., Y.S.), Chinese University of Hong Kong; Department of Neurology (S.H., R.V., T.I.), University of Heidelberg, Germany; Department of Internal Medicine (Y.K., N.S., N.H., T.S.), Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London, UK; Department of Neurosurgery (K.D.F.), Kushiro City General Hospital, Hokkaido, Japan; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology; University Hospitals Leuven (R.L.), Department of Neurology, Belgium; and Department of Neurology (T.-J.S.), College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Korea
| | - Vincent Thijs
- From the J. Philip Kistler Stroke Research Center (A.C.), Department of Neurology, Massachusetts General Hospital; Harvard Medical School (A.C.), Boston, MA; META-MICROBLEEDS Initiative/Consortium (A.C.); Stroke and Ageing Research Centre (C.K., S.M.G., T.G.P., R.V.C., V.S.), Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Sisli Hamidiye Etfal Education and Research Hospital (D.N.O.), Department of Neurology, Istanbul, Turkey; Department of Neurology (V.T.), Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Neurology (J.K.), CHA Bundang Medical Centre, CHA University, Seongnam, Korea; Stroke Unit (T.G.P., V.S.), Neurosciences, and Neuroradiology Service (C.S., R.V.C., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Australia; Department of Neurology (S.H.), Mayo Clinic, Rochester, MN; Department of Medicine and Therapeutics (V.M., K.T.L., L.K.S.W., Y.S.), Chinese University of Hong Kong; Department of Neurology (S.H., R.V., T.I.), University of Heidelberg, Germany; Department of Internal Medicine (Y.K., N.S., N.H., T.S.), Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London, UK; Department of Neurosurgery (K.D.F.), Kushiro City General Hospital, Hokkaido, Japan; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology; University Hospitals Leuven (R.L.), Department of Neurology, Belgium; and Department of Neurology (T.-J.S.), College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Korea
| | - Robin Lemmens
- From the J. Philip Kistler Stroke Research Center (A.C.), Department of Neurology, Massachusetts General Hospital; Harvard Medical School (A.C.), Boston, MA; META-MICROBLEEDS Initiative/Consortium (A.C.); Stroke and Ageing Research Centre (C.K., S.M.G., T.G.P., R.V.C., V.S.), Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Sisli Hamidiye Etfal Education and Research Hospital (D.N.O.), Department of Neurology, Istanbul, Turkey; Department of Neurology (V.T.), Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Neurology (J.K.), CHA Bundang Medical Centre, CHA University, Seongnam, Korea; Stroke Unit (T.G.P., V.S.), Neurosciences, and Neuroradiology Service (C.S., R.V.C., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Australia; Department of Neurology (S.H.), Mayo Clinic, Rochester, MN; Department of Medicine and Therapeutics (V.M., K.T.L., L.K.S.W., Y.S.), Chinese University of Hong Kong; Department of Neurology (S.H., R.V., T.I.), University of Heidelberg, Germany; Department of Internal Medicine (Y.K., N.S., N.H., T.S.), Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London, UK; Department of Neurosurgery (K.D.F.), Kushiro City General Hospital, Hokkaido, Japan; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology; University Hospitals Leuven (R.L.), Department of Neurology, Belgium; and Department of Neurology (T.-J.S.), College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Korea
| | - Jinkwon Kim
- From the J. Philip Kistler Stroke Research Center (A.C.), Department of Neurology, Massachusetts General Hospital; Harvard Medical School (A.C.), Boston, MA; META-MICROBLEEDS Initiative/Consortium (A.C.); Stroke and Ageing Research Centre (C.K., S.M.G., T.G.P., R.V.C., V.S.), Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Sisli Hamidiye Etfal Education and Research Hospital (D.N.O.), Department of Neurology, Istanbul, Turkey; Department of Neurology (V.T.), Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Neurology (J.K.), CHA Bundang Medical Centre, CHA University, Seongnam, Korea; Stroke Unit (T.G.P., V.S.), Neurosciences, and Neuroradiology Service (C.S., R.V.C., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Australia; Department of Neurology (S.H.), Mayo Clinic, Rochester, MN; Department of Medicine and Therapeutics (V.M., K.T.L., L.K.S.W., Y.S.), Chinese University of Hong Kong; Department of Neurology (S.H., R.V., T.I.), University of Heidelberg, Germany; Department of Internal Medicine (Y.K., N.S., N.H., T.S.), Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London, UK; Department of Neurosurgery (K.D.F.), Kushiro City General Hospital, Hokkaido, Japan; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology; University Hospitals Leuven (R.L.), Department of Neurology, Belgium; and Department of Neurology (T.-J.S.), College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Korea
| | - Su Mei Goh
- From the J. Philip Kistler Stroke Research Center (A.C.), Department of Neurology, Massachusetts General Hospital; Harvard Medical School (A.C.), Boston, MA; META-MICROBLEEDS Initiative/Consortium (A.C.); Stroke and Ageing Research Centre (C.K., S.M.G., T.G.P., R.V.C., V.S.), Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Sisli Hamidiye Etfal Education and Research Hospital (D.N.O.), Department of Neurology, Istanbul, Turkey; Department of Neurology (V.T.), Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Neurology (J.K.), CHA Bundang Medical Centre, CHA University, Seongnam, Korea; Stroke Unit (T.G.P., V.S.), Neurosciences, and Neuroradiology Service (C.S., R.V.C., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Australia; Department of Neurology (S.H.), Mayo Clinic, Rochester, MN; Department of Medicine and Therapeutics (V.M., K.T.L., L.K.S.W., Y.S.), Chinese University of Hong Kong; Department of Neurology (S.H., R.V., T.I.), University of Heidelberg, Germany; Department of Internal Medicine (Y.K., N.S., N.H., T.S.), Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London, UK; Department of Neurosurgery (K.D.F.), Kushiro City General Hospital, Hokkaido, Japan; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology; University Hospitals Leuven (R.L.), Department of Neurology, Belgium; and Department of Neurology (T.-J.S.), College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Korea
| | - Thanh G Phan
- From the J. Philip Kistler Stroke Research Center (A.C.), Department of Neurology, Massachusetts General Hospital; Harvard Medical School (A.C.), Boston, MA; META-MICROBLEEDS Initiative/Consortium (A.C.); Stroke and Ageing Research Centre (C.K., S.M.G., T.G.P., R.V.C., V.S.), Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Sisli Hamidiye Etfal Education and Research Hospital (D.N.O.), Department of Neurology, Istanbul, Turkey; Department of Neurology (V.T.), Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Neurology (J.K.), CHA Bundang Medical Centre, CHA University, Seongnam, Korea; Stroke Unit (T.G.P., V.S.), Neurosciences, and Neuroradiology Service (C.S., R.V.C., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Australia; Department of Neurology (S.H.), Mayo Clinic, Rochester, MN; Department of Medicine and Therapeutics (V.M., K.T.L., L.K.S.W., Y.S.), Chinese University of Hong Kong; Department of Neurology (S.H., R.V., T.I.), University of Heidelberg, Germany; Department of Internal Medicine (Y.K., N.S., N.H., T.S.), Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London, UK; Department of Neurosurgery (K.D.F.), Kushiro City General Hospital, Hokkaido, Japan; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology; University Hospitals Leuven (R.L.), Department of Neurology, Belgium; and Department of Neurology (T.-J.S.), College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Korea
| | - Cathy Soufan
- From the J. Philip Kistler Stroke Research Center (A.C.), Department of Neurology, Massachusetts General Hospital; Harvard Medical School (A.C.), Boston, MA; META-MICROBLEEDS Initiative/Consortium (A.C.); Stroke and Ageing Research Centre (C.K., S.M.G., T.G.P., R.V.C., V.S.), Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Sisli Hamidiye Etfal Education and Research Hospital (D.N.O.), Department of Neurology, Istanbul, Turkey; Department of Neurology (V.T.), Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Neurology (J.K.), CHA Bundang Medical Centre, CHA University, Seongnam, Korea; Stroke Unit (T.G.P., V.S.), Neurosciences, and Neuroradiology Service (C.S., R.V.C., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Australia; Department of Neurology (S.H.), Mayo Clinic, Rochester, MN; Department of Medicine and Therapeutics (V.M., K.T.L., L.K.S.W., Y.S.), Chinese University of Hong Kong; Department of Neurology (S.H., R.V., T.I.), University of Heidelberg, Germany; Department of Internal Medicine (Y.K., N.S., N.H., T.S.), Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London, UK; Department of Neurosurgery (K.D.F.), Kushiro City General Hospital, Hokkaido, Japan; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology; University Hospitals Leuven (R.L.), Department of Neurology, Belgium; and Department of Neurology (T.-J.S.), College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Korea
| | - Ronil V Chandra
- From the J. Philip Kistler Stroke Research Center (A.C.), Department of Neurology, Massachusetts General Hospital; Harvard Medical School (A.C.), Boston, MA; META-MICROBLEEDS Initiative/Consortium (A.C.); Stroke and Ageing Research Centre (C.K., S.M.G., T.G.P., R.V.C., V.S.), Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Sisli Hamidiye Etfal Education and Research Hospital (D.N.O.), Department of Neurology, Istanbul, Turkey; Department of Neurology (V.T.), Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Neurology (J.K.), CHA Bundang Medical Centre, CHA University, Seongnam, Korea; Stroke Unit (T.G.P., V.S.), Neurosciences, and Neuroradiology Service (C.S., R.V.C., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Australia; Department of Neurology (S.H.), Mayo Clinic, Rochester, MN; Department of Medicine and Therapeutics (V.M., K.T.L., L.K.S.W., Y.S.), Chinese University of Hong Kong; Department of Neurology (S.H., R.V., T.I.), University of Heidelberg, Germany; Department of Internal Medicine (Y.K., N.S., N.H., T.S.), Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London, UK; Department of Neurosurgery (K.D.F.), Kushiro City General Hospital, Hokkaido, Japan; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology; University Hospitals Leuven (R.L.), Department of Neurology, Belgium; and Department of Neurology (T.-J.S.), College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Korea
| | - Lee-Anne Slater
- From the J. Philip Kistler Stroke Research Center (A.C.), Department of Neurology, Massachusetts General Hospital; Harvard Medical School (A.C.), Boston, MA; META-MICROBLEEDS Initiative/Consortium (A.C.); Stroke and Ageing Research Centre (C.K., S.M.G., T.G.P., R.V.C., V.S.), Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Sisli Hamidiye Etfal Education and Research Hospital (D.N.O.), Department of Neurology, Istanbul, Turkey; Department of Neurology (V.T.), Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Neurology (J.K.), CHA Bundang Medical Centre, CHA University, Seongnam, Korea; Stroke Unit (T.G.P., V.S.), Neurosciences, and Neuroradiology Service (C.S., R.V.C., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Australia; Department of Neurology (S.H.), Mayo Clinic, Rochester, MN; Department of Medicine and Therapeutics (V.M., K.T.L., L.K.S.W., Y.S.), Chinese University of Hong Kong; Department of Neurology (S.H., R.V., T.I.), University of Heidelberg, Germany; Department of Internal Medicine (Y.K., N.S., N.H., T.S.), Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London, UK; Department of Neurosurgery (K.D.F.), Kushiro City General Hospital, Hokkaido, Japan; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology; University Hospitals Leuven (R.L.), Department of Neurology, Belgium; and Department of Neurology (T.-J.S.), College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Korea
| | - Shamir Haji
- From the J. Philip Kistler Stroke Research Center (A.C.), Department of Neurology, Massachusetts General Hospital; Harvard Medical School (A.C.), Boston, MA; META-MICROBLEEDS Initiative/Consortium (A.C.); Stroke and Ageing Research Centre (C.K., S.M.G., T.G.P., R.V.C., V.S.), Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Sisli Hamidiye Etfal Education and Research Hospital (D.N.O.), Department of Neurology, Istanbul, Turkey; Department of Neurology (V.T.), Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Neurology (J.K.), CHA Bundang Medical Centre, CHA University, Seongnam, Korea; Stroke Unit (T.G.P., V.S.), Neurosciences, and Neuroradiology Service (C.S., R.V.C., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Australia; Department of Neurology (S.H.), Mayo Clinic, Rochester, MN; Department of Medicine and Therapeutics (V.M., K.T.L., L.K.S.W., Y.S.), Chinese University of Hong Kong; Department of Neurology (S.H., R.V., T.I.), University of Heidelberg, Germany; Department of Internal Medicine (Y.K., N.S., N.H., T.S.), Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London, UK; Department of Neurosurgery (K.D.F.), Kushiro City General Hospital, Hokkaido, Japan; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology; University Hospitals Leuven (R.L.), Department of Neurology, Belgium; and Department of Neurology (T.-J.S.), College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Korea
| | - Vincent Mok
- From the J. Philip Kistler Stroke Research Center (A.C.), Department of Neurology, Massachusetts General Hospital; Harvard Medical School (A.C.), Boston, MA; META-MICROBLEEDS Initiative/Consortium (A.C.); Stroke and Ageing Research Centre (C.K., S.M.G., T.G.P., R.V.C., V.S.), Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Sisli Hamidiye Etfal Education and Research Hospital (D.N.O.), Department of Neurology, Istanbul, Turkey; Department of Neurology (V.T.), Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Neurology (J.K.), CHA Bundang Medical Centre, CHA University, Seongnam, Korea; Stroke Unit (T.G.P., V.S.), Neurosciences, and Neuroradiology Service (C.S., R.V.C., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Australia; Department of Neurology (S.H.), Mayo Clinic, Rochester, MN; Department of Medicine and Therapeutics (V.M., K.T.L., L.K.S.W., Y.S.), Chinese University of Hong Kong; Department of Neurology (S.H., R.V., T.I.), University of Heidelberg, Germany; Department of Internal Medicine (Y.K., N.S., N.H., T.S.), Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London, UK; Department of Neurosurgery (K.D.F.), Kushiro City General Hospital, Hokkaido, Japan; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology; University Hospitals Leuven (R.L.), Department of Neurology, Belgium; and Department of Neurology (T.-J.S.), College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Korea
| | - Solveig Horstmann
- From the J. Philip Kistler Stroke Research Center (A.C.), Department of Neurology, Massachusetts General Hospital; Harvard Medical School (A.C.), Boston, MA; META-MICROBLEEDS Initiative/Consortium (A.C.); Stroke and Ageing Research Centre (C.K., S.M.G., T.G.P., R.V.C., V.S.), Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Sisli Hamidiye Etfal Education and Research Hospital (D.N.O.), Department of Neurology, Istanbul, Turkey; Department of Neurology (V.T.), Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Neurology (J.K.), CHA Bundang Medical Centre, CHA University, Seongnam, Korea; Stroke Unit (T.G.P., V.S.), Neurosciences, and Neuroradiology Service (C.S., R.V.C., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Australia; Department of Neurology (S.H.), Mayo Clinic, Rochester, MN; Department of Medicine and Therapeutics (V.M., K.T.L., L.K.S.W., Y.S.), Chinese University of Hong Kong; Department of Neurology (S.H., R.V., T.I.), University of Heidelberg, Germany; Department of Internal Medicine (Y.K., N.S., N.H., T.S.), Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London, UK; Department of Neurosurgery (K.D.F.), Kushiro City General Hospital, Hokkaido, Japan; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology; University Hospitals Leuven (R.L.), Department of Neurology, Belgium; and Department of Neurology (T.-J.S.), College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Korea
| | - Kam Tat Leung
- From the J. Philip Kistler Stroke Research Center (A.C.), Department of Neurology, Massachusetts General Hospital; Harvard Medical School (A.C.), Boston, MA; META-MICROBLEEDS Initiative/Consortium (A.C.); Stroke and Ageing Research Centre (C.K., S.M.G., T.G.P., R.V.C., V.S.), Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Sisli Hamidiye Etfal Education and Research Hospital (D.N.O.), Department of Neurology, Istanbul, Turkey; Department of Neurology (V.T.), Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Neurology (J.K.), CHA Bundang Medical Centre, CHA University, Seongnam, Korea; Stroke Unit (T.G.P., V.S.), Neurosciences, and Neuroradiology Service (C.S., R.V.C., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Australia; Department of Neurology (S.H.), Mayo Clinic, Rochester, MN; Department of Medicine and Therapeutics (V.M., K.T.L., L.K.S.W., Y.S.), Chinese University of Hong Kong; Department of Neurology (S.H., R.V., T.I.), University of Heidelberg, Germany; Department of Internal Medicine (Y.K., N.S., N.H., T.S.), Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London, UK; Department of Neurosurgery (K.D.F.), Kushiro City General Hospital, Hokkaido, Japan; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology; University Hospitals Leuven (R.L.), Department of Neurology, Belgium; and Department of Neurology (T.-J.S.), College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Korea
| | - Yuichiro Kawamura
- From the J. Philip Kistler Stroke Research Center (A.C.), Department of Neurology, Massachusetts General Hospital; Harvard Medical School (A.C.), Boston, MA; META-MICROBLEEDS Initiative/Consortium (A.C.); Stroke and Ageing Research Centre (C.K., S.M.G., T.G.P., R.V.C., V.S.), Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Sisli Hamidiye Etfal Education and Research Hospital (D.N.O.), Department of Neurology, Istanbul, Turkey; Department of Neurology (V.T.), Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Neurology (J.K.), CHA Bundang Medical Centre, CHA University, Seongnam, Korea; Stroke Unit (T.G.P., V.S.), Neurosciences, and Neuroradiology Service (C.S., R.V.C., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Australia; Department of Neurology (S.H.), Mayo Clinic, Rochester, MN; Department of Medicine and Therapeutics (V.M., K.T.L., L.K.S.W., Y.S.), Chinese University of Hong Kong; Department of Neurology (S.H., R.V., T.I.), University of Heidelberg, Germany; Department of Internal Medicine (Y.K., N.S., N.H., T.S.), Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London, UK; Department of Neurosurgery (K.D.F.), Kushiro City General Hospital, Hokkaido, Japan; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology; University Hospitals Leuven (R.L.), Department of Neurology, Belgium; and Department of Neurology (T.-J.S.), College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Korea
| | - Nobuyuki Sato
- From the J. Philip Kistler Stroke Research Center (A.C.), Department of Neurology, Massachusetts General Hospital; Harvard Medical School (A.C.), Boston, MA; META-MICROBLEEDS Initiative/Consortium (A.C.); Stroke and Ageing Research Centre (C.K., S.M.G., T.G.P., R.V.C., V.S.), Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Sisli Hamidiye Etfal Education and Research Hospital (D.N.O.), Department of Neurology, Istanbul, Turkey; Department of Neurology (V.T.), Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Neurology (J.K.), CHA Bundang Medical Centre, CHA University, Seongnam, Korea; Stroke Unit (T.G.P., V.S.), Neurosciences, and Neuroradiology Service (C.S., R.V.C., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Australia; Department of Neurology (S.H.), Mayo Clinic, Rochester, MN; Department of Medicine and Therapeutics (V.M., K.T.L., L.K.S.W., Y.S.), Chinese University of Hong Kong; Department of Neurology (S.H., R.V., T.I.), University of Heidelberg, Germany; Department of Internal Medicine (Y.K., N.S., N.H., T.S.), Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London, UK; Department of Neurosurgery (K.D.F.), Kushiro City General Hospital, Hokkaido, Japan; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology; University Hospitals Leuven (R.L.), Department of Neurology, Belgium; and Department of Neurology (T.-J.S.), College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Korea
| | - Naoyuki Hasebe
- From the J. Philip Kistler Stroke Research Center (A.C.), Department of Neurology, Massachusetts General Hospital; Harvard Medical School (A.C.), Boston, MA; META-MICROBLEEDS Initiative/Consortium (A.C.); Stroke and Ageing Research Centre (C.K., S.M.G., T.G.P., R.V.C., V.S.), Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Sisli Hamidiye Etfal Education and Research Hospital (D.N.O.), Department of Neurology, Istanbul, Turkey; Department of Neurology (V.T.), Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Neurology (J.K.), CHA Bundang Medical Centre, CHA University, Seongnam, Korea; Stroke Unit (T.G.P., V.S.), Neurosciences, and Neuroradiology Service (C.S., R.V.C., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Australia; Department of Neurology (S.H.), Mayo Clinic, Rochester, MN; Department of Medicine and Therapeutics (V.M., K.T.L., L.K.S.W., Y.S.), Chinese University of Hong Kong; Department of Neurology (S.H., R.V., T.I.), University of Heidelberg, Germany; Department of Internal Medicine (Y.K., N.S., N.H., T.S.), Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London, UK; Department of Neurosurgery (K.D.F.), Kushiro City General Hospital, Hokkaido, Japan; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology; University Hospitals Leuven (R.L.), Department of Neurology, Belgium; and Department of Neurology (T.-J.S.), College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Korea
| | - Tsukasa Saito
- From the J. Philip Kistler Stroke Research Center (A.C.), Department of Neurology, Massachusetts General Hospital; Harvard Medical School (A.C.), Boston, MA; META-MICROBLEEDS Initiative/Consortium (A.C.); Stroke and Ageing Research Centre (C.K., S.M.G., T.G.P., R.V.C., V.S.), Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Sisli Hamidiye Etfal Education and Research Hospital (D.N.O.), Department of Neurology, Istanbul, Turkey; Department of Neurology (V.T.), Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Neurology (J.K.), CHA Bundang Medical Centre, CHA University, Seongnam, Korea; Stroke Unit (T.G.P., V.S.), Neurosciences, and Neuroradiology Service (C.S., R.V.C., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Australia; Department of Neurology (S.H.), Mayo Clinic, Rochester, MN; Department of Medicine and Therapeutics (V.M., K.T.L., L.K.S.W., Y.S.), Chinese University of Hong Kong; Department of Neurology (S.H., R.V., T.I.), University of Heidelberg, Germany; Department of Internal Medicine (Y.K., N.S., N.H., T.S.), Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London, UK; Department of Neurosurgery (K.D.F.), Kushiro City General Hospital, Hokkaido, Japan; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology; University Hospitals Leuven (R.L.), Department of Neurology, Belgium; and Department of Neurology (T.-J.S.), College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Korea
| | - Lawrence K S Wong
- From the J. Philip Kistler Stroke Research Center (A.C.), Department of Neurology, Massachusetts General Hospital; Harvard Medical School (A.C.), Boston, MA; META-MICROBLEEDS Initiative/Consortium (A.C.); Stroke and Ageing Research Centre (C.K., S.M.G., T.G.P., R.V.C., V.S.), Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Sisli Hamidiye Etfal Education and Research Hospital (D.N.O.), Department of Neurology, Istanbul, Turkey; Department of Neurology (V.T.), Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Neurology (J.K.), CHA Bundang Medical Centre, CHA University, Seongnam, Korea; Stroke Unit (T.G.P., V.S.), Neurosciences, and Neuroradiology Service (C.S., R.V.C., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Australia; Department of Neurology (S.H.), Mayo Clinic, Rochester, MN; Department of Medicine and Therapeutics (V.M., K.T.L., L.K.S.W., Y.S.), Chinese University of Hong Kong; Department of Neurology (S.H., R.V., T.I.), University of Heidelberg, Germany; Department of Internal Medicine (Y.K., N.S., N.H., T.S.), Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London, UK; Department of Neurosurgery (K.D.F.), Kushiro City General Hospital, Hokkaido, Japan; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology; University Hospitals Leuven (R.L.), Department of Neurology, Belgium; and Department of Neurology (T.-J.S.), College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Korea
| | - Yannie Soo
- From the J. Philip Kistler Stroke Research Center (A.C.), Department of Neurology, Massachusetts General Hospital; Harvard Medical School (A.C.), Boston, MA; META-MICROBLEEDS Initiative/Consortium (A.C.); Stroke and Ageing Research Centre (C.K., S.M.G., T.G.P., R.V.C., V.S.), Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Sisli Hamidiye Etfal Education and Research Hospital (D.N.O.), Department of Neurology, Istanbul, Turkey; Department of Neurology (V.T.), Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Neurology (J.K.), CHA Bundang Medical Centre, CHA University, Seongnam, Korea; Stroke Unit (T.G.P., V.S.), Neurosciences, and Neuroradiology Service (C.S., R.V.C., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Australia; Department of Neurology (S.H.), Mayo Clinic, Rochester, MN; Department of Medicine and Therapeutics (V.M., K.T.L., L.K.S.W., Y.S.), Chinese University of Hong Kong; Department of Neurology (S.H., R.V., T.I.), University of Heidelberg, Germany; Department of Internal Medicine (Y.K., N.S., N.H., T.S.), Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London, UK; Department of Neurosurgery (K.D.F.), Kushiro City General Hospital, Hokkaido, Japan; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology; University Hospitals Leuven (R.L.), Department of Neurology, Belgium; and Department of Neurology (T.-J.S.), College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Korea
| | - Roland Veltkamp
- From the J. Philip Kistler Stroke Research Center (A.C.), Department of Neurology, Massachusetts General Hospital; Harvard Medical School (A.C.), Boston, MA; META-MICROBLEEDS Initiative/Consortium (A.C.); Stroke and Ageing Research Centre (C.K., S.M.G., T.G.P., R.V.C., V.S.), Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Sisli Hamidiye Etfal Education and Research Hospital (D.N.O.), Department of Neurology, Istanbul, Turkey; Department of Neurology (V.T.), Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Neurology (J.K.), CHA Bundang Medical Centre, CHA University, Seongnam, Korea; Stroke Unit (T.G.P., V.S.), Neurosciences, and Neuroradiology Service (C.S., R.V.C., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Australia; Department of Neurology (S.H.), Mayo Clinic, Rochester, MN; Department of Medicine and Therapeutics (V.M., K.T.L., L.K.S.W., Y.S.), Chinese University of Hong Kong; Department of Neurology (S.H., R.V., T.I.), University of Heidelberg, Germany; Department of Internal Medicine (Y.K., N.S., N.H., T.S.), Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London, UK; Department of Neurosurgery (K.D.F.), Kushiro City General Hospital, Hokkaido, Japan; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology; University Hospitals Leuven (R.L.), Department of Neurology, Belgium; and Department of Neurology (T.-J.S.), College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Korea
| | - Kelly D Flemming
- From the J. Philip Kistler Stroke Research Center (A.C.), Department of Neurology, Massachusetts General Hospital; Harvard Medical School (A.C.), Boston, MA; META-MICROBLEEDS Initiative/Consortium (A.C.); Stroke and Ageing Research Centre (C.K., S.M.G., T.G.P., R.V.C., V.S.), Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Sisli Hamidiye Etfal Education and Research Hospital (D.N.O.), Department of Neurology, Istanbul, Turkey; Department of Neurology (V.T.), Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Neurology (J.K.), CHA Bundang Medical Centre, CHA University, Seongnam, Korea; Stroke Unit (T.G.P., V.S.), Neurosciences, and Neuroradiology Service (C.S., R.V.C., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Australia; Department of Neurology (S.H.), Mayo Clinic, Rochester, MN; Department of Medicine and Therapeutics (V.M., K.T.L., L.K.S.W., Y.S.), Chinese University of Hong Kong; Department of Neurology (S.H., R.V., T.I.), University of Heidelberg, Germany; Department of Internal Medicine (Y.K., N.S., N.H., T.S.), Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London, UK; Department of Neurosurgery (K.D.F.), Kushiro City General Hospital, Hokkaido, Japan; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology; University Hospitals Leuven (R.L.), Department of Neurology, Belgium; and Department of Neurology (T.-J.S.), College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Korea
| | - Toshio Imaizumi
- From the J. Philip Kistler Stroke Research Center (A.C.), Department of Neurology, Massachusetts General Hospital; Harvard Medical School (A.C.), Boston, MA; META-MICROBLEEDS Initiative/Consortium (A.C.); Stroke and Ageing Research Centre (C.K., S.M.G., T.G.P., R.V.C., V.S.), Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Sisli Hamidiye Etfal Education and Research Hospital (D.N.O.), Department of Neurology, Istanbul, Turkey; Department of Neurology (V.T.), Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Neurology (J.K.), CHA Bundang Medical Centre, CHA University, Seongnam, Korea; Stroke Unit (T.G.P., V.S.), Neurosciences, and Neuroradiology Service (C.S., R.V.C., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Australia; Department of Neurology (S.H.), Mayo Clinic, Rochester, MN; Department of Medicine and Therapeutics (V.M., K.T.L., L.K.S.W., Y.S.), Chinese University of Hong Kong; Department of Neurology (S.H., R.V., T.I.), University of Heidelberg, Germany; Department of Internal Medicine (Y.K., N.S., N.H., T.S.), Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London, UK; Department of Neurosurgery (K.D.F.), Kushiro City General Hospital, Hokkaido, Japan; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology; University Hospitals Leuven (R.L.), Department of Neurology, Belgium; and Department of Neurology (T.-J.S.), College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Korea
| | - Velandai Srikanth
- From the J. Philip Kistler Stroke Research Center (A.C.), Department of Neurology, Massachusetts General Hospital; Harvard Medical School (A.C.), Boston, MA; META-MICROBLEEDS Initiative/Consortium (A.C.); Stroke and Ageing Research Centre (C.K., S.M.G., T.G.P., R.V.C., V.S.), Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Sisli Hamidiye Etfal Education and Research Hospital (D.N.O.), Department of Neurology, Istanbul, Turkey; Department of Neurology (V.T.), Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Neurology (J.K.), CHA Bundang Medical Centre, CHA University, Seongnam, Korea; Stroke Unit (T.G.P., V.S.), Neurosciences, and Neuroradiology Service (C.S., R.V.C., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Australia; Department of Neurology (S.H.), Mayo Clinic, Rochester, MN; Department of Medicine and Therapeutics (V.M., K.T.L., L.K.S.W., Y.S.), Chinese University of Hong Kong; Department of Neurology (S.H., R.V., T.I.), University of Heidelberg, Germany; Department of Internal Medicine (Y.K., N.S., N.H., T.S.), Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London, UK; Department of Neurosurgery (K.D.F.), Kushiro City General Hospital, Hokkaido, Japan; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology; University Hospitals Leuven (R.L.), Department of Neurology, Belgium; and Department of Neurology (T.-J.S.), College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Korea
| | - Ji Hoe Heo
- From the J. Philip Kistler Stroke Research Center (A.C.), Department of Neurology, Massachusetts General Hospital; Harvard Medical School (A.C.), Boston, MA; META-MICROBLEEDS Initiative/Consortium (A.C.); Stroke and Ageing Research Centre (C.K., S.M.G., T.G.P., R.V.C., V.S.), Department of Medicine, School for Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology (J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Sisli Hamidiye Etfal Education and Research Hospital (D.N.O.), Department of Neurology, Istanbul, Turkey; Department of Neurology (V.T.), Austin Health and Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia; Department of Neurology (J.K.), CHA Bundang Medical Centre, CHA University, Seongnam, Korea; Stroke Unit (T.G.P., V.S.), Neurosciences, and Neuroradiology Service (C.S., R.V.C., L.-A.S.), Monash Imaging, Monash Health, Melbourne, Australia; Department of Neurology (S.H.), Mayo Clinic, Rochester, MN; Department of Medicine and Therapeutics (V.M., K.T.L., L.K.S.W., Y.S.), Chinese University of Hong Kong; Department of Neurology (S.H., R.V., T.I.), University of Heidelberg, Germany; Department of Internal Medicine (Y.K., N.S., N.H., T.S.), Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Japan; Department of Stroke Medicine (R.V.), Division of Brain Sciences, Imperial College London, UK; Department of Neurosurgery (K.D.F.), Kushiro City General Hospital, Hokkaido, Japan; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease; VIB (R.L.), Vesalius Research Center, Laboratory of Neurobiology; University Hospitals Leuven (R.L.), Department of Neurology, Belgium; and Department of Neurology (T.-J.S.), College of Medicine, Ewha Woman's University, Yangcheon-gu, Seoul, Korea
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Leng X, Lan L, Ip VHL, Liu H, Abrigo J, Liebeskind DS, Wong LKS, Leung TW. Noninvasive fractional flow in intracranial atherosclerotic stenosis: Reproducibility, limitations, and perspectives. J Neurol Sci 2017; 381:150-152. [PMID: 28991669 DOI: 10.1016/j.jns.2017.08.3239] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 07/28/2017] [Accepted: 08/21/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Xinyi Leng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, China
| | - Linfang Lan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, China
| | - Vincent H L Ip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, China
| | - Haipeng Liu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, China
| | - Jill Abrigo
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, China
| | - David S Liebeskind
- Neurovascular Imaging Research Core, Department of Neurology, University of California, Los Angeles, CA, USA
| | - Lawrence K S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, China
| | - Thomas W Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, China.
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Pu Y, Wei N, Yu D, Wang Y, Zou X, Soo YOY, Pan Y, Leung TWH, Wong LKS, Wang Y, Liu L. Sex Differences Do Not Exist in Outcomes among Stroke Patients with Intracranial Atherosclerosis in China: Subgroup Analysis from the Chinese Intracranial Atherosclerosis Study. Neuroepidemiology 2017; 48:48-54. [PMID: 28334718 DOI: 10.1159/000469717] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 08/21/2016] [Accepted: 03/10/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To date, sex difference in outcomes among patients with intracranial atherosclerosis (ICAS) has rarely been discussed in China as well as in the world. This study aimed to estimate the sex difference in outcomes among patients with ICAS in Chinese cerebral ischemia patients. METHODS We analyzed 1,335 men and women with ICAS who were enrolled in the Chinese Intracranial Atherosclerosis study. They were followed-up for ischemic stroke recurrence, any cause of death, cerebral vascular events (including transient ischemic attack, ischemic and hemorrhagic stroke), combined end points (including cerebral vascular events, angina or myocardial infarction, pulmonary embolism, peripheral vascular events), and unfavorable outcome (modified Rankin scale score of 3-6) at 1 year. RESULTS During the follow-up period, 59 (13.44%) combined end points were documented in women and 107 (11.94%) in men. Of the combined end points, 47 were recurrent ischemic stroke events (14 in women and 33 in men), and 51 other causes of deaths (24 in women and 27 in men). There were 349 unfavorable end points (117 in women and 232 in men). The cumulative probability of death was higher in women, but after adjusting for age, diabetes mellitus, hypertension, family history of stroke, current smoker, heavy drinking, hyperhomocysteinemia, and heart disease, there was no significant difference. There was also a lack of difference in 1-year ischemic stroke recurrence, cerebral vascular events, combined end points, and unfavorable outcome between women and men at 1 year. CONCLUSIONS These results suggest no sex difference in outcome among patients with ICAS in Chinese cerebral ischemia patients.
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Affiliation(s)
- Yuehua Pu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, SAR, China
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15
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Wong A, Lau AYL, Yang J, Wang Z, Liu W, Lam BYK, Au L, Shi L, Wang D, Chu WCW, Xiong YY, Lo ESK, Law LSN, Leung TWH, Lam LCW, Chan AYY, Soo YOY, Leung EYL, Wong LKS, Mok VCT. Neuropsychiatric Symptom Clusters in Stroke and Transient Ischemic Attack by Cognitive Status and Stroke Subtype: Frequency and Relationships with Vascular Lesions, Brain Atrophy and Amyloid. PLoS One 2016; 11:e0162846. [PMID: 27632159 PMCID: PMC5025073 DOI: 10.1371/journal.pone.0162846] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 08/29/2016] [Indexed: 02/01/2023] Open
Abstract
Background The objectives of this study are 1) to examine the frequencies of neuropsychiatric symptom clusters in patients with stroke or transient ischemic attack (TIA) by cognitive level and stroke subtype; and 2) to evaluate effect of demographic, clinical, and neuroimaging measures of chronic brain changes and amyloid upon neuropsychiatric symptom clusters. Methods Hospital-based, cross-sectional study. 518 patients were administered the Neuropsychiatric Inventory (NPI) 3–6 months post index admission. NPI symptoms were classified into four symptom clusters (Behavioral Problems, Psychosis, Mood Disturbance & Euphoria) derived from a confirmatory factor analysis of the 12 NPI items. Multivariable logistic regression was used to determine independent associations between demographic, clinical and neuroimaging measures of chronic brain changes (white matter changes, old infarcts, whole brain atrophy, medial temporal lobe atrophy [MTLA] and frontal lobe atrophy [FLA]) with the presence of NPI symptoms and all symptom clusters except euphoria. 11C-Pittsburg Compound B Positron Emission Tomography (11C-PiB PET) was performed in 24 patients to measure amyloid retention for Alzheimer’s Disease (AD) pathology. Results 50.6% of the whole sample, including 28.7% cognitively normal and 66.7% of patients with mild cognitive symptoms, had ≥1 NPI symptoms. Frequencies of symptom clusters were largely similar between stroke subtypes. Compared to patients with cardioembolic stroke and intracranial haemorrhage, those with TIA had less frequent mood disturbance. Stroke severity at admission and MTLA were the most robust correlates of symptoms. FLA was associated with behavioral problems cluster only. Frequency of symptom clusters did not differ between patients with and without significant amyloid retention. Conclusion Frequency of neuropsychiatric symptoms increased with level of cognitive impairment but was largely similar between stroke subtypes. Stroke severity and MTLA were associated with neuropsychiatric symptoms. AD pathology appeared to be unrelated to neuropsychiatric manifestations but further studies with larger sample size are required to substantiate this finding.
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Affiliation(s)
- Adrian Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Alexander Y. L. Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Jie Yang
- Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University and Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and Ministry of Education of China, Guangzhou, 510260, China
| | - Zhaolu Wang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Wenyan Liu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Bonnie Y. K. Lam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Lisa Au
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Lin Shi
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Defeng Wang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Winnie C. W. Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Yun-yun Xiong
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Eugene S. K. Lo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Lorraine S. N. Law
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas W. H. Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Linda C. W. Lam
- Department of Psychiatry, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Anne Y. Y. Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Yannie O. Y. Soo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Eric Y. L. Leung
- Department of Nuclear Medicine, Hong Kong Sanatorium and Hospital, Hong Kong, China
| | - Lawrence K. S. Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent C. T. Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
- * E-mail:
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16
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Wong A, Lau AYL, Lo E, Tang M, Wang Z, Liu W, Tanner N, Chau N, Law L, Shi L, Chu WCW, Yang J, Xiong YY, Lam BYK, Au L, Chan AYY, Soo Y, Leung TWH, Wong LKS, Lam LCW, Mok VCT. Relations between Recent Past Leisure Activities with Risks of Dementia and Cognitive Functions after Stroke. PLoS One 2016; 11:e0159952. [PMID: 27454124 PMCID: PMC4959678 DOI: 10.1371/journal.pone.0159952] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 07/11/2016] [Indexed: 11/22/2022] Open
Abstract
Background Leisure activity participation has been shown to lower risks of cognitive decline in non-stroke populations. However, effects of leisure activities participation upon cognitive functions and risk of dementia after stroke are unclear. The purpose of this study is to examine the effects of recent past leisure activities participation upon cognitive functions and risk of incident dementia after stroke. Methods Hospital-based, retrospective cohort study. 88 of 1,013 patients with stroke or TIA having no prestroke dementia were diagnosed to have incident poststroke dementia (PSD) 3–6 months after stroke. Regular participation (≥3 times per week) in intellectual, recreational, social and physical activities over the year before the index stroke was retrospectively recorded at 3–6 months after stroke. Results Logistic regression analyses showed that regular participation in intellectual (RR 0.36, 95%CI 0.20–0.63) and stretching & toning physical exercise (0.37, 0.21–0.64) was significantly associated with a reduced risk of PSD after controlling for age, education, prestroke cognitive decline, stroke subtype, prior strokes and chronic brain changes including white matter changes, old infarcts and global atrophy. Results were similar in patients with past strokes in unadjusted models. Participation in increased number of activities in general (r = 0.41, p<0.01) and in intellectual (r = 0.40, p<0.01), recreational (r = 0.24, p<0.01), strenuous aerobic (r = 0.23, p<0.01) and mind-body (r = 0.10, p<0.01) activities was associated with higher poststroke Mini-mental State Examination scores in models adjusted for prestroke cognitive decline. Conclusions Regular participation in intellectual activities and stretching & toning exercise was associated with a significantly reduced short-term risk of PSD in patients with and without recurrent strokes. Participation in greater number of recent past leisure activities was associated with better poststroke cognitive performance. Findings of this retrospective cohort study call for studies of activity intervention for prevention of cognitive decline in individuals at elevated risk of stroke.
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Affiliation(s)
- Adrian Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Alexander Y. L. Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Eugene Lo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Michael Tang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Zhaolu Wang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Wenyan Liu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Nicole Tanner
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Natalie Chau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Lorraine Law
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Lin Shi
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Winnie C. W. Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Jie Yang
- Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University and Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and Ministry of Education of China, Guangzhou, China
| | - Yun-yun Xiong
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Bonnie Y. K. Lam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Lisa Au
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Anne Y. Y. Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Yannie Soo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas W. H. Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Lawrence K. S. Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Linda C. W. Lam
- Department of Psychiatry, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent C. T. Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
- * E-mail:
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Mok VCT, Lam BYK, Wang Z, Liu W, Au L, Leung EYL, Chen S, Yang J, Chu WCW, Lau AYL, Chan AYY, Shi L, Fan F, Ma SH, Ip V, Soo YOY, Leung TWH, Kwok TCY, Ho CL, Wong LKS, Wong A. Delayed-onset dementia after stroke or transient ischemic attack. Alzheimers Dement 2016; 12:1167-1176. [PMID: 27327542 DOI: 10.1016/j.jalz.2016.05.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [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: 12/02/2015] [Revised: 05/11/2016] [Accepted: 05/22/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Patients surviving stroke without immediate dementia are at high risk of delayed-onset dementia. Mechanisms underlying delayed-onset dementia are complex and may involve vascular and/or neurodegenerative diseases. METHODS Dementia-free patients with stroke and/or transient ischemic attack (TIA; n = 919) were studied for 3 years prospectively, excluding those who developed dementia 3 to 6 months after stroke and/or TIA. RESULTS Forty subjects (4.4%) developed dementia during the study period. Imaging markers of severe small vessel disease (SVD), namely presence of ≥3 lacunes and confluent white matter changes; history of hypertension and diabetes mellitus independently predicted delayed-onset dementia after adjustment for age, gender, and education. Only 6 of 31 (19.4%) subjects with delayed cognitive decline harbored Alzheimer's disease-like Pittsburg compound B (PiB) retention. Most PiB cases (16/25, 64%) had evidence of severe SVD. DISCUSSION Severe SVD contributes importantly to delayed-onset dementia after stroke and/or TIA. Future clinical trials aiming to prevent delayed-onset dementia after stroke and/or TIA should target this high-risk group.
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Affiliation(s)
- Vincent C T Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, Hong Kong SAR, China
| | - Bonnie Y K Lam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, Hong Kong SAR, China
| | - Zhaolu Wang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wenyan Liu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lisa Au
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Eric Y L Leung
- Department of Nuclear Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China
| | - Sirong Chen
- Department of Nuclear Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China
| | - Jie Yang
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Winnie C W Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Alexander Y L Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Anne Y Y Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lin Shi
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Florence Fan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sze H Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Vincent Ip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yannie O Y Soo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Thomas W H Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Timothy C Y Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chi L Ho
- Department of Nuclear Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China
| | - Lawrence K S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Adrian Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, Hong Kong SAR, China.
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Wong A, Wang D, Black SE, Nyenhuis DL, Shi L, Chu WCW, Xiong YY, Au L, Lau A, Chan AYY, Wong LKS, Mok V. Volumetric magnetic resonance imaging correlates of the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network vascular cognitive impairment neuropsychology protocols. J Clin Exp Neuropsychol 2016; 37:1004-12. [PMID: 26332179 DOI: 10.1080/13803395.2015.1038983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 12/17/2022]
Abstract
BACKGROUND Vascular cognitive impairment (VCI) refers to the entire spectrum of cognitive dysfunction attributable to vascular changes in the brain. The objective of this study is to evaluate magnetic resonance imaging (MRI) correlates of performance on the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network (NINDS-CSN) VCI neuropsychology protocols. METHOD Fifty ischemic stroke patients and 50 normal elderly persons completed the VCI protocols and MRI. Relationships between the four cognitive domains (executive/activation, language, visuospatial, and memory) and three protocol (60-, 30-, and 5-min) summary scores with MRI measures of volumes of white matter hyperintensities (WMH) and global brain and hippocampal atrophy were assessed using linear regression. RESULTS All cognitive domain scores were associated with WMH volume and, with the exception of language domain, with global atrophy. Additional relationships were found between executive/activation and language domains with left hippocampal volume, visuospatial domain with right hippocampal volume, and memory domain with bilateral hippocampal volumes. All protocol summary scores showed comparable relationships with WMH and hippocampal volumes, with additional relationships found between the 60- and 30-min protocols with global brain volume. CONCLUSIONS Performance on the NINDS-CSN VCI protocols reflects underlying volumetric brain changes implicated in cognitive dysfunctions in VCI.
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Affiliation(s)
- Adrian Wong
- a Department of Medicine and Therapeutics , Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong , Shatin , Hong Kong SAR , China
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Lan L, Leng X, Abrigo J, Fang H, Ip VHL, Soo YOY, Leung TWH, Yu SCH, Wong LKS. Diminished Signal Intensities Distal to Intracranial Arterial Stenosis on Time-of-Flight MR Angiography Might Indicate Delayed Cerebral Perfusion. Cerebrovasc Dis 2016; 42:232-9. [PMID: 27173386 DOI: 10.1159/000445842] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 03/29/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intracranial arterial stenosis (ICAS) is a predominant cause of ischemic stroke in Asia. Changes in the signal intensities (SIs) across ICAS lesions on time-of-flight magnetic resonance angiography (TOF-MRA) have been indicated to partially reflect the hemodynamic significance of the lesions, which we aimed to verify by correlating it with cerebral perfusion features provided by CT perfusion (CTP) imaging. METHODS Ischemic stroke or transient ischemic attack patients with unilateral symptomatic stenosis (≥50%) of intracranial internal carotid artery or middle cerebral artery (MCA) were included in this study. Change of SIs across an ICAS lesion on TOF-MRA was calculated by the distal and proximal SI ratio (SIR). Cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT) within the MCA territory of ipsilateral and contralateral hemispheres were evaluated on the CTP images at the basal ganglia level. Relative CBV, CBF and MTT were defined as ratios of the values obtained from ipsilateral and contralateral hemispheres. The relationships between SIR and CTP parameters were analyzed. RESULTS Fifty subjects (74% male, mean age 62) were recruited. Overall, the mean SIR was 0.77 ± 0.17. SIR of ICAS was significantly, linearly and negatively correlated with ipsilateral CBV (r = -0.335, p = 0.017), ipsilateral MTT (r = -0.301, p = 0.034), and ipsilateral/contralateral MTT ratio (r = -0.443, p = 0.001). CONCLUSIONS Diminished SIs distal to ICAS on TOF-MRA might be associated with delayed ipsilateral cerebral perfusion. Changes of the SIs across ICAS lesions on TOF-MRA may be a simple marker to reflect cerebral perfusion changes in patients with symptomatic ICAS.
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Affiliation(s)
- Linfang Lan
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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Amarenco P, Lavallée PC, Labreuche J, Albers GW, Bornstein NM, Canhão P, Caplan LR, Donnan GA, Ferro JM, Hennerici MG, Molina C, Rothwell PM, Sissani L, Školoudík D, Steg PG, Touboul PJ, Uchiyama S, Vicaut É, Wong LKS. One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke. N Engl J Med 2016; 374:1533-42. [PMID: 27096581 DOI: 10.1056/nejmoa1412981] [Citation(s) in RCA: 369] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Previous studies conducted between 1997 and 2003 estimated that the risk of stroke or an acute coronary syndrome was 12 to 20% during the first 3 months after a transient ischemic attack (TIA) or minor stroke. The TIAregistry.org project was designed to describe the contemporary profile, etiologic factors, and outcomes in patients with a TIA or minor ischemic stroke who receive care in health systems that now offer urgent evaluation by stroke specialists. METHODS We recruited patients who had had a TIA or minor stroke within the previous 7 days. Sites were selected if they had systems dedicated to urgent evaluation of patients with TIA. We estimated the 1-year risk of stroke and of the composite outcome of stroke, an acute coronary syndrome, or death from cardiovascular causes. We also examined the association of the ABCD(2) score for the risk of stroke (range, 0 [lowest risk] to 7 [highest risk]), findings on brain imaging, and cause of TIA or minor stroke with the risk of recurrent stroke over a period of 1 year. RESULTS From 2009 through 2011, we enrolled 4789 patients at 61 sites in 21 countries. A total of 78.4% of the patients were evaluated by stroke specialists within 24 hours after symptom onset. A total of 33.4% of the patients had an acute brain infarction, 23.2% had at least one extracranial or intracranial stenosis of 50% or more, and 10.4% had atrial fibrillation. The Kaplan-Meier estimate of the 1-year event rate of the composite cardiovascular outcome was 6.2% (95% confidence interval, 5.5 to 7.0). Kaplan-Meier estimates of the stroke rate at days 2, 7, 30, 90, and 365 were 1.5%, 2.1%, 2.8%, 3.7%, and 5.1%, respectively. In multivariable analyses, multiple infarctions on brain imaging, large-artery atherosclerosis, and an ABCD(2) score of 6 or 7 were each associated with more than a doubling of the risk of stroke. CONCLUSIONS We observed a lower risk of cardiovascular events after TIA than previously reported. The ABCD(2) score, findings on brain imaging, and status with respect to large-artery atherosclerosis helped stratify the risk of recurrent stroke within 1 year after a TIA or minor stroke. (Funded by Sanofi and Bristol-Myers Squibb.).
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Affiliation(s)
- Pierre Amarenco
- From the Departments of Neurology (P.A., P.C.L., J.L., L.S., P.-J.T.) and Cardiology (P.G.S.) and the Stroke Center (P.A., P.C.L., J.L., L.S., P.-J.T.), Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, and the Department of Biostatistics, AP-HP Fernand Widal Hospital (E.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Santé Publique, Epidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel (N.M.B.); the Department of Neurosciences, Hospital Santa Maria, University of Lisbon, Lisbon, Portugal (P.C., J.M.F.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg, Germany (M.G.H.); the Department of Neurology, Stroke Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona (C.M.); the Nuffield Department of Clinical Neuroscience, Stroke Prevention Research Unit, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the Department of Nursing, Palacky University, Olomouc, Czech Republic (D.S.); Clinical Research Center, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong K
| | - Philippa C Lavallée
- From the Departments of Neurology (P.A., P.C.L., J.L., L.S., P.-J.T.) and Cardiology (P.G.S.) and the Stroke Center (P.A., P.C.L., J.L., L.S., P.-J.T.), Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, and the Department of Biostatistics, AP-HP Fernand Widal Hospital (E.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Santé Publique, Epidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel (N.M.B.); the Department of Neurosciences, Hospital Santa Maria, University of Lisbon, Lisbon, Portugal (P.C., J.M.F.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg, Germany (M.G.H.); the Department of Neurology, Stroke Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona (C.M.); the Nuffield Department of Clinical Neuroscience, Stroke Prevention Research Unit, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the Department of Nursing, Palacky University, Olomouc, Czech Republic (D.S.); Clinical Research Center, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong K
| | - Julien Labreuche
- From the Departments of Neurology (P.A., P.C.L., J.L., L.S., P.-J.T.) and Cardiology (P.G.S.) and the Stroke Center (P.A., P.C.L., J.L., L.S., P.-J.T.), Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, and the Department of Biostatistics, AP-HP Fernand Widal Hospital (E.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Santé Publique, Epidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel (N.M.B.); the Department of Neurosciences, Hospital Santa Maria, University of Lisbon, Lisbon, Portugal (P.C., J.M.F.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg, Germany (M.G.H.); the Department of Neurology, Stroke Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona (C.M.); the Nuffield Department of Clinical Neuroscience, Stroke Prevention Research Unit, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the Department of Nursing, Palacky University, Olomouc, Czech Republic (D.S.); Clinical Research Center, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong K
| | - Gregory W Albers
- From the Departments of Neurology (P.A., P.C.L., J.L., L.S., P.-J.T.) and Cardiology (P.G.S.) and the Stroke Center (P.A., P.C.L., J.L., L.S., P.-J.T.), Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, and the Department of Biostatistics, AP-HP Fernand Widal Hospital (E.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Santé Publique, Epidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel (N.M.B.); the Department of Neurosciences, Hospital Santa Maria, University of Lisbon, Lisbon, Portugal (P.C., J.M.F.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg, Germany (M.G.H.); the Department of Neurology, Stroke Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona (C.M.); the Nuffield Department of Clinical Neuroscience, Stroke Prevention Research Unit, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the Department of Nursing, Palacky University, Olomouc, Czech Republic (D.S.); Clinical Research Center, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong K
| | - Natan M Bornstein
- From the Departments of Neurology (P.A., P.C.L., J.L., L.S., P.-J.T.) and Cardiology (P.G.S.) and the Stroke Center (P.A., P.C.L., J.L., L.S., P.-J.T.), Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, and the Department of Biostatistics, AP-HP Fernand Widal Hospital (E.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Santé Publique, Epidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel (N.M.B.); the Department of Neurosciences, Hospital Santa Maria, University of Lisbon, Lisbon, Portugal (P.C., J.M.F.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg, Germany (M.G.H.); the Department of Neurology, Stroke Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona (C.M.); the Nuffield Department of Clinical Neuroscience, Stroke Prevention Research Unit, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the Department of Nursing, Palacky University, Olomouc, Czech Republic (D.S.); Clinical Research Center, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong K
| | - Patrícia Canhão
- From the Departments of Neurology (P.A., P.C.L., J.L., L.S., P.-J.T.) and Cardiology (P.G.S.) and the Stroke Center (P.A., P.C.L., J.L., L.S., P.-J.T.), Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, and the Department of Biostatistics, AP-HP Fernand Widal Hospital (E.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Santé Publique, Epidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel (N.M.B.); the Department of Neurosciences, Hospital Santa Maria, University of Lisbon, Lisbon, Portugal (P.C., J.M.F.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg, Germany (M.G.H.); the Department of Neurology, Stroke Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona (C.M.); the Nuffield Department of Clinical Neuroscience, Stroke Prevention Research Unit, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the Department of Nursing, Palacky University, Olomouc, Czech Republic (D.S.); Clinical Research Center, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong K
| | - Louis R Caplan
- From the Departments of Neurology (P.A., P.C.L., J.L., L.S., P.-J.T.) and Cardiology (P.G.S.) and the Stroke Center (P.A., P.C.L., J.L., L.S., P.-J.T.), Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, and the Department of Biostatistics, AP-HP Fernand Widal Hospital (E.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Santé Publique, Epidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel (N.M.B.); the Department of Neurosciences, Hospital Santa Maria, University of Lisbon, Lisbon, Portugal (P.C., J.M.F.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg, Germany (M.G.H.); the Department of Neurology, Stroke Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona (C.M.); the Nuffield Department of Clinical Neuroscience, Stroke Prevention Research Unit, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the Department of Nursing, Palacky University, Olomouc, Czech Republic (D.S.); Clinical Research Center, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong K
| | - Geoffrey A Donnan
- From the Departments of Neurology (P.A., P.C.L., J.L., L.S., P.-J.T.) and Cardiology (P.G.S.) and the Stroke Center (P.A., P.C.L., J.L., L.S., P.-J.T.), Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, and the Department of Biostatistics, AP-HP Fernand Widal Hospital (E.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Santé Publique, Epidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel (N.M.B.); the Department of Neurosciences, Hospital Santa Maria, University of Lisbon, Lisbon, Portugal (P.C., J.M.F.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg, Germany (M.G.H.); the Department of Neurology, Stroke Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona (C.M.); the Nuffield Department of Clinical Neuroscience, Stroke Prevention Research Unit, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the Department of Nursing, Palacky University, Olomouc, Czech Republic (D.S.); Clinical Research Center, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong K
| | - José M Ferro
- From the Departments of Neurology (P.A., P.C.L., J.L., L.S., P.-J.T.) and Cardiology (P.G.S.) and the Stroke Center (P.A., P.C.L., J.L., L.S., P.-J.T.), Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, and the Department of Biostatistics, AP-HP Fernand Widal Hospital (E.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Santé Publique, Epidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel (N.M.B.); the Department of Neurosciences, Hospital Santa Maria, University of Lisbon, Lisbon, Portugal (P.C., J.M.F.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg, Germany (M.G.H.); the Department of Neurology, Stroke Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona (C.M.); the Nuffield Department of Clinical Neuroscience, Stroke Prevention Research Unit, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the Department of Nursing, Palacky University, Olomouc, Czech Republic (D.S.); Clinical Research Center, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong K
| | - Michael G Hennerici
- From the Departments of Neurology (P.A., P.C.L., J.L., L.S., P.-J.T.) and Cardiology (P.G.S.) and the Stroke Center (P.A., P.C.L., J.L., L.S., P.-J.T.), Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, and the Department of Biostatistics, AP-HP Fernand Widal Hospital (E.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Santé Publique, Epidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel (N.M.B.); the Department of Neurosciences, Hospital Santa Maria, University of Lisbon, Lisbon, Portugal (P.C., J.M.F.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg, Germany (M.G.H.); the Department of Neurology, Stroke Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona (C.M.); the Nuffield Department of Clinical Neuroscience, Stroke Prevention Research Unit, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the Department of Nursing, Palacky University, Olomouc, Czech Republic (D.S.); Clinical Research Center, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong K
| | - Carlos Molina
- From the Departments of Neurology (P.A., P.C.L., J.L., L.S., P.-J.T.) and Cardiology (P.G.S.) and the Stroke Center (P.A., P.C.L., J.L., L.S., P.-J.T.), Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, and the Department of Biostatistics, AP-HP Fernand Widal Hospital (E.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Santé Publique, Epidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel (N.M.B.); the Department of Neurosciences, Hospital Santa Maria, University of Lisbon, Lisbon, Portugal (P.C., J.M.F.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg, Germany (M.G.H.); the Department of Neurology, Stroke Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona (C.M.); the Nuffield Department of Clinical Neuroscience, Stroke Prevention Research Unit, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the Department of Nursing, Palacky University, Olomouc, Czech Republic (D.S.); Clinical Research Center, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong K
| | - Peter M Rothwell
- From the Departments of Neurology (P.A., P.C.L., J.L., L.S., P.-J.T.) and Cardiology (P.G.S.) and the Stroke Center (P.A., P.C.L., J.L., L.S., P.-J.T.), Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, and the Department of Biostatistics, AP-HP Fernand Widal Hospital (E.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Santé Publique, Epidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel (N.M.B.); the Department of Neurosciences, Hospital Santa Maria, University of Lisbon, Lisbon, Portugal (P.C., J.M.F.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg, Germany (M.G.H.); the Department of Neurology, Stroke Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona (C.M.); the Nuffield Department of Clinical Neuroscience, Stroke Prevention Research Unit, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the Department of Nursing, Palacky University, Olomouc, Czech Republic (D.S.); Clinical Research Center, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong K
| | - Leila Sissani
- From the Departments of Neurology (P.A., P.C.L., J.L., L.S., P.-J.T.) and Cardiology (P.G.S.) and the Stroke Center (P.A., P.C.L., J.L., L.S., P.-J.T.), Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, and the Department of Biostatistics, AP-HP Fernand Widal Hospital (E.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Santé Publique, Epidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel (N.M.B.); the Department of Neurosciences, Hospital Santa Maria, University of Lisbon, Lisbon, Portugal (P.C., J.M.F.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg, Germany (M.G.H.); the Department of Neurology, Stroke Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona (C.M.); the Nuffield Department of Clinical Neuroscience, Stroke Prevention Research Unit, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the Department of Nursing, Palacky University, Olomouc, Czech Republic (D.S.); Clinical Research Center, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong K
| | - David Školoudík
- From the Departments of Neurology (P.A., P.C.L., J.L., L.S., P.-J.T.) and Cardiology (P.G.S.) and the Stroke Center (P.A., P.C.L., J.L., L.S., P.-J.T.), Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, and the Department of Biostatistics, AP-HP Fernand Widal Hospital (E.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Santé Publique, Epidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel (N.M.B.); the Department of Neurosciences, Hospital Santa Maria, University of Lisbon, Lisbon, Portugal (P.C., J.M.F.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg, Germany (M.G.H.); the Department of Neurology, Stroke Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona (C.M.); the Nuffield Department of Clinical Neuroscience, Stroke Prevention Research Unit, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the Department of Nursing, Palacky University, Olomouc, Czech Republic (D.S.); Clinical Research Center, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong K
| | - Philippe Gabriel Steg
- From the Departments of Neurology (P.A., P.C.L., J.L., L.S., P.-J.T.) and Cardiology (P.G.S.) and the Stroke Center (P.A., P.C.L., J.L., L.S., P.-J.T.), Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, and the Department of Biostatistics, AP-HP Fernand Widal Hospital (E.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Santé Publique, Epidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel (N.M.B.); the Department of Neurosciences, Hospital Santa Maria, University of Lisbon, Lisbon, Portugal (P.C., J.M.F.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg, Germany (M.G.H.); the Department of Neurology, Stroke Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona (C.M.); the Nuffield Department of Clinical Neuroscience, Stroke Prevention Research Unit, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the Department of Nursing, Palacky University, Olomouc, Czech Republic (D.S.); Clinical Research Center, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong K
| | - Pierre-Jean Touboul
- From the Departments of Neurology (P.A., P.C.L., J.L., L.S., P.-J.T.) and Cardiology (P.G.S.) and the Stroke Center (P.A., P.C.L., J.L., L.S., P.-J.T.), Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, and the Department of Biostatistics, AP-HP Fernand Widal Hospital (E.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Santé Publique, Epidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel (N.M.B.); the Department of Neurosciences, Hospital Santa Maria, University of Lisbon, Lisbon, Portugal (P.C., J.M.F.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg, Germany (M.G.H.); the Department of Neurology, Stroke Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona (C.M.); the Nuffield Department of Clinical Neuroscience, Stroke Prevention Research Unit, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the Department of Nursing, Palacky University, Olomouc, Czech Republic (D.S.); Clinical Research Center, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong K
| | - Shinichiro Uchiyama
- From the Departments of Neurology (P.A., P.C.L., J.L., L.S., P.-J.T.) and Cardiology (P.G.S.) and the Stroke Center (P.A., P.C.L., J.L., L.S., P.-J.T.), Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, and the Department of Biostatistics, AP-HP Fernand Widal Hospital (E.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Santé Publique, Epidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel (N.M.B.); the Department of Neurosciences, Hospital Santa Maria, University of Lisbon, Lisbon, Portugal (P.C., J.M.F.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg, Germany (M.G.H.); the Department of Neurology, Stroke Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona (C.M.); the Nuffield Department of Clinical Neuroscience, Stroke Prevention Research Unit, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the Department of Nursing, Palacky University, Olomouc, Czech Republic (D.S.); Clinical Research Center, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong K
| | - Éric Vicaut
- From the Departments of Neurology (P.A., P.C.L., J.L., L.S., P.-J.T.) and Cardiology (P.G.S.) and the Stroke Center (P.A., P.C.L., J.L., L.S., P.-J.T.), Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, and the Department of Biostatistics, AP-HP Fernand Widal Hospital (E.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Santé Publique, Epidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel (N.M.B.); the Department of Neurosciences, Hospital Santa Maria, University of Lisbon, Lisbon, Portugal (P.C., J.M.F.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg, Germany (M.G.H.); the Department of Neurology, Stroke Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona (C.M.); the Nuffield Department of Clinical Neuroscience, Stroke Prevention Research Unit, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the Department of Nursing, Palacky University, Olomouc, Czech Republic (D.S.); Clinical Research Center, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong K
| | - Lawrence K S Wong
- From the Departments of Neurology (P.A., P.C.L., J.L., L.S., P.-J.T.) and Cardiology (P.G.S.) and the Stroke Center (P.A., P.C.L., J.L., L.S., P.-J.T.), Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, and the Department of Biostatistics, AP-HP Fernand Widal Hospital (E.V.), Université Paris-Diderot, Sorbonne-Paris Cité, Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Santé Publique, Epidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel (N.M.B.); the Department of Neurosciences, Hospital Santa Maria, University of Lisbon, Lisbon, Portugal (P.C., J.M.F.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg, Germany (M.G.H.); the Department of Neurology, Stroke Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona (C.M.); the Nuffield Department of Clinical Neuroscience, Stroke Prevention Research Unit, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the Department of Nursing, Palacky University, Olomouc, Czech Republic (D.S.); Clinical Research Center, International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong K
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Wang Z, Wong A, Liu W, Yang J, Chu WCW, Au L, Lau A, Chan A, Xiong Y, Soo Y, Leung T, Wong LKS, Mok VCT. Cerebral Microbleeds and Cognitive Function in Ischemic Stroke or Transient Ischemic Attack Patients. Dement Geriatr Cogn Disord 2016; 40:130-6. [PMID: 26088186 DOI: 10.1159/000379744] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We explored the association between cerebral microbleeds (CMBs) and cognitive impairment in patients with ischemic stroke/transient ischemic attack (TIA). METHODS A total of 488 ischemic stroke/TIA patients received magnetic resonance imaging. Montreal Cognitive Assessment (MoCA) was used to evaluate global cognitive function and cognitive domains. The association of CMB quantity with cognitive function and the impact of CMB locations (strictly lobar, strictly deep, and mixed regions) on cognitive impairment were examined in regression models with adjustments for confounders. RESULTS A total of 113 subjects (23.2%) had ≥1 CMB. Strictly lobar, strictly deep, and mixed CMBs were identified in 36, 40, and 37 patients, respectively. The presence of ≥5 CMBs or strictly deep CMBs was associated with the MoCA total score (p = 0.007 and 0.020, respectively). Of all MoCA domains tested, a lower score in the attention domain was related to the presence of ≥5 CMBs (p = 0.014) and strictly deep CMBs (p = 0.028). CONCLUSION CMBs were associated with cognitive dysfunction in stroke/TIA patients, especially in the attention domain. This association was mainly driven by CMBs in the deep region, underlining the role of hypertensive microangiopathy in stroke-related cognitive impairment.
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Affiliation(s)
- Zhaolu Wang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
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Johnston SC, Amarenco P, Albers GW, Denison H, Easton JD, Held P, Jonasson J, Minematsu K, Molina CA, Wong LKS. Acute Stroke or Transient Ischemic Attack Treated with Aspirin or Ticagrelor and Patient Outcomes (Socrates) Trial: Rationale and Design. Int J Stroke 2015; 10:1304-8. [DOI: 10.1111/ijs.12610] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 05/24/2015] [Indexed: 11/30/2022]
Abstract
Rationale The risk of recurrent ischemia is high in the acute period after ischemic stroke and transient ischemic attack. Aspirin is recommended by guidelines for this indication, but more intensive antiplatelet therapy may be justified. Aims We aim to evaluate whether ticagrelor, a potent antiplatelet agent that blocks the P2Y12 receptor without requiring metabolic activation, reduces the risk of major vascular events compared with aspirin when randomization occurs within 24 h after symptom onset of a nonsevere ischemic stroke or high-risk transient ischemic attack. Design Acute Stroke or Transient Ischemic Attack Treated with Aspirin or Ticagrelor and Patient Outcomes (SOCRATES) is a randomized, double-blind, event-driven trial and will include an estimated 13 600 participants randomized in 33 countries worldwide to collect 844 primary events. Study outcomes The primary endpoint is the composite of stroke (ischemic or hemorrhagic), myocardial infarction, and death. Time to the first primary endpoint will be compared in the treatment groups during 90-day follow-up, with major hemorrhage serving as the primary safety endpoint. Participants will be followed for an additional 30 days after the randomized treatment period. Discussion The SOCRATES trial fulfills an important clinical need by evaluating a potent antiplatelet agent as a superior alternative to current standard of care in patients presenting acutely with ischemic stroke or transient ischemic attack.
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Affiliation(s)
| | - Pierre Amarenco
- Department of Neurology and Stroke Center, Bichat University Hospital and Medical School, Paris, France
| | - Gregory W. Albers
- Stanford University Medical Center, Stanford Stroke Center, Palo Alto, CA, USA
| | | | - J. Donald Easton
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Kazuo Minematsu
- National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | | | - Lawrence K. S. Wong
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, HKSAR, China
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Wong A, Nyenhuis D, Black SE, Law LSN, Lo ESK, Kwan PWL, Au L, Chan AYY, Wong LKS, Nasreddine Z, Mok V. Montreal Cognitive Assessment 5-minute protocol is a brief, valid, reliable, and feasible cognitive screen for telephone administration. Stroke 2015; 46:1059-64. [PMID: 25700290 DOI: 10.1161/strokeaha.114.007253] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Vascular Cognitive Impairment Harmonization working group proposed a brief cognitive protocol for screening of vascular cognitive impairment. We investigated the validity, reliability, and feasibility of the Montreal Cognitive Assessment 5-minute protocol (MoCA 5-minute protocol) administered over the telephone. METHODS Four items examining attention, verbal learning and memory, executive functions/language, and orientation were extracted from the MoCA to form the MoCA 5-minute protocol. One hundred four patients with stroke or transient ischemic attack, including 53 with normal cognition (Clinical Dementia Rating, 0) and 51 with cognitive impairment (Clinical Dementia Rating, 0.5 or 1), were administered the MoCA in clinic and a month later, the MoCA 5-minute protocol over the telephone. RESULTS Administration of the MoCA 5-minute protocol took 5 minutes over the telephone. Total score of the MoCA 5-minute protocol correlated negatively with age (r=-0.36; P<0.001) and positively with years of education (r=0.41; P<0.001) but not with sex (ρ=0.03; P=0.773). Total scores of the MoCA and MoCA 5-minute protocol were highly correlated (r=0.87; P<0.001). The MoCA 5-minute protocol performed equally well as the MoCA in differentiating patients with cognitive impairment from those without (areas under receiver operating characteristics curve for MoCA 5-minute protocol, 0.78; MoCA=0.74; P>0.05 for difference; Cohen d for group difference, 0.80-1.13). It differentiated cognitively impaired patients with executive domain impairment from those without (areas under receiver operating characteristics curve, 0.89; P<0.001; Cohen d=1.7 for group difference). Thirty-day test-retest reliability was excellent (intraclass correlation coefficient, 0.89). CONCLUSIONS The MoCA 5-minute protocol is a free, valid, and reliable cognitive screen for stroke and transient ischemic attack. It is brief and highly feasible for telephone administration.
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Affiliation(s)
- Adrian Wong
- From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.)
| | - David Nyenhuis
- From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.)
| | - Sandra E Black
- From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.)
| | - Lorraine S N Law
- From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.)
| | - Eugene S K Lo
- From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.)
| | - Pauline W L Kwan
- From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.)
| | - Lisa Au
- From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.)
| | - Anne Y Y Chan
- From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.)
| | - Lawrence K S Wong
- From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.)
| | - Ziad Nasreddine
- From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.)
| | - Vincent Mok
- From the Department of Medicine and Therapeutics, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China (A.W., L.S.N.L., E.S.K.L., P.W.L.K., L.A., A.Y.Y.C., L.K.S.W., V.M.); Hauenstein Neuroscience Center at Saint Mary's Health Care, Grand Rapids, MI (D.N.); Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (S.E.B.); and Centre Diagnostique et Recherche sur la Maladie d'Alzheimer, Québec, Quebec, Canada (Z.N.).
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Leung H, Zhu CXL, Chan DTM, Poon WS, Shi L, Mok VCT, Wong LKS. Ictal high-frequency oscillations and hyperexcitability in refractory epilepsy. Clin Neurophysiol 2015; 126:2049-57. [PMID: 25746721 DOI: 10.1016/j.clinph.2015.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 08/02/2014] [Revised: 12/24/2014] [Accepted: 01/01/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE High-frequency oscillations (HFOs, 80-500Hz) from intracranial electroencephalography (EEG) may represent a biomarker of epileptogenicity for epilepsy. We explored the relationship between ictal HFOs and hyperexcitability with a view to improving surgical outcome. METHODS We evaluated 262 patients with refractory epilepsy. Fifteen patients underwent electrode implantation, and surgical resection was performed in 12 patients using a semi-prospective design. Ictal intracranial EEGs were examined by continuous wavelet transform (CWT). Significant ictal HFOs were denoted by normalized wavelet power above the 50th percentile across all channels. Each patient underwent functional mapping with cortical electrical stimulation. Hyperexcitability was defined as the appearance of afterdischarges or clinical seizures after electrical stimulation (50Hz, biphasic, pulse width=0.5ms, 5s, 5mA). RESULTS Among the group of patients achieving Engel Class I/II outcome at 1+ year, the mean proportion of significant ictal HFOs among resected channels for any given patient was 69% (33.3-100%). The respective figures for conventional frequency ictal patterns (CFIPs), hyperexcitability, and radiological lesion were 68.3% (26.3-100%), 39.6% (0-100%), and 52.8% (0-100%). Statistical significance was only achieved with ictal HFOs when comparing patients with Engel Class I/II outcomes versus III/IV outcomes (12.6% vs. 4.2%, the number of channels as the denominator, p=0.005). Further analysis from all patients irrespective of the surgical outcome showed that ictal HFOs co-occurred with CFIP (p<0.001), hyperexcitability (p<0.001), and radiological lesion (p<0.001). The combination of ictal HFOs/hyperexcitability improved the sensitivity from 66.7% to 100%, and the specificity from 66.7% to 75% when compared with ictal HFOs or hyperexcitability alone. CONCLUSIONS We confirmed the utility of ictal HFOs in determining surgical outcome. Ictal HFOs are affiliated to cortical hyperexcitability, which may represent a pathological manifestation of epileptogenicity. SIGNIFICANCE Presurgical evaluation of refractory epilepsy may incorporate both ictal HFOs and cortical stimulation in determining epileptogenic foci.
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Affiliation(s)
- Howan Leung
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| | - Cannon X L Zhu
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Danny T M Chan
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Wai S Poon
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Lin Shi
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Vincent C T Mok
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Lawrence K S Wong
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
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Liu LP, Wong LKS, Wang DZ, Miao ZR. Current status of endovascular procedures in management of ischemic stroke in China. CNS Neurosci Ther 2014; 20:483-4. [PMID: 24836738 DOI: 10.1111/cns.12281] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Li-Ping Liu
- Department of Neurology and Stroke Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Mok V, Srikanth V, Xiong Y, Phan TG, Moran C, Chu S, Zhao Q, Chu WWC, Wong A, Hong Z, Liu X, Wong LKS, Ding D. Race-Ethnicity and Cerebral Small Vessel Disease – Comparison between Chinese and White Populations. Int J Stroke 2014; 9 Suppl A100:36-42. [PMID: 24661839 DOI: 10.1111/ijs.12270] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 01/30/2014] [Indexed: 11/28/2022]
Abstract
Background and Aim Studies in stroke patients suggest that lacunar stroke and intracerebral hemorrhage might be more common in Chinese than Whites. We hypothesized that other manifestations of subclinical cerebral small vessel disease, namely white matter hyperintensities (WMH), lacunes, and microbleeds, are also more common in Chinese than Whites. We compared the community prevalence of these lesions between Han Chinese and White Australians. Methods Magnetic resonance imaging (1·5-Tesla) was performed on participants of the Shanghai Aging Study ( n = 321, mean age 69 ± 6 years) and Tasmanian Study of Cognition and Gait ( n = 397, mean age 72 ± 7 years). A single-rater recorded measures of WMH, lacunes, and microbleeds. We compared lesion prevalence between age- and gender-matched subgroups from the two cohorts. Among all subjects ( n = 718), we performed multivariable logistic regression to examine if race-ethnicity was independently associated with these lesions. Results Among age- and gender-matched subjects, confluent WMH were significantly more prevalent in Chinese (38·5%) than Whites (28·4%; P = 0·01). There was no difference in the prevalence of lacunes (Chinese 29·1% vs. Whites 29·5%, P = 0·93) and microbleeds (Chinese 10·1% vs. 9·0%, P = 0·67) between Chinese and Whites. In multivariable logistic regression, Chinese ethnicity was associated with confluent WMH (odds ratio 1·7, 95% confidence interval 1·1–2·6, P = 0·01), but no differences were seen for lacunes and microbleeds. The association between Chinese ethnicity with confluent WMH became insignificant when subjects with history of stroke were excluded. Conclusions In this population-based cross-national comparison, Han Chinese had a higher prevalence of confluent WMH than White Australians, but had a similar prevalence of lacunes and microbleeds.
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Affiliation(s)
- Vincent Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Velandai Srikanth
- Stroke and Aging Research Center, Medicine, Southern Clinical School, Monash Medical Centre, Clayton Victoria, Melbourne, Vic., Australia
| | - Yunyun Xiong
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China
| | - Thanh G. Phan
- Stroke and Aging Research Center, Medicine, Southern Clinical School, Monash Medical Centre, Clayton Victoria, Melbourne, Vic., Australia
| | - Chris Moran
- Stroke and Aging Research Center, Medicine, Southern Clinical School, Monash Medical Centre, Clayton Victoria, Melbourne, Vic., Australia
| | - Shuguang Chu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qianhua Zhao
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Winnie W. C. Chu
- Department of Radiology & Organ Imaging, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Adrian Wong
- Department of Psychological Studies and Center for Psychosocial Health and Aging, The Hong Kong Institute of Education, Taipo, Hong Kong
| | - Zhen Hong
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China
| | - Lawrence K. S. Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ding Ding
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
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Tsoi H, Yu ACS, Chen ZS, Ng NKN, Chan AYY, Yuen LYP, Abrigo JM, Tsang SY, Tsui SKW, Tong TMF, Lo IFM, Lam STS, Mok VCT, Wong LKS, Ngo JCK, Lau KF, Chan TF, Chan HYE. A novel missense mutation in CCDC88C activates the JNK pathway and causes a dominant form of spinocerebellar ataxia. J Med Genet 2014; 51:590-5. [PMID: 25062847 PMCID: PMC4145425 DOI: 10.1136/jmedgenet-2014-102333] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [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: 12/30/2022]
Abstract
Background Spinocerebellar ataxias (SCAs) are a group of clinically and genetically diverse and autosomal-dominant disorders characterised by neurological deficits in the cerebellum. At present, there is no cure for SCAs. Of the different distinct subtypes of autosomal-dominant SCAs identified to date, causative genes for only a fraction of them are currently known. In this study, we investigated the cause of an autosomal-dominant SCA phenotype in a family that exhibits cerebellar ataxia and pontocerebellar atrophy along with a global reduction in brain volume. Methods and results Whole-exome analysis revealed a missense mutation c.G1391A (p.R464H) in the coding region of the coiled-coil domain containing 88C (CCDC88C) gene in all affected individuals. Functional studies showed that the mutant form of CCDC88C activates the c-Jun N-terminal kinase (JNK) pathway, induces caspase 3 cleavage and triggers apoptosis. Conclusions This study expands our understanding of the cause of autosomal-dominant SCAs, a group of heterogeneous congenital neurological conditions in humans, and unveils a link between the JNK stress pathway and cerebellar atrophy.
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Affiliation(s)
- Ho Tsoi
- Faculty of Science, Laboratory of Drosophila Research, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong Faculty of Science, Biochemistry Programme, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Allen C S Yu
- Faculty of Science, Biochemistry Programme, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Zhefan S Chen
- Faculty of Science, Laboratory of Drosophila Research, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong Faculty of Science, Biochemistry Programme, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Nelson K N Ng
- Faculty of Science, Laboratory of Drosophila Research, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong Faculty of Science, Biochemistry Programme, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Anne Y Y Chan
- Faculty of Medicine, Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Liz Y P Yuen
- Faculty of Medicine, Department of Chemical Pathology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jill M Abrigo
- Faculty of Medicine, Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Suk Ying Tsang
- Faculty of Science, Biochemistry Programme, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong Partner State Key Laboratory of Agrobiotechnology, The Chinese University of Hong Kong, Hong Kong
| | - Stephen K W Tsui
- Faculty of Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Tony M F Tong
- Clinical Genetic Service, Department of Health, The Government of Hong Kong, Hong Kong, Hong Kong
| | - Ivan F M Lo
- Clinical Genetic Service, Department of Health, The Government of Hong Kong, Hong Kong, Hong Kong
| | - Stephen T S Lam
- Clinical Genetic Service, Department of Health, The Government of Hong Kong, Hong Kong, Hong Kong
| | - Vincent C T Mok
- Faculty of Medicine, Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Lawrence K S Wong
- Faculty of Medicine, Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jacky C K Ngo
- Faculty of Science, Biochemistry Programme, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Kwok-Fai Lau
- Faculty of Science, Biochemistry Programme, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Ting-Fung Chan
- Faculty of Science, Biochemistry Programme, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong Partner State Key Laboratory of Agrobiotechnology, The Chinese University of Hong Kong, Hong Kong
| | - H Y Edwin Chan
- Faculty of Science, Laboratory of Drosophila Research, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong Faculty of Science, Biochemistry Programme, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Heeley EL, Wei JW, Wang JG, Arima H, Huang Y, Wong LKS, Anderson CS. Comparative effects of antihypertensive drugs on stroke outcome in China. Int J Stroke 2014; 9 Suppl A100:113-8. [PMID: 25042450 DOI: 10.1111/ijs.12330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 12/23/2013] [Accepted: 05/01/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Antihypertensive drugs are useful in the prevention of stroke; however, much debate surrounds which class of agent provides the most benefit post-stroke. AIMS The aim of this study was to examine the impact of different classes of antihypertensive agent on stroke outcome using data from the ChinaQUEST study, a prospective, hospital-based stroke registry undertaken across 62 hospitals in China. METHODS Logistic regression analysis was used to determine the comparative associations of different antihypertensive medications when initiated in-hospital post-stroke on the following poor outcomes in stroke survivors at three- and 12 months post-stroke: (1) death and dependency, based on modified Rankin Scale scores 3-5; (2) death; and (3) dependency. RESULTS Of the 6416 patients with baseline data, 3986 (62%) were on at least one antihypertensive agent. After adjustment for baseline characteristics and concomitant therapies, there were no differences in outcomes between therapies at three- and 12 months, but at 12 months, calcium channel blocker use was associated with reduced risks of death/dependency (odds ratio 0·78, P = 0·001) and death (odds ratio 0·66, P < 0·001). In addition, angiotensin-converting enzyme inhibitor/angiotensin II receptor antagonist use was associated with reduced risk of death (odds ratio 0·76, P = 0·009), whereas both beta-blockers and diuretics were shown to increase the risk of death/dependency and death but had no effect on the risk of dependency. CONCLUSION This study suggests that early initiation of calcium channel blockers is associated with improved outcome after stroke. Further randomized studies are warranted to confirm these findings and to delineate differential beneficial effects of antihypertensive therapy in stroke prevention.
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Affiliation(s)
- Emma L Heeley
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia
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Leng X, Wong LKS, Soo Y, Leung T, Zou X, Wang Y, Feldmann E, Liu L, Liebeskind D. Signal intensity ratio as a novel measure of hemodynamic significance for intracranial atherosclerosis. Int J Stroke 2014; 8:E46. [PMID: 24024922 DOI: 10.1111/ijs.12080] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Xinyi Leng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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Yu SCH, Zou WXY, Soo YOY, Wang L, Hui JWY, Chan AYY, Lee KT, Ip VHL, Fan FSY, Chan ALC, Wong LKS, Leung TW. Evaluation of carotid angioplasty and stenting for radiation-induced carotid stenosis. Stroke 2014; 45:1402-7. [PMID: 24699055 DOI: 10.1161/strokeaha.113.003995] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to evaluate the procedural safety, clinical, and angiographic outcome of carotid angioplasty and stenting for high-grade (≥70%) radiation-induced carotid stenosis (RIS) using atherosclerotic stenosis (AS) as a control. METHODS In this 6-year prospective nonrandomized study, we compared the carotid angioplasty and stenting outcome of 65 consecutive patients (84 vessels) with RIS with that of a control group of 129 consecutive patients (150 vessels) with AS. Study end points were 30-day periprocedural stroke or death, ipsilateral ischemic stroke, technical success, procedural characteristics, instent restenosis (ISR; ≥50%) and symptomatic ISR. RESULTS The median follow-up was 47.3 months (95% confidence interval, 26.9-61.6). Imaging assessment was available in 74 vessels (RIS) and 120 vessels (AS) in 2 years. Comparing RIS group with AS group, the rates of periprocedural stroke or death were 1.5% (1/65) versus 1.6% (2/129; P=1); ipsilateral ischemic stroke rates were 4.6% (3/65) versus 4.7% (6/129; P=1); the annual risks of ipsilateral ischemic stroke were 1.2% (3 patient/254.7 patient year) versus 1.2% (6 patient/494.2 patient year; P=0.89); technical success rates were both 100%. Stenting of common carotid artery and the use of multiple stents was more common in the RIS group (P=0 in both cases); ISR rates were 25.7% (19/74) versus 4.2% (5/120; P<0.001); symptomatic ISR rates were 6.8% (5/74) versus 0.8% (1/120; P=0.031). CONCLUSIONS The safety, effectiveness, and technical difficulty of carotid angioplasty and stenting for RIS are comparable with that for AS although it is associated with a higher rate of ISR. CLINICAL TRIAL REGISTRATION This trial was not registered as enrollment started in 2006.
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Affiliation(s)
- Simon C H Yu
- From the Department of Imaging and Interventional Radiology, Prince of Wales Hospital (S.C.H.Y., J.W.Y.H., K.T.L.), Vascular and Interventional Radiology Foundation Clinical Science Center (S.C.H.Y., J.W.Y.H., K.T.L., T.W.L.), and Department of Medicine and Therapeutics, Prince of Wales Hospital (W.X.Y.Z., Y.O.Y.S., L.W., A.Y.Y.C., V.H.L.I., F.S.Y.F., A.L.C.C., L.K.S.W., T.W.L.), The Chinese University of Hong Kong, Hong Kong, China
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Yang J, Wong A, Wang Z, Liu W, Au L, Xiong Y, Chu WWC, Leung EYL, Chen S, Lau C, Chan AYY, Lau AYL, Fan F, Ip V, Soo Y, Leung T, Ho CL, Wong LKS, Mok VCT. Risk factors for incident dementia after stroke and transient ischemic attack. Alzheimers Dement 2014; 11:16-23. [PMID: 24603162 DOI: 10.1016/j.jalz.2014.01.003] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [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: 09/08/2013] [Revised: 12/29/2013] [Accepted: 01/09/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND We hypothesized that chronic brain changes are important substrates for incident dementia after stroke and transient ischemic attack (TIA). METHODS We compared clinical and imaging features between patients with consecutive stroke/TIA with (n = 88) and without (n = 925) incident dementia at 3 to 6 months after a stroke/TIA. Pittsburg compound B (PiB) positron emission tomography was performed in 50 patients, including those with (n = 37) and without (n = 13) incident dementia. RESULTS Age, history of diabetes mellitus, severity of white matter changes (WMCs), and medial temporal lobe atrophy (MTLA) were associated with incident dementia. Alzheimer's disease (AD)--like PiB retention was found in 29.7% and 7.7% (P = .032) of patients with and without incident dementia, respectively. CONCLUSIONS Chronic brain changes including WMCs, MTLA, and AD pathology are associated with incident dementia after stroke/TIA. Interventions targeting these chronic brain changes may reduce burden of vascular cognitive impairment.
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Affiliation(s)
- Jie Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Adrian Wong
- Department of Psychological Studies, d Center for Psychosocial Health and Aging, The Hong Kong Institute of Education, Tai-po, Hong Kong SAR, China; Center for Psychosocial Health and Aging, The Hong Kong Institute of Education, Hong Kong SAR, China
| | - Zhaolu Wang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Wenyan Liu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Lisa Au
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Yunyun Xiong
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Winnie W C Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Eric Y L Leung
- Department of Nuclear Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China
| | - Sirong Chen
- Department of Nuclear Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China
| | - Christine Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Anne Y Y Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Alexander Y L Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Florence Fan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Vincent Ip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Yannie Soo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Thomas Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Chi L Ho
- Department of Nuclear Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China
| | - Lawrence K S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Vincent C T Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
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Liu LP, Xu AD, Wong LKS, Wang DZ, Wang YJ. Chinese consensus statement on the evaluation and intervention of collateral circulation for ischemic stroke. CNS Neurosci Ther 2014; 20:202-8. [PMID: 24495505 PMCID: PMC4233984 DOI: 10.1111/cns.12226] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 12/20/2013] [Accepted: 12/22/2013] [Indexed: 02/06/2023] Open
Abstract
Background Collateral circulation is becoming more significant in the individual management strategy of ischemic stroke, there are more data updated recently. Aim To make the further acknowledgment of the evaluation and how to improving collateral flow, for better treatment selection. Method A panel of experts on stroke providing related statement based on review the results from most up‐to‐date clinical research. Results DSA is the gold standard in evaluating all levels of collaterals. CTA can be used for evaluating leptomeningeal collaterals, MRA for CoW, TCD or TCCS can be used as screening tool for primary evaluation. The treatment modalities include direct interventions, such as Extracranial–Intracranial bypass, and indirect interventions, as External counterpulsation and pressor therapy. The consideration of methodology to augment and improve can be considered on an individual basis. Discussion In this consensus, we interpret the definition, neuroimaging evaluation, intervention and potential strategy on collaterals in the future. Conclusion Assessment of collateral circulation is crucial for selecting therapeutic options, predicting infarction volume and making prognosis after ischemic stroke. Data is still needed to provide therapeutic evidence for many new developed technologies. Until more evidence is available, the clinical significance of applying the new technologies is unclear and perhaps limited.
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Affiliation(s)
- Li-Ping Liu
- Departments of Neurology and Stroke Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Shi L, Wang D, Chu WCW, Liu S, Xiong Y, Wang Y, Wang Y, Wong LKS, Mok VCT. Abnormal organization of white matter network in patients with no dementia after ischemic stroke. PLoS One 2013; 8:e81388. [PMID: 24349063 PMCID: PMC3862493 DOI: 10.1371/journal.pone.0081388] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 10/12/2013] [Indexed: 01/07/2023] Open
Abstract
Structural changes after ischemic stroke could affect information communication extensively in the brain network. It is likely that the defects in the white matter (WM) network play a key role in information interchange. In this study, we used graph theoretical analysis to examine potential organization alteration in the WM network architecture derived from diffusion tensor images from subjects with no dementia and experienced stroke in the past 5.4-14.8 months (N = 47, Mini-Mental Screening Examination, MMSE range 18-30), compared with a normal control group with 44 age and gender-matched healthy volunteers (MMSE range 26-30). Region-wise connectivity was derived from fiber connection density of 90 different cortical and subcortical parcellations across the whole brain. Both normal controls and patients with chronic stroke exhibited efficient small-world properties in their WM structural networks. Compared with normal controls, topological efficiency was basically unaltered in the patients with chronic stroke, as reflected by unchanged local and global clustering coefficient, characteristic path length, and regional efficiency. No significant difference in hub distribution was found between normal control and patient groups. Patients with chronic stroke, however, were found to have reduced betweenness centrality and predominantly located in the orbitofrontal cortex, whereas increased betweenness centrality and vulnerability were observed in parietal-occipital cortex. The National Institutes of Health Stroke Scale (NIHSS) score of patient is correlated with the betweenness centrality of right pallidum and local clustering coefficient of left superior occipital gyrus. Our findings suggest that patients with chronic stroke still exhibit efficient small-world organization and unaltered topological efficiency, with altered topology at orbitofrontal cortex and parietal-occipital cortex in the overall structural network. Findings from this study could help in understanding the mechanism of cognitive impairment and functional compensation occurred in patients with chronic stroke.
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Affiliation(s)
- Lin Shi
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Defeng Wang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
- CUHK Shenzhen Research Institute, Shenzhen, China
- * E-mail: (DW); (VCTM)
| | - Winnie C. W. Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Shangping Liu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Yunyun Xiong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lawrence K. S. Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Vincent C. T. Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
- * E-mail: (DW); (VCTM)
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Wong EHC, Yu SCH, Lau AYL, Hui VSW, Leung CSF, Hui JWY, Siu DYW, Abrigo JM, Lee KT, Graham CA, Wong LKS, Leung TWH. Intra-arterial revascularisation therapy for acute ischaemic stroke: initial experience in a Hong Kong hospital. Hong Kong Med J 2013; 19:135-141. [PMID: 23535673] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVES To assess the outcome of acute ischaemic stroke patients who received intra-arterial therapy in our unit. DESIGN Case series. SETTING A tertiary hospital in Hong Kong. PATIENTS Patients with ischaemic stroke due to large artery occlusion treated within 6 hours from symptom onset between January 2007 and May 2011. INTERVENTION Acute intra-arterial revascularisation therapy. MAIN OUTCOME MEASURES Primary outcome was functional independence (modified Rankin Scale score of ≤ 2) at 3 months. Secondary outcome was rate of recanalisation. Safety outcomes were symptomatic intracranial haemorrhage and 3-month mortality. RESULTS Twenty-one patients with a mean age of 67 years fulfilled the inclusion criteria. Their mean National Institutes of Health Stroke Scale score was 18. The mean onset-to-puncture time was 212 minutes. Nine received intra-arterial tissue plasminogen activator alone, 11 had an adjunctive mechanical thrombectomy, and one received balloon angioplasty without tissue plasminogen activator. At the end of the procedure, thrombolysis grade 2a or better was attained in 18 (86%) of the patients, and 8 (38%) achieved functional independence at 3 months. Rates of symptomatic intracranial haemorrhage and 3-month mortality were 10% and 24%, respectively. CONCLUSION In this setting, intra-arterial revascularisation therapy appeared safe and efficacious for this selected group of ischaemic stroke patients with large artery occlusions. Experience gained from this pilot study may help improve clinical outcomes of such patients.
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Affiliation(s)
- Edward H C Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong.
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Navarro JC, Chen CLH, Lagamayo PDJ, Geslani MB, Eow GB, Poungvarin N, de Silva A, Wong LKS, Venketasubramanian N. CHIMES-I: sub-group analyzes of the effects of NeuroAiD according to baseline brain imaging characteristics among patients randomized in the CHIMES study. Int J Stroke 2013; 8:491-4. [PMID: 23506216 DOI: 10.1111/ijs.12044] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
RATIONALE The clinical effects of neuroprotective and/or neurorestorative therapies may vary according to location and size of the ischemic injury. Imaging techniques can be useful in stratifying patients for trials that may be beneficial against particular ischemic lesion characteristics. AIM To test the hypothesis that the efficacy of NeuroAiD compared with placebo in improving functional outcome and reducing neurological deficit in patients with cerebral infarction of intermediate severity varies between sub-groups of patients randomized in the main Chinese Medicine Neuroaid Efficacy on Stroke study when categorized according to baseline imaging characteristics. DESIGN This is a retrospective cohort sub-group analysis of patients who participated in the main Chinese Medicine Neuroaid Efficacy on Stroke study, a multicenter, double-blind, placebo-controlled trial that recruited 1100 patients within 72 h of ischemic stroke onset with National Institutes of Health Stroke Scale 6-14 and were randomized to either NeuroAiD or placebo taken four capsules three times daily for three months. Review of the baseline images to classify the acute stroke lesions in terms of size, location, and extent of involvement will be performed retrospectively by two readers who will remain blinded as to treatment allocation and outcomes of the subjects. STUDY OUTCOMES The primary efficacy end-point in the main Chinese Medicine Neuroaid Efficacy on Stroke study is the modified Rankin Scale grades at three-months. Secondary efficacy end-points are the National Institutes of Health Stroke Scale score at three-months; difference of National Institutes of Health Stroke Scale scores between baseline and 10 days and between baseline and three-months; difference of National Institutes of Health Stroke Scale sub-scores between baseline and 10 days and between baseline and three-months; modified Rankin Scale at 10 days, one-month, and three-months; Barthel index at three-months; and Mini Mental State Examination at 10 days and three-months. Analysis of these primary and secondary end-points will be performed for sub-groups defined in this study after review of the baseline brain imaging: nonlacunar and lacunar, cortical and sub-cortical, hemispheric vs. brainstem, Alberta Stroke Program Early CT score <7 and 7-10, and score <8 and 8-10.
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Affiliation(s)
- Jose C Navarro
- University of Santo Tomas Hospital, Manila, Philippines.
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Xiong L, Leung HHW, Chen XY, Han JH, Leung TWH, Soo YOY, Chan AYY, Lau AYL, Wong LKS. Comprehensive assessment for autonomic dysfunction in different phases after ischemic stroke. Int J Stroke 2012; 8:645-51. [PMID: 22759410 DOI: 10.1111/j.1747-4949.2012.00829.x] [Citation(s) in RCA: 36] [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: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Studies mostly use the analysis of heart rate variability to measure cardiovascular autonomic regulation in ischemic stroke. Besides power spectral analysis of heart rate variability, this study sought to determine whether autonomic function was impaired during different phases in ischemic stroke by Ewing's battery of autonomic function tests. METHODS Ninety-four patients with ischemic stroke (34 patients in acute phase and 60 patients in chronic phase, average six-months after stroke onset) and thirty-seven elderly controls were recruited. Ewing's battery autonomic function tests and power spectral analysis of heart rate variability were performed in all the subjects. RESULTS From power spectral analysis of heart rate variability, stroke patients of both acute and chronic phases had significantly lower low frequency power spectral density than controls. From Ewing's battery of autonomic function tests, patients in acute phase showed impairment in two parasympathetic tests (Valsalva ratio: P = 0·002; heart rate response to deep breathing: P < 0·001) and those in chronic phase showed impairment in all parasympathetic tests (all P < 0·05) in comparison with controls. CONCLUSIONS The comprehensive assessment indicates that autonomic dysfunction occurs in acute phase of ischemic stroke and may persist up to six-months after stroke. Parasympathetic dysfunction rather than sympathetic dysfunction is predominant after ischemic stroke.
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Affiliation(s)
- Li Xiong
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong, China
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Soo YOY, Siu DYW, Abrigo J, Yu S, Ng N, Ahuja AT, Wong LKS, Leung TW. Risk of intracerebral hemorrhage in patients with cerebral microbleeds undergoing endovascular intervention. Stroke 2012; 43:1532-6. [PMID: 22535273 DOI: 10.1161/strokeaha.111.626853] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [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 AND PURPOSE Cerebral microbleeds (CMBs) on MRI gradient echo images are hemosiderin deposits, which may predict intracerebral hemorrhage (ICH). The risk of ICH in patients with CMBs could be exacerbated by the use of antithrombotics. The purpose of our study is to prospectively evaluate the risk of ICH in patients with ischemic stroke who receive dual antiplatelet therapy for endovascular intervention. METHODS We analyzed MRI of 133 patients admitted consecutively for intra- and extracranial stenting for symptomatic large artery atherosclerosis who received aspirin and clopidogrel. Quantity and location of CMBs were recorded by neuroradiologists independent from the angioplasty team. The primary end point was symptomatic ICH as evident in CT of the brain within 12 weeks of procedure. RESULTS CMBs were identified in 23 patients. Mean number of CMBs was 2.3 ± 1.6. Four patients had >5 CMBs. Forty-seven patients had intracranial stents, 84 patients had extracranial stents, and 2 patients had both intracranial and extracranial stents. There was no difference in risk of symptomatic ICH between those with (4.3%) and without CMBs (5.5%) patient with CMBs (P=1.000). CONCLUSIONS The presence of a small number of CMBs does not cause a large increase in the short-term risk of symptomatic ICH in patients with ischemic stroke who undergo endovascular intervention with dual antiplatelet therapy. The risk of ICH in patients with ≥ 5 CMBs, however, remains unclear. Further studies with a larger sample size of patients with multiple CMBs are needed.
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Affiliation(s)
- Yannie O Y Soo
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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Wong EHC, Lau AYL, Soo YOY, Siu DYW, Hui VSW, Graham CA, Leung TWH, Wong LKS. Is stroke thrombolysis safe and efficacious in Hong Kong? Hong Kong Med J 2012; 18:92-98. [PMID: 22477731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE To investigate the safety and efficacy of stroke thrombolysis in a local hospital. DESIGN Historical cohort study. SETTING A tertiary hospital in Hong Kong. PATIENTS The outcome of acute ischaemic stroke patients treated with intravenous tissue plasminogen activator between October 2008 and May 2011 was compared to those admitted during the same period who were thrombolysis-eligible, but treated conservatively due to unavailability of the thrombolysis service after-hours. INTERVENTIONS Intravenous tissue plasminogen activator. MAIN OUTCOME MEASURES Primary outcome was functional independence (modified Rankin Scale score of 2 or below) at 3 months. Safety outcomes were symptomatic intracranial haemorrhage and 3-month mortality. Secondary outcomes were hospital length of stay, direct home discharge, and nursing home discharge. RESULTS A total of 48 thrombolysis and 63 non-thrombolysis patients were identified. Fifty-two percent of the thrombolysis group achieved functional independence compared to 24% of non-thrombolysis group (P=0.003), without significant increase in mortality (15% vs 13%, P=0.51) or symptomatic intracranial haemorrhage (4% vs 2%, P=0.58). Twenty-nine percent of the thrombolysis group patients were discharged home directly, versus 6% of non-thrombolysis group (P<0.001). Mean length of stay was shorter for the thrombolysis group (25 vs 35 days; P=0.034). A similar percentage from each group was discharged to nursing homes. CONCLUSION Implementation of the stroke thrombolysis service in Hong Kong appeared safe and efficacious. Patients who received thrombolysis had better outcomes compared to non-thrombolysis cohort. Further studies are needed to investigate the economics of stroke thrombolysis in Hong Kong, which may help to improve funding for provision of this service.
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Affiliation(s)
- Edward H C Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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von Reutern GM, Goertler MW, Bornstein NM, Del Sette M, Evans DH, Hetzel A, Kaps M, Perren F, Razumovky A, von Reutern M, Shiogai T, Titianova E, Traubner P, Venketasubramanian N, Wong LKS, Yasaka M. Grading carotid stenosis using ultrasonic methods. Stroke 2012; 43:916-21. [PMID: 22343647 DOI: 10.1161/strokeaha.111.636084] [Citation(s) in RCA: 206] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The controversy as to whether Doppler ultrasonic methods should play a role in clinical decision-making in the prevention of stroke is attributable to reported disagreement between angiographic and ultrasonic results and the lack of internationally accepted ultrasound criteria for describing the degree of stenosis. Foremost among the explanations for both is the broad scatter of peak systolic velocities in the stenosis, the criterion that has so far received most attention. Grading based on a set of main and additional criteria can overcome diagnostic errors. Morphological measurements (B-mode images and color flow imaging) are the main criteria for low and moderate degrees of stenosis. Increased velocities in the stenosis indicate narrowing, but the appearance of collateral flow and decreased poststenotic flow velocity prove a high degree stenosis (≥70%), additionally allowing the estimation of the hemodynamic effect in the category of high-degree stenosis. Additional criteria refer to the effect of a stenosis on prestenotic flow (common carotid artery), the extent of poststenotic flow disturbances, and derived velocity criteria (diastolic peak velocity and the carotid ratio). This multiparametric approach is intended to increase the reliability and the standard of reporting of ultrasonic results for arteriosclerotic disease of the carotid artery.
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Jin H, Zhu S, Wei JW, Wang J, Liu M, Wu Y, Wong LKS, Cheng Y, Xu E, Yang Q, Anderson CS, Huang Y. Factors associated with prehospital delays in the presentation of acute stroke in urban China. Stroke 2012; 43:362-70. [PMID: 22246693 DOI: 10.1161/strokeaha.111.623512] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [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 AND PURPOSE Low rates of thrombolysis for ischemic stroke in China have mainly been attributed to delays in presentation to the hospital. This study aimed to evaluate factors associated with these delays. METHODS Data were from a prospective, multicenter, hospital-based registry of patients with acute stroke (ChinaQUEST [Quality Evaluation of Stroke Care and Treatment]), which involved 62 hospitals across a variety of economic and geographic regions in China during 2006. Univariate and multivariate analyses were undertaken to determine associations between variables of interest and delays to hospital presentation. RESULTS Median time to hospital presentation was 15.0 hours for 6102 cases (interquartile range, 2.8-51.0 hours). A total of 1546 (25%) patients arrived within 3 hours and 2244 (37%) patients arrived within 6 hours after symptom onset. Factors that prolonged time to presentation were: visiting a local doctor before presenting at emergency (OR, 0.48; P<0.001), symptom onset at home (OR, 0.62; P<0.001), transfer to a large (Level III) hospital for management (OR, 0.70; P=0.04), and history of diabetes (OR, 0.78; P=0.01). In contrast, factors that accelerated presentation to the hospital were hemorrhagic stroke (OR, 2.25; P<0.001), history of atrial fibrillation (OR, 1.94; P<0.001), unconsciousness at presentation (OR, 1.91; P<0.001), transfer by ambulance (OR, 1.91; P<0.001), and history of coronary artery disease (OR, 1.20; P=0.04). CONCLUSIONS Health promotion strategies to improve community awareness of early symptoms of stroke, establishment of an alert system to cater for patients likely to experience stroke at home, and wider availability and use of ambulance services are promising methods to help expedite presentation to hospital poststroke and thereby improve the management of stroke in China.
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Affiliation(s)
- Haiqiang Jin
- Department of Neurology, Peking University First Hospital, Beijing, China
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Xiong YY, Wong A, Mok VCT, Tang WK, Lam WWM, Kwok TCY, Chu WCW, Chan AYY, Wong LKS. Frequency and predictors of proxy-confirmed post-stroke cognitive complaints in lacunar stroke patients without major depression. Int J Geriatr Psychiatry 2011; 26:1144-51. [PMID: 21184437 DOI: 10.1002/gps.2652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 09/20/2010] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Many lacunar stroke patients complained of cognitive decline after stroke. This study aims to investigate the factors underlying post-stroke cognitive complaints in these patients. METHODS Seventy-five consecutive lacunar stroke patients without major depression were recruited for the study. Stroke severity was measured using NIHSS score and MRI was performed during the acute admission period. At 3 months, objective psychometric performance and depressive symptoms were assessed. Post-stroke cognitive complaints were corroborated by a proxy. Using logistic regression we examined the contribution of demographic features, stroke severity, objective psychometric scores, depressive symptoms, and imaging features (white matter lesion volume and infarct measures) to post-stroke cognitive complaints. RESULTS Thirty-two (42.7%) patients had post-stroke cognitive complaints. Patients with post-stroke cognitive complaints had more depressive symptoms and worse psychometric performance than those without. In the multivariate logistic regression model, only the severity of depressive symptoms was independently associated with post-stroke cognitive complaints. CONCLUSIONS This study suggests that post-stroke cognitive complaints are frequent among lacunar stroke patients without major depression and are prominently determined by the subclinical depressive symptomatology.
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Affiliation(s)
- Yun-Yun Xiong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories Hong Kong, China
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Yu SCH, Leung TWH, Lee KT, Hui JWY, Wong LKS. Angioplasty and stenting of atherosclerotic middle cerebral arteries with Wingspan: evaluation of clinical outcome, restenosis, and procedure outcome. AJNR Am J Neuroradiol 2011; 32:753-8. [PMID: 21436335 DOI: 10.3174/ajnr.a2363] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MCA is a common location of intracranial stenosis. It is relatively more peripherally located and of a smaller caliber, and could therefore be a site technically more challenging and risky for angioplasty and stenting. The study aimed to evaluate the clinical outcome, restenosis rate, and procedural safety of Wingspan stent placement for atherosclerosis in the MCA compared with stenosis in other arteries. MATERIALS AND METHODS Patients who underwent Wingspan stent placement for symptomatic intracranial stenosis of ≥70% (or stenosis of ≥50% for recurrent ischemia despite medical therapy) were recruited prospectively and allocated into a study group (MCA stenosis, n=35) and a control group (other stenosis, n=25). Primary end points were the following: 1) all stroke or death rate at 1 year, and 2) significant in-stent restenosis rate at 1 year. Secondary end points were the following: 1) periprocedural complications within 24 hours, rate of TIA during the procedure, all stroke or death rate within 30 days; and 2) the inability to complete the procedure due to technical problems. RESULTS Results of study group versus the control group were the following: degree of stenosis, 78.4 ± 10.9% versus 72.5 ± 11.2% (P value=.0456); diameter of stenosis, 0.6 ± 0.3 versus 1.0 ± 0.5 mm (P=.0017); all stroke or death rate at 1 year, 14.3% versus 12% (OR=1.22); in-stent restenosis rate at 1 year, 10% versus 10.5% (OR=1.05); periprocedural complication rate at 24 hours, 2.9% versus 4% (OR=0.70); TIA rate during the procedure, 8.6% versus 4% (OR=2.25); all stroke or death rate at 30 days, 5.7% versus 12% (OR=0.44); and technical failure rate, 2.9% versus 0%. CONCLUSIONS In this study, there were no significant differences in procedural safety, patient outcome, and restenosis rates of stent placement between the group with MCA stenosis and the group with stenoses located at other sites.
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Affiliation(s)
- S C H Yu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing St, Shatin, Hong Kong, China.
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Leung TW, Lau AYL, Graham CA, Wong EHC, Soo YOY, Wong LKS. Thrombolysis for acute ischaemic stroke is evidence-based. Hong Kong Med J 2011; 17:168. [PMID: 21471605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
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Wei JW, Huang Y, Wang JG, Liu M, Wong LKS, Huang Q, Wu L, Heeley EL, Arima H, Anderson CS. Current management of intracerebral haemorrhage in China: a national, multi-centre, hospital register study. BMC Neurol 2011; 11:16. [PMID: 21276264 PMCID: PMC3040709 DOI: 10.1186/1471-2377-11-16] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 01/30/2011] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We aimed to examine current practice of the management and secondary prevention of intracerebral haemorrhage (ICH) in China where the disease is more common than in Western populations. METHODS Data on baseline characteristics, management in-hospital and post-stroke, and outcome of ICH patients are from the ChinaQUEST (QUality Evaluation of Stroke Care and Treatment) study, a multi-centre, prospective, 62 hospital registry in China during 2006-07. RESULTS Nearly all ICH patients (n = 1572) received an intravenous haemodiluting agent such as mannitol (96%) or a neuroprotectant (72%), and there was high use of intravenous traditional Chinese medicine (TCM) (42%). Neurosurgery was undertaken in 137 (9%) patients; being overweight, having a low Glasgow Coma Scale (GCS) score on admission, and Total Anterior Circulation Syndrome (TACS) clinical pattern on admission, were the only baseline factors associated with this intervention in multivariate analyses. Neurosurgery was associated with nearly three times higher risk of death/disability at 3 months post-stroke (odd ratio [OR] 2.60, p < 0.001). Continuation of antihypertensives in-hospital and at 3 and 12 months post-stroke was reported in 732/935 (78%), 775/935 (83%), and 752/935 (80%) living patients with hypertension, respectively. CONCLUSIONS The management of ICH in China is characterised by high rates of use of intravenous haemodiluting agents, neuroprotectants, and TCM, and of antihypertensives for secondary prevention. The controversial efficacy of these therapies, coupled with the current lack of treatments of proven benefit, is a call for action for more outcomes based research in ICH.
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Affiliation(s)
- Jade W Wei
- The George Institute for Global Health, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia.
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Huang Y, Wang JG, Wei JW, Headley AP, Wong LKS, Heeley EL, Arima H, Sun J, Li Q, Liu M, Li Z, Wu L, Cheng Y, Huang Q, Zhang S, Xu E, Yang Q, Lu C, Anderson CS. Age and gender variations in the management of ischaemic stroke in China. Int J Stroke 2011; 5:351-9. [PMID: 20854617 DOI: 10.1111/j.1747-4949.2010.00460.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Stroke is a major health issue in China. AIMS We aimed to describe the management of patients admitted to hospitals in China with acute ischaemic stroke, and to determine whether there were any differences by age and gender. METHODS Using a multicentre prospective hospital register across all eight major economic (geographic) regions in China, data on the socioeconomic characteristics, medical history, clinical features, and in-hospital investigations, management, and outcomes were collected on consecutive patients with acute stroke due to cerebral ischaemia during a 5-month period in 2006. RESULTS Overall, traditional Chinese medicine and neuroprotectant use were remarkably high, with nearly 80% of patients receiving the former and >70% receiving the latter in hospital. Length of hospital stay was also long (median duration 16-days). Multivariate analyses revealed no clinically important differences in management between the genders. For the age-specific analyses, there were significant trends of decreasing use of thrombolysis (P=0·04), warfarin (P=0·01), corticosteroids (P=0·03), and lipid-lowering therapy (P=0·001); however, more assisted feeding (P=0·004) and rising rates of disability and in-hospital complications occurred with increasing age. CONCLUSIONS New information is provided regarding the current state of ischaemic stroke management in China. Notably, there is high use of traditional Chinese medicine and neuroprotectants and long lengths of hospital stay. Similar to many other countries, differences in stroke care and management by age and gender also exist to a small extent in China.
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Affiliation(s)
- Yining Huang
- Department of Neurology, Peking University First Hospital, Beijing, China
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Abstract
OBJECTIVE Based on its efficacy in treating neuropathic pain, gabapentin may be effective for the treatment of carpal tunnel syndrome (CTS). The purpose of this study was to evaluate the efficacy of gabapentin for symptom relief in CTS. METHODS We conducted a randomized, double-blinded, placebo-controlled trial recruiting patients with newly diagnosed idiopathic CTS of more than a period of three months. Diagnosis was based on characteristic symptoms with electrophysiological confirmation. Patients were randomly assigned to an active group receiving gabapentin (starting dose 300 mg once daily to a target of 900 mg daily) or a placebo group. Primary end-point was the global symptom score (GSS), which was measured at baseline, two, and eight weeks. RESULTS There was no significant difference in baseline variables between the two treatment groups. Hundred and forty patients were enrolled in the study, of whom 71 were randomly assigned to gabapentin group and 69 assigned to placebo group. Both gabapentin and placebo produced significant improvement in symptoms at two and eight weeks. The GSS at 2 and 8 weeks was 16.4 (SD 9.4) and 13.4 (SD 9.7), respectively, in the active group versus 14.9 (SD 9.0) and 12.5 (SD 8.9) in the control group (P < 0.01). But by eight weeks, the mean reduction in symptom severity of patients on gabapentin [-10.4 (SD 10.8)] was not significant when compared with placebo [-8.7 (SD 8.1), P < 0.39]. Adverse events were not severe and included dizziness, somnolence, and headache. CONCLUSIONS Gabapentin did not produce a significant reduction in symptom severity compared with placebo over an eight-week period.
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Affiliation(s)
- A C F Hui
- Department of Medicine, Electrodiagnostic Unit, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
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Lau AYL, Soo YOY, Graham CA, Woo WK, Wong EHC, Leung H, Chan AYY, Au LWC, Ip VHL, Leung CSF, Hui V, Shum WC, Abrigo J, Siu DYW, Yu SCH, Wong LKS, Leung TW. An expedited stroke triage pathway: the key to shortening the door-to-needle time in delivery of thrombolysis. Hong Kong Med J 2010; 16:455-462. [PMID: 21135422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
OBJECTIVES To assess time management of stroke thrombolysis triage and functional outcomes in patients receiving recombinant tissue plasminogen activator for hyperacute stroke, and identify bottlenecks in delivery of the treatment. DESIGN Prospective study. SETTING A university teaching hospital in Hong Kong. PATIENTS Patients with suspected hyperacute stroke referred to the stroke thrombolysis team during October 2008 to September 2009. MAIN OUTCOME MEASURES Time performance records including door-to-stroke team, door-to-needle, and onset-to-thrombolysis times. Functional outcomes by modified Rankin Scale score at 3 months, and thrombolysis-related complications including haemorrhagic transformations and mortality. RESULTS During the 12-month period, 95 thrombolysis calls were received; recombinant tissue plasminogen activator was given intravenously to 17 (18%) of the patients and intra-arterially to 11 (12%). The mean (standard deviation) door-to-stroke team and the door-to-needle times for intravenous recombinant tissue plasminogen activator patients were 33 (25) and 80 (25) minutes, respectively; both were about 20 minutes longer than that recommended by the National Institute of Neurological Disorders and Stroke. The mean National Institute of Health Stroke Scale score for patients received intravenous recombinant tissue plasminogen activator was 16 (standard deviation, 7). The mean (standard deviation) onset-to-treatment time was 144 (42) minutes. Nine (53%) patients who received intravenous recombinant tissue plasminogen activator achieved favourable outcomes at 3 months, with a modified Rankin Scale score of 0 to 1. Symptomatic haemorrhage and mortality occurred in one (6%) patient. CONCLUSION A dedicated stroke triage pathway is essential to ensure efficient and safe delivery of thrombolysis therapy. Improvements in door-to-stroke team time through integration with emergency medicine staff and neuroradiologists may improve thrombolysis eligibility.
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Affiliation(s)
- A Y L Lau
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong
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Wong A, Xiong YY, Kwan PWL, Chan AYY, Lam WWM, Wang K, Chu WCW, Nyenhuis DL, Nasreddine Z, Wong LKS, Mok VCT. The validity, reliability and clinical utility of the Hong Kong Montreal Cognitive Assessment (HK-MoCA) in patients with cerebral small vessel disease. Dement Geriatr Cogn Disord 2009; 28:81-7. [PMID: 19672065 DOI: 10.1159/000232589] [Citation(s) in RCA: 203] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS To evaluate the psychometric properties of the Hong Kong Montreal Cognitive Assessment (HK-MoCA) in patients with cerebral small vessel disease (SVD). METHODS 40 SVD patients and 40 matched controls were recruited. Concurrent and criterion validity, inter-rater and test-retest reliability, internal consistency of the HK-MoCA were examined and clinical observations were made. RESULTS Performance on the HK-MoCA was significantly predicted by both executive (beta = 0.23, p = 0.013) and non-executive (beta = 0.64, p < 0.001) composite scores. It differentiated SVD patients from controls (area under the curve = 0.81, p < 0.001) with an optimal cutoff at 21/22. Reliability, internal consistency and clinical utility were good. CONCLUSION The HK-MoCA is a useful cognitive screening instrument for use in SVD patients.
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Affiliation(s)
- Adrian Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China
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Lee DHF, Leung TW, Yu SCH, Chan JWS, Wong LKS. Subclavian steal syndrome. Hong Kong Med J 2009; 15:311-312. [PMID: 19652245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Affiliation(s)
- David H F Lee
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong
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Mok VCT, Lau AYL, Wong A, Lam WWM, Chan A, Leung H, Wong E, Soo Y, Leung T, Wong LKS. Long-term prognosis of Chinese patients with a lacunar infarct associated with small vessel disease: a five-year longitudinal study. Int J Stroke 2009; 4:81-8. [PMID: 19383047 DOI: 10.1111/j.1747-4949.2009.00262.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
RATIONALE Lacunar infarct associated with small vessel disease is a common stroke subtype in China and has a favorable short-term prognosis. Data on its long-term prognosis among Chinese patients are lacking. AIMS We aimed to study its long-term prognosis and predictors for poor outcomes. DESIGN We followed up to 75 consecutive Chinese stroke patients who had a lacunar infarct for a period of 5 years. Clinical outcomes with respect to mortality and recurrent stroke were noted. We evaluated baseline clinical and imaging predictors for such outcomes using the Cox regression analysis. STUDY OUTCOMES Sixteen (21.3%) patients died and 12 (16%) patients had recurrent stroke during follow-up. Twenty-one (28%) patients had combined events of either death and/or recurrent stroke. Univariate Cox regression analysis showed that age, literacy, National Institute of Health Stroke Scale, incident stroke/transient ischemic attack, and white matter lesion volume predicted survival, while, age, National Institute of Health Stroke Scale, systolic blood pressure, hyperhomocysteinemia, silent lacunes, microbleeds, and white matter lesion volume predicted recurrent stroke. Multivariate Cox regression analysis showed that National Institute of Health Stroke Scale (HR 1.25, 95% CI 1.05-1.48) and white matter lesion volume (HR 1.46, 95% CI 1.11-1.92) predicted combined events of mortality and/or recurrent stroke after age adjustment. CONCLUSION Approximately one in four patients either died and/or had recurrent stroke within 5 years after a lacunar infarct. Age, stroke severity, and volume of white matter lesion predict a poor long-term prognosis.
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Affiliation(s)
- Vincent C T Mok
- Department of Medicine and Therapeutics, Division of Neurology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
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