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Lim A, Ma H, Johnston SC, Singhal S, Muthusamy S, Wang Y, Pan Y, Coutts SB, Hill MD, Ois A, Kapral MK, Knoflach M, Woodhouse LJ, Bath PM, Phan TG. Ninety-Day Stroke Recurrence in Minor Stroke: Systematic Review and Meta-Analysis of Trials and Observational Studies. J Am Heart Assoc 2024; 13:e032471. [PMID: 38641856 DOI: 10.1161/jaha.123.032471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/18/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Risk of recurrence after minor ischemic stroke is usually reported with transient ischemic attack. No previous meta-analysis has focused on minor ischemic stroke alone. The objective was to evaluate the pooled proportion of 90-day stroke recurrence for minor ischemic stroke, defined as a National Institutes of Health Stroke Scale severity score of ≤5. METHODS AND RESULTS Published papers found on PubMed from 2000 to January 12, 2021, reference lists of relevant articles, and experts in the field were involved in identifying relevant studies. Randomized controlled trials and observational studies describing minor stroke cohort with reported 90-day stroke recurrence were selected by 2 independent reviewers. Altogether 14 of 432 (3.2%) studies met inclusion criteria. Multilevel random-effects meta-analysis was performed. A total of 6 randomized controlled trials and 8 observational studies totaling 45 462 patients were included. The pooled 90-day stroke recurrence was 8.6% (95% CI, 6.5-10.7), reducing by 0.60% (95% CI, 0.09-1.1; P=0.02) with each subsequent year of publication. Recurrence was lowest in dual antiplatelet trial arms (6.3%, 95% CI, 4.5-8.0) when compared with non-dual antiplatelet trial arms (7.2%, 95% CI, 4.7-9.6) and observational studies 10.6% (95% CI, 7.0-14.2). Age, hypertension, diabetes, ischemic heart disease, or known atrial fibrillation had no significant association with outcome. Defining minor stroke with a lower National Institutes of Health Stroke Scale threshold made no difference - score ≤3: 8.6% (95% CI, 6.0-11.1), score ≤4: 8.4% (95% CI, 6.1-10.6), as did excluding studies with n<500%-7.3% (95% CI, 5.5-9.0). CONCLUSIONS The risk of recurrence after minor ischemic stroke is declining over time but remains important.
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Affiliation(s)
- Andy Lim
- School of Clinical Sciences at Monash Health Monash University Melbourne Victoria Australia
- Department of Emergency Medicine Monash Health Melbourne Victoria Australia
| | - Henry Ma
- School of Clinical Sciences at Monash Health Monash University Melbourne Victoria Australia
- Department of Neurology Monash Health Melbourne Victoria Australia
| | | | - Shaloo Singhal
- School of Clinical Sciences at Monash Health Monash University Melbourne Victoria Australia
- Department of Neurology Monash Health Melbourne Victoria Australia
| | - Subramanian Muthusamy
- School of Clinical Sciences at Monash Health Monash University Melbourne Victoria Australia
- Department of Neurology Monash Health Melbourne Victoria Australia
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Centre for Neurological Diseases Beijing China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Centre for Neurological Diseases Beijing China
| | - Shelagh B Coutts
- Department of Clinical Neurosciences, Radiology and Community Health Sciences Hotchkiss Brain Institute, University of Calgary Alberta Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Radiology and Community Health Sciences Hotchkiss Brain Institute, University of Calgary Alberta Canada
| | - Angel Ois
- Servicio de Neurologı'a, Hospital del Mar Barcelona Spain
| | - Moira K Kapral
- Department of Medicine University of Toronto Ontario Canada
| | - Michael Knoflach
- Department of Neurology Innsbruck Medical University Innsbruck Austria
| | - Lisa J Woodhouse
- Stroke Trials Unit, Mental Health & Clinical Neuroscience University of Nottingham, Queen's Medical Centre Nottingham United Kingdom
| | - Philip M Bath
- Stroke Trials Unit, Mental Health & Clinical Neuroscience University of Nottingham, Queen's Medical Centre Nottingham United Kingdom
| | - Thanh G Phan
- School of Clinical Sciences at Monash Health Monash University Melbourne Victoria Australia
- Department of Neurology Monash Health Melbourne Victoria Australia
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Singh N, Kenney C, Butcher K, Buck B, Barber PA, Field TS, Choi P, Yu AYX, Kleinig T, Appireddy R, Molina CA, Muir KW, Hill MD, Coutts SB. A Randomized Controlled Trial of Tenecteplase Versus Standard of Care for Minor Ischemic Stroke With Proven Occlusion (TEMPO-2): Rational and design of a multicenter, randomized open-label clinical trial. Int J Stroke 2024:17474930241253702. [PMID: 38676572 DOI: 10.1177/17474930241253702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
BACKGROUND Almost half of acute ischemic stroke patients present with mild symptoms and there are large practice variations in their treatment globally. Individuals with an intracranial occlusion who present with minor stroke are at an increased risk of early neurological deterioration and poor outcomes. Individual patient data meta-analysis in the subgroup of patients with minor deficits showed benefit of alteplase in improving outcomes, however, this benefit has not been seen with intravenous alteplase in published randomized trials. DESIGN TEMPO-2 (A Randomized Controlled Trial of tenecteplase Versus Standard of Care for Minor Ischemic Stroke With Proven Occlusion) is a prospective, open label with blinded outcome assessment, randomized controlled trial, designed to test the superiority of intravenous tenecteplase (0.25mg/kg) over non thrombolytic standard of care, with an estimated sample size of 1274 patients. Adult patients presenting with acute ischemic stroke with NIHSS <5 and visible arterial occlusion or perfusion deficit within 12 hours of onset are randomized to receive either tenecteplase (0.25 mg/kg) or standard of care. The primary outcome is return to baseline neurological functioning, measured by the modified Rankin Scale (mRS) at 90 days. Safety outcomes include death and symptomatic hemorrhage (intra or extra-cranial). Other secondary outcomes include mRS 0-1, mRS 0-2, ordinal shift analysis of the mRS, partial and full recanalization on follow up CT Angiogram. CONCLUSION Results of this trial will aid in determining whether there is benefit of using tenecteplase (0.25mg/kg) in treating patients presenting with minor stroke who are at high risk of developing poor outcomes due to presence of an intracranial occlusion. TRIAL REGISTRY NAME A Randomized Controlled Trial of tenecteplase Versus Standard of Care for Minor Ischemic Stroke With Proven Occlusion, Registration number: NCT02398656; URL: https://clinicaltrials.gov/study/NCT02398656.
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Affiliation(s)
- Nishita Singh
- Department of Internal Medicine (Neurology Division), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Carol Kenney
- University of Calgary, Department of Neurosciences, Radiology and Community Health Sciences, Calgary, Canada
| | - Kenneth Butcher
- School of Clinical Medicine, University of New South Wales, Australia
| | - Brian Buck
- University of Alberta, Division of Neurology, Department of Medicine, Edmonton, Canada
| | - Philip A Barber
- University of Calgary, Department of Neurosciences, Radiology and Community Health Sciences, Calgary, Canada
| | - Thalia Shoshana Field
- Vancouver Stroke Program, Division of Neurology, University of British Columbia, Vancouver, Canada
| | - Philip Choi
- Department of Neurosciences, Box Hill Hospital, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Amy Ying Xin Yu
- Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre, ON, Canada
| | - Tim Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ramana Appireddy
- Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | | | - Keith W Muir
- School of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Michael D Hill
- University of Calgary, Department of Neurosciences, Radiology and Community Health Sciences, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine Calgary, Canada
- Department of Medicine, Department of Radiology, Cumming School of Medicine
| | - Shelagh B Coutts
- University of Calgary, Department of Neurosciences, Radiology and Community Health Sciences, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine Calgary, Canada
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Moores M, Joundi RA, Singh N, Penn AM, Votova K, Smith EE, Coutts SB. Magnetic Resonance Imaging Assists With Determining Etiology After Transient Ischemic Attack or Minor Stroke. J Am Heart Assoc 2024; 13:e033817. [PMID: 38533977 DOI: 10.1161/jaha.123.033817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/16/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Magnetic resonance imaging infarct topography may assist with determining stroke etiology. The influence of diffusion-weighted imaging (DWI)-positive lesions on etiology determination in patients with transient ischemic attack or minor stroke is not well studied. METHODS AND RESULTS We prospectively enrolled patients between 2010 and 2017 in 2 studies; participants with a final diagnosis of probable or definite transient ischemic attack or stroke were pooled for analysis. The primary outcome was the adjudicated ischemic etiology. We compared proportion of each etiology (cardioembolic, large-vessel, small-vessel disease, other) in patients who had DWI positivity compared with DWI negativity. We used logistic regression to determine the adjusted odds ratio (OR) for each etiology compared with undetermined by DWI positivity. The final analysis included 1498 patients: 832 (55.5%) were DWI-positive. DWI-positive patients were more likely to be diagnosed with small-vessel disease (19.1% versus 5.3%) and less likely with undetermined etiology (36.9% versus 53.0%; P<0.001). After adjustment, the presence of any DWI lesion was associated with increased odds of assigning any etiology (OR, 1.8 [95% CI, 1.3-2.5]). A single DWI lesion was associated with increased odds of small-vessel disease diagnosis (OR, 9.5 [95% CI, 6.4-14.0]), and multiple DWI lesions with reduced odds of small-vessel disease (OR, 0.2 [95% CI, 0.1-0.4]) but increased odds of all other etiologies compared with undetermined etiology. CONCLUSIONS Any DWI-positive lesion after suspected transient ischemic attack or minor stroke was associated with increased odds of assigning a etiology. Presence and topography of DWI lesions on magnetic resonance imaging may assist with etiology determination and may impact stroke prevention therapies.
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Affiliation(s)
- Margaret Moores
- Kelowna General Hospital & University of British Columbia Kelowna British Columbia Canada
| | - Raed A Joundi
- Faculty of Health Sciences McMaster University Hamilton Ontario Canada
| | - Nishita Singh
- Department of Internal Medicine (Neurology Division), Rady Faculty of Health Sciences University of Manitoba Winnipeg Manitoba Canada
| | - Andrew M Penn
- Stroke Rapid Assessment Unit, Island Health Victoria British Columbia Canada
| | - Kristine Votova
- Island Health Regional Health Authority, Division of Medical Sciences University of Victoria Victoria British Columbia Canada
| | - Eric E Smith
- Department of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine University of Calgary Calgary Alberta Canada
| | - Shelagh B Coutts
- Department of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine University of Calgary Calgary Alberta Canada
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Khan F, Coutts SB, Hill MD. Letter by Khan et al Regarding Article, "Long-Term Incidence of Ischemic Stroke After Transient Ischemic Attack: A Nationwide Study from 2014 to 2020". Circulation 2024; 149:797-798. [PMID: 38437480 DOI: 10.1161/circulationaha.123.067840] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Affiliation(s)
- Faizan Khan
- Department of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, AB, Canada (F.K., S.B.C., M.D.H.)
- Public Health Agency of Canada, Ottawa, ON (F.K.)
| | - Shelagh B Coutts
- Department of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, AB, Canada (F.K., S.B.C., M.D.H.)
| | - Michael D Hill
- Department of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, AB, Canada (F.K., S.B.C., M.D.H.)
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Bala F, Almekhlafi M, Singh N, Alhabli I, Ademola A, Coutts SB, Deschaintre Y, Khosravani H, Appireddy R, Moreau F, Phillips S, Gubitz G, Tkach A, Catanese L, Dowlatshahi D, Medvedev G, Mandzia J, Pikula A, Shankar J, Williams H, Field TS, Manosalva A, Siddiqui M, Zafar A, Imoukhoude O, Hunter G, Benali F, Horn M, Hill MD, Shamy M, Sajobi TT, Buck BH, Swartz RH, Menon BK, Poppe AY. Safety and efficacy of tenecteplase versus alteplase in stroke patients with carotid tandem lesions: Results from the AcT trial. Int J Stroke 2024; 19:322-330. [PMID: 37731173 PMCID: PMC10903116 DOI: 10.1177/17474930231205208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Carotid tandem lesions ((TL) ⩾70% stenosis or occlusion) account for 15-20% of acute stroke with large vessel occlusion. AIMS We investigated the safety and efficacy of intravenous tenecteplase (0.25 mg/kg) versus intravenous alteplase (0.9 mg/kg) in patients with carotid TL. METHODS This is a substudy of the alteplase compared with the tenecteplase trial. Patients with ⩾70% stenosis of the extracranial internal carotid artery (ICA) and concomitant occlusion of the intracranial ICA, M1 or M2 segments of the middle cerebral artery on baseline computed tomography angiography (CTA) were included. Primary outcome was 90-day-modified Rankin Scale (mRS) 0-1. Secondary outcomes were mRS 0-2, mortality, and symptomatic ICH (sICH). Angiographic outcomes were successful recanalization (revised Arterial Occlusive Lesion (rAOL) 2b-3) on first and successful reperfusion (eTICI 2b-3) on final angiographic acquisitions. Multivariable mixed-effects logistic regression was performed. RESULTS Among 1577 alteplase versus tenecteplase randomized controlled trial (AcT) patients, 128 (18.8%) had carotid TL. Of these, 93 (72.7%) underwent intravenous thrombolysis plus endovascular thrombectomy (IVT + EVT), while 35 (27.3%) were treated with IVT alone. In the IVT + EVT group, tenecteplase was associated with higher odds of 90-day-mRS 0-1 (46.0% vs. 32.6%, adjusted OR (aOR) 3.21; 95% CI = 1.06-9.71) compared with alteplase. No statistically significant differences in rates of mRS 0-2 (aOR 1.53; 95% CI = 0.51-4.55), initial rAOL 2b-3 (16.3% vs. 28.6%), final eTICI 2b-3 (83.7% vs. 85.7%), and mortality (18.0% vs. 16.3%) were found. SICH only occurred in one patient. There were no differences in outcomes between thrombolytic agents in the IVT-only group. CONCLUSION In patients with carotid TL treated with EVT, intravenous tenecteplase may be associated with similar or better clinical outcomes, similar angiographic reperfusion rates, and safety outcomes as compared with alteplase.
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Affiliation(s)
- Fouzi Bala
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
| | - Mohammed Almekhlafi
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Nishita Singh
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Ibrahim Alhabli
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Ayoola Ademola
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Shelagh B Coutts
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Yan Deschaintre
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
| | - Houman Khosravani
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Ramana Appireddy
- Division of Neurology, Department of Medicine, Queen’s University, Kingston, ON, Canada
| | | | | | - Gord Gubitz
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | | | - Luciana Catanese
- Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Dar Dowlatshahi
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - George Medvedev
- The University of British Columbia, Vancouver, BC, Canada
- Fraser Health Authority, New Westminster, BC, Canada
| | - Jennifer Mandzia
- London Health Sciences Centre, Western University, London, ON, Canada
| | - Aleksandra Pikula
- Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Jay Shankar
- University of Manitoba, Winnipeg, MB, Canada
| | | | - Thalia S Field
- Vancouver Stroke Program, Division of Neurology, The University of British Columbia, Vancouver, BC, Canada
| | | | | | - Atif Zafar
- St. Michael’s Hospital, Toronto, ON, Canada
| | | | - Gary Hunter
- University of Saskatchewan, Saskatoon, SK, Canada
| | - Faysal Benali
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - MacKenzie Horn
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Michel Shamy
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Tolulope T Sajobi
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Brian H Buck
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Richard H Swartz
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Bijoy K Menon
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Alexandre Y Poppe
- Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada
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6
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Sajobi TT, Arimoro OI, Ademola A, Singh N, Bala F, Almekhlafi MA, Deschaintre Y, Coutts SB, Thirunavukkarasu S, Khosravani H, Appireddy R, Moreau F, Gubitz GJ, Tkach A, Catanese L, Dowlatshahi D, Medvedev G, Mandzia J, Pikula A, Shankar JS, Williams H, Field TS, Manosalva A, Siddiqui M, Zafar A, Imoukhuede O, Hunter G, Demchuk AM, Mishra SM, Gioia LC, Jalini S, Cayer C, Phillips SJ, Elamin E, Shoamanesh A, Subramaniam S, Kate MP, Jacquin G, Camden MC, Benali F, Alhabli I, Horn M, Stotts G, Hill MD, Gladstone DJ, Poppe AY, Sehgal A, Zhang Q, Lethebe B, Doram C, Shamy M, Kenney C, Buck BH, Swartz RH, Menon BK. Quality of Life After Intravenous Thrombolysis for Acute Ischemic Stroke: Results From the AcT Randomized Controlled Trial. Stroke 2024; 55:524-531. [PMID: 38275116 DOI: 10.1161/strokeaha.123.044690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 11/30/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Recent evidence from thrombolysis trials indicates the noninferiority of intravenous tenecteplase to intravenous alteplase with respect to good functional outcomes in patients with acute stroke. We examined whether the health-related quality of life (HRQOL) of patients with acute stroke differs by the type of thrombolysis treatment received. In addition, we examined the association between the modified Rankin Scale score 0 to 1 and HRQOL and patient-reported return to prebaseline stroke functioning at 90 days. METHODS Data were from all patients included in the AcT trial (Alteplase Compared to Tenecteplase), a pragmatic, registry-linked randomized trial comparing tenecteplase with alteplase. HRQOL at 90-day post-randomization was assessed using the 5-item EuroQOL questionnaire (EQ5D), which consists of 5 items and a visual analog scale (VAS). EQ5D index values were estimated from the EQ5D items using the time tradeoff approach based on Canadian norms. Tobit regression and quantile regression models were used to evaluate the adjusted effect of tenecteplase versus alteplase treatment on the EQ5D index values and VAS score, respectively. The association between return to prebaseline stroke functioning and the modified Rankin Scale score 0 to 1 and HRQOL was quantified using correlation coefficient (r) with 95% CI. RESULTS Of 1577 included in the intention-to-treat analysis patients, 1503 (95.3%) had complete data on the EQ5D. Of this, 769 (51.2%) were administered tenecteplase and 717 (47.7%) were female. The mean EQ5D VAS score and EQ5D index values were not significantly higher for those who received intravenous tenecteplase compared with those who received intravenous alteplase (P=0.10). Older age (P<0.01), more severe stroke assessed using the National Institutes of Health Stroke Scale (P<0.01), and longer stroke onset-to-needle time (P=0.004) were associated with lower EQ5D index and VAS scores. There was a strong association (r, 0.85 [95% CI, 0.81-0.89]) between patient-reported return to prebaseline functioning and modified Rankin Scale score 0 to 1 Similarly, there was a moderate association between return to prebaseline functioning and EQ5D index (r, 0.45 [95% CI, 0.40-0.49]) and EQ5D VAS scores (r, 0.42 [95% CI, 0.37-0.46]). CONCLUSIONS Although there is no differential effect of thrombolysis type on patient-reported global HRQOL and EQ 5D-5L index values in patients with acute stroke, sex- and age-related differences in HRQOL were noted in this study. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03889249.
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Affiliation(s)
- Tolulope T Sajobi
- Department of Community Health Sciences, University of Calgary, AB, Canada (T.T.S., O.I.A., A.A., M.A.A., S.B.C., A.M.D., M.D.H., B.L., B.K.M.)
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Olayinka I Arimoro
- Department of Community Health Sciences, University of Calgary, AB, Canada (T.T.S., O.I.A., A.A., M.A.A., S.B.C., A.M.D., M.D.H., B.L., B.K.M.)
| | - Ayoola Ademola
- Department of Community Health Sciences, University of Calgary, AB, Canada (T.T.S., O.I.A., A.A., M.A.A., S.B.C., A.M.D., M.D.H., B.L., B.K.M.)
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Nishita Singh
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (N.S., J.S.S.)
- University of Manitoba, Winnipeg, Canada (N.S., J.S.S.)
| | - Fouzi Bala
- Department of Diagnostic and Interventional Neuroradiology, Tours University Hospital, France (F. Bala)
| | - Mohammed A Almekhlafi
- Department of Community Health Sciences, University of Calgary, AB, Canada (T.T.S., O.I.A., A.A., M.A.A., S.B.C., A.M.D., M.D.H., B.L., B.K.M.)
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Radiology (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Hotchkiss Brain Institute, Calgary, AB, Canada (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.)
| | - Yan Deschaintre
- Département of Neurosciences, Université de Montréal, QC, Canada (Y.D., L.C.G., G.J., A.Y.P.)
- Centre Hospitalier de l'Université de Montréal, QC, Canada (Y.D., L.C.G., G.J., A.Y.P.)
| | - Shelagh B Coutts
- Department of Community Health Sciences, University of Calgary, AB, Canada (T.T.S., O.I.A., A.A., M.A.A., S.B.C., A.M.D., M.D.H., B.L., B.K.M.)
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Radiology (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Hotchkiss Brain Institute, Calgary, AB, Canada (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.)
| | - Sibi Thirunavukkarasu
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (S.T., S.M.M., M.P.K., B.H.B.)
| | - Houman Khosravani
- Division of Neurology, Department of Medicine, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada (H.K., D.J.G., R.H.S.)
| | - Ramana Appireddy
- Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada (R.A., S.J.)
| | | | - Gordon J Gubitz
- Queen Elizabeth Health Sciences Centre, Halifax, NS, Canada (G.J.G., S.J.P., A. Shoamanesh)
| | | | - Luciana Catanese
- Hamilton Health Sciences Centre, McMaster University, Hamilton, ON, Canada (L.C.)
| | - Dar Dowlatshahi
- Department of Medicine, Ottawa Heart Research Institute, University of Ottawa, ON, Canada (D.D., M. Shamy)
| | - George Medvedev
- Department of Medicine, University of British Columbia & Fraser Health Authority, New Westminster, BC, Canada (G.M., G.S.)
- University of British Columbia, Fraser Health Authority, New Westminster, BC, Canada (G.M., G.S.)
| | - Jennifer Mandzia
- London Health Sciences Centre and Western University, ON, Canada (J.M.)
| | | | - Jai Shiva Shankar
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (N.S., J.S.S.)
- University of Manitoba, Winnipeg, Canada (N.S., J.S.S.)
| | | | - Thalia S Field
- Vancouver Stroke Program, Division of Neurology, The University of British Columbia, Vancouver, Canada (T.S.F.)
| | | | | | - Atif Zafar
- St. Michael's Hospital, Toronto, ON, Canada (A.Z.)
| | | | - Gary Hunter
- University of Saskatchewan, Saskatoon, Canada (G.H.)
| | - Andrew M Demchuk
- Department of Community Health Sciences, University of Calgary, AB, Canada (T.T.S., O.I.A., A.A., M.A.A., S.B.C., A.M.D., M.D.H., B.L., B.K.M.)
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Radiology (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Sachin M Mishra
- Hotchkiss Brain Institute, Calgary, AB, Canada (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.)
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (S.T., S.M.M., M.P.K., B.H.B.)
| | - Laura C Gioia
- Département of Neurosciences, Université de Montréal, QC, Canada (Y.D., L.C.G., G.J., A.Y.P.)
- Centre Hospitalier de l'Université de Montréal, QC, Canada (Y.D., L.C.G., G.J., A.Y.P.)
| | - Shirin Jalini
- Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada (R.A., S.J.)
| | - Caroline Cayer
- Centre de recherche du CHUS, Centre intégré Universitaire de Santé et des Services Sociaux de l'Estrie, Sherbrooke, QC, Canada (C.C.)
| | - Stephen J Phillips
- Queen Elizabeth Health Sciences Centre, Halifax, NS, Canada (G.J.G., S.J.P., A. Shoamanesh)
| | | | - Ashkan Shoamanesh
- Queen Elizabeth Health Sciences Centre, Halifax, NS, Canada (G.J.G., S.J.P., A. Shoamanesh)
| | - Suresh Subramaniam
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Mahesh P Kate
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (S.T., S.M.M., M.P.K., B.H.B.)
| | - Gregory Jacquin
- Département of Neurosciences, Université de Montréal, QC, Canada (Y.D., L.C.G., G.J., A.Y.P.)
- Centre Hospitalier de l'Université de Montréal, QC, Canada (Y.D., L.C.G., G.J., A.Y.P.)
| | - Marie-Christine Camden
- Enfant-Jésus Hospital, Centre Hospitalier Universitaire de Québec, Laval University, Canada (M.-C.C.)
| | - Faysal Benali
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Ibrahim Alhabli
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - MacKenzie Horn
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Grant Stotts
- Department of Medicine, University of British Columbia & Fraser Health Authority, New Westminster, BC, Canada (G.M., G.S.)
- University of British Columbia, Fraser Health Authority, New Westminster, BC, Canada (G.M., G.S.)
| | - Michael D Hill
- Department of Community Health Sciences, University of Calgary, AB, Canada (T.T.S., O.I.A., A.A., M.A.A., S.B.C., A.M.D., M.D.H., B.L., B.K.M.)
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Radiology (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Hotchkiss Brain Institute, Calgary, AB, Canada (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.)
| | - David J Gladstone
- Division of Neurology, Department of Medicine, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada (H.K., D.J.G., R.H.S.)
| | - Alexandre Y Poppe
- Département of Neurosciences, Université de Montréal, QC, Canada (Y.D., L.C.G., G.J., A.Y.P.)
- Centre Hospitalier de l'Université de Montréal, QC, Canada (Y.D., L.C.G., G.J., A.Y.P.)
| | - Arshia Sehgal
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Qiao Zhang
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Brendan Lethebe
- Department of Community Health Sciences, University of Calgary, AB, Canada (T.T.S., O.I.A., A.A., M.A.A., S.B.C., A.M.D., M.D.H., B.L., B.K.M.)
| | - Craig Doram
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Michel Shamy
- Department of Medicine, Ottawa Heart Research Institute, University of Ottawa, ON, Canada (D.D., M. Shamy)
| | - Carol Kenney
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
| | - Brian H Buck
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (S.T., S.M.M., M.P.K., B.H.B.)
| | - Richard H Swartz
- Division of Neurology, Department of Medicine, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada (H.K., D.J.G., R.H.S.)
| | - Bijoy K Menon
- Department of Community Health Sciences, University of Calgary, AB, Canada (T.T.S., O.I.A., A.A., M.A.A., S.B.C., A.M.D., M.D.H., B.L., B.K.M.)
- Department of Clinical Neurosciences (T.T.S., A.A., M.A.A., S.B.C., A.M.D., S.S., F. Benali, I.A., M.H., M.D.H., A. Sehgal, Q.Z., C.D., C.K., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Department of Radiology (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.), Cumming School of Medicine, University of Calgary, AB, Canada
- Hotchkiss Brain Institute, Calgary, AB, Canada (M.A.A., S.B.C., A.M.D., M.D.H., B.K.M.)
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7
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Lim A, Rothwell PM, Li L, Coutts SB, Hill MD, Guarino M, Barone V, Rondelli F, Kleinig T, Cornell-Farrow R, Krause M, Wronski M, Singhal S, Ma H, Phan TG. Rapid outpatient transient ischemic attack clinic and stroke service activity during the SARS-CoV-2 pandemic: a multicenter time series analysis. Front Neurol 2024; 15:1351769. [PMID: 38385034 PMCID: PMC10879819 DOI: 10.3389/fneur.2024.1351769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/23/2024] [Indexed: 02/23/2024] Open
Abstract
Background and aim Rapid outpatient evaluation and treatment of TIA in structured clinics have been shown to reduce stroke recurrence. It is unclear whether short-term downtrends in TIA incidence and admissions have had enduring impact on TIA clinic activity. This study aims to measure the impact of the pandemic on hospitals with rapid TIA clinics. Methods Relevant services were identified by literature search and contacted. Three years of monthly data were requested - a baseline pre-COVID period (April 2018 to March 2020) and an intra-COVID period (April 2020 to March 2021). TIA presentations, ischemic stroke presentations, and reperfusion trends inclusive of IV thrombolysis (IVT) and endovascular thrombectomy (EVT) were recorded. Pandemic impact was measured with interrupted time series analysis, a segmented regression approach to test an effect of an intervention on a time-dependent outcome using a defined impact model. Results Six centers provided data for a total of 6,231 TIA and 13,191 ischemic stroke presentations from Australia (52.1%), Canada (35.0%), Italy (7.6%), and England (5.4%). TIA clinic volumes remained constant during the pandemic (2.9, 95% CI -1.8 to 7.6, p = 0.24), as did ischemic stroke (2.9, 95% CI -7.8 to 1.9, p = 0.25), IVT (-14.3, 95% CI -36.7, 6.1, p < 0.01), and EVT (0, 95% CI -16.9 to 16.9, p = 0.98) counts. Proportion of ischemic strokes requiring IVT decreased from 13.2 to 11.4% (p < 0.05), but those requiring EVT did not change (16.0 to 16.7%, p = 0.33). Conclusion This suggests that the pandemic has not had an enduring effect on TIA clinic or stroke service activity for these centers. Furthermore, the disproportionate decrease in IVT suggests that patients may be presenting outside the IVT window during the pandemic - delays in seeking treatment in this group could be the target for public health intervention.
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Affiliation(s)
- Andy Lim
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Peter M. Rothwell
- Wolfson Center for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Linxin Li
- Wolfson Center for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Shelagh B. Coutts
- Departments of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Michael D. Hill
- Departments of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Maria Guarino
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Valentina Barone
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | | | - Timothy Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Martin Krause
- Department of Neurology, Royal North Shore Hospital and Kolling Institute, University of Sydney, St Leonards, NSW, Australia
| | - Miriam Wronski
- Department of Neurology, Royal North Shore Hospital and Kolling Institute, University of Sydney, St Leonards, NSW, Australia
| | - Shaloo Singhal
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Monash Health, Melbourne, VIC, Australia
| | - Henry Ma
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Monash Health, Melbourne, VIC, Australia
| | - Thanh G. Phan
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Monash Health, Melbourne, VIC, Australia
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8
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Kim DJ, Singh N, Catanese L, Yu AYX, Demchuk AM, Lloret-Villas MI, Deschaintre Y, Coutts SB, Khosravani H, Appireddy R, Moreau F, Gubitz G, Tkach A, Dowlatshahi D, Medvedev G, Mandzia J, Pikula A, Shankar J, Williams H, Manosalva H, Siddiqui M, Zafar A, Imoukhuede O, Hunter G, Phillips S, Hill MD, Poppe AY, Ademola A, Shamy M, Bala F, Sajobi TT, Swartz RH, Almekhlafi MA, Menon BK, Field TS. Sex-Based Analysis of Workflow and Outcomes in Acute Ischemic Stroke Patients Treated With Alteplase Versus Tenecteplase. Stroke 2024; 55:288-295. [PMID: 38174568 DOI: 10.1161/strokeaha.123.045320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Understanding sex differences in stroke care is important in reducing potential disparities. Our objective was to explore sex differences in workflow efficiency, treatment efficacy, and safety in the AcT trial (Alteplase Compared to Tenecteplase). METHODS AcT was a multicenter, registry-linked randomized noninferiority trial comparing tenecteplase (0.25 mg/kg) with alteplase (0.9 mg/kg) in acute ischemic stroke within 4.5 hours of onset. In this post hoc analysis, baseline characteristics, workflow times, successful reperfusion (extended Thrombolysis in Cerebral Infarction score ≥2b), symptomatic intracerebral hemorrhage, 90-day functional independence (modified Rankin Scale score, 0-1), and 90-day mortality were compared by sex. Mixed-effects regression analysis was used adjusting for age, stroke severity, and occlusion site for outcomes. RESULTS Of 1577 patients treated with intravenous thrombolysis (2019-2022), 755 (47.9%) were women. Women were older (median, 77 [68-86] years in women versus 70 [59-79] years in men) and had a higher proportion of severe strokes (National Institutes of Health Stroke Scale score >15; 32.4% versus 24.9%) and large vessel occlusions (28.7% versus 21.5%) compared with men. All workflow times were comparable between sexes. Women were less likely to achieve functional independence (31.7% versus 39.8%; unadjusted relative risk, 0.80 [95% CI, 0.70-0.91]) and had higher mortality (17.7% versus 13.3%; unadjusted relative risk, 1.33 [95% CI, 1.06-1.69]). Adjusted analysis showed no difference in outcomes between sexes. CONCLUSIONS Differences in prognostic factors of age, stroke severity, and occlusion site largely accounted for higher functional dependence and mortality in women. No sex disparities were apparent in workflow quality indicators. Given the integration of the AcT trial into clinical practice, these results provide reassurance that no major sex biases are apparent in acute stroke management throughout participating Canadian centers. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03889249.
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Affiliation(s)
- Diana J Kim
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Nishita Singh
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada (N.S., J.S.)
| | - Luciana Catanese
- Hamilton Health Sciences Centre, McMaster University, Hamilton, ON, Canada (L.C.)
| | - Amy Y X Yu
- Division of Neurology, Sunnybrook Health Sciences Centre (A.Y.X.Y., H.K., R.H.S.), University of Toronto, ON, Canada
| | - Andrew M Demchuk
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | | | - Yan Deschaintre
- Department of Neurosciences, Université de Montréal, QC, Canada (Y.D.)
| | - Shelagh B Coutts
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Houman Khosravani
- Division of Neurology, Sunnybrook Health Sciences Centre (A.Y.X.Y., H.K., R.H.S.), University of Toronto, ON, Canada
| | - Ramana Appireddy
- Division of Neurology, Queen's University, Kingston, ON, Canada (R.A.)
| | | | - Gord Gubitz
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (G.G., S.P.)
| | | | - Dar Dowlatshahi
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada (D.D., M. Shamy)
| | - George Medvedev
- Royal Columbian Hospital, New Westminster, BC, Canada (G.M.)
| | - Jennifer Mandzia
- London Health Sciences Centre, Western University, London, ON, Canada (J.M.)
| | | | - Jai Shankar
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada (N.S., J.S.)
| | | | | | | | - Atif Zafar
- St Michael's Hospital, Toronto, ON, Canada (A.Z.)
| | | | - Gary Hunter
- University of Saskatchewan, Saskatoon, Canada (G.H.)
| | - Stephen Phillips
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (G.G., S.P.)
| | - Michael D Hill
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | | | - Ayoola Ademola
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Michel Shamy
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada (D.D., M. Shamy)
| | - Fouzi Bala
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Tolulope T Sajobi
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Richard H Swartz
- Division of Neurology, Sunnybrook Health Sciences Centre (A.Y.X.Y., H.K., R.H.S.), University of Toronto, ON, Canada
| | - Mohammed A Almekhlafi
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Bijoy K Menon
- Department of Clinical Neurosciences, Cumming School of Medicine (D.J.K., A.M.D., S.B.C., M.D.H., A.A., F.B., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., M.A.A., B.K.M.), University of Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine (A.M.D., S.B.C., M.D.H., A.A., T.T.S., M.A.A., B.K.M.), University of Calgary, AB, Canada
| | - Thalia S Field
- Vancouver Stroke Program, Division of Neurology, The University of British Columbia, Vancouver, Canada (T.S.F.)
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9
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Healey JS, Lopes RD, Granger CB, Alings M, Rivard L, McIntyre WF, Atar D, Birnie DH, Boriani G, Camm AJ, Conen D, Erath JW, Gold MR, Hohnloser SH, Ip J, Kautzner J, Kutyifa V, Linde C, Mabo P, Mairesse G, Benezet Mazuecos J, Cosedis Nielsen J, Philippon F, Proietti M, Sticherling C, Wong JA, Wright DJ, Zarraga IG, Coutts SB, Kaplan A, Pombo M, Ayala-Paredes F, Xu L, Simek K, Nevills S, Mian R, Connolly SJ. Apixaban for Stroke Prevention in Subclinical Atrial Fibrillation. N Engl J Med 2024; 390:107-117. [PMID: 37952132 DOI: 10.1056/nejmoa2310234] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
BACKGROUND Subclinical atrial fibrillation is short-lasting and asymptomatic and can usually be detected only by long-term continuous monitoring with pacemakers or defibrillators. Subclinical atrial fibrillation is associated with an increased risk of stroke by a factor of 2.5; however, treatment with oral anticoagulation is of uncertain benefit. METHODS We conducted a trial involving patients with subclinical atrial fibrillation lasting 6 minutes to 24 hours. Patients were randomly assigned in a double-blind, double-dummy design to receive apixaban at a dose of 5 mg twice daily (2.5 mg twice daily when indicated) or aspirin at a dose of 81 mg daily. The trial medication was discontinued and anticoagulation started if subclinical atrial fibrillation lasting more than 24 hours or clinical atrial fibrillation developed. The primary efficacy outcome, stroke or systemic embolism, was assessed in the intention-to-treat population (all the patients who had undergone randomization); the primary safety outcome, major bleeding, was assessed in the on-treatment population (all the patients who had undergone randomization and received at least one dose of the assigned trial drug, with follow-up censored 5 days after permanent discontinuation of trial medication for any reason). RESULTS We included 4012 patients with a mean (±SD) age of 76.8±7.6 years and a mean CHA2DS2-VASc score of 3.9±1.1 (scores range from 0 to 9, with higher scores indicating a higher risk of stroke); 36.1% of the patients were women. After a mean follow-up of 3.5±1.8 years, stroke or systemic embolism occurred in 55 patients in the apixaban group (0.78% per patient-year) and in 86 patients in the aspirin group (1.24% per patient-year) (hazard ratio, 0.63; 95% confidence interval [CI], 0.45 to 0.88; P = 0.007). In the on-treatment population, the rate of major bleeding was 1.71% per patient-year in the apixaban group and 0.94% per patient-year in the aspirin group (hazard ratio, 1.80; 95% CI, 1.26 to 2.57; P = 0.001). Fatal bleeding occurred in 5 patients in the apixaban group and 8 patients in the aspirin group. CONCLUSIONS Among patients with subclinical atrial fibrillation, apixaban resulted in a lower risk of stroke or systemic embolism than aspirin but a higher risk of major bleeding. (Funded by the Canadian Institutes of Health Research and others; ARTESIA ClinicalTrials.gov number, NCT01938248.).
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Affiliation(s)
- Jeff S Healey
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Renato D Lopes
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Christopher B Granger
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Marco Alings
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Lena Rivard
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - William F McIntyre
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Dan Atar
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - David H Birnie
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Giuseppe Boriani
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - A John Camm
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - David Conen
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Julia W Erath
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Michael R Gold
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Stefan H Hohnloser
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - John Ip
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Josef Kautzner
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Valentina Kutyifa
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Cecilia Linde
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Philippe Mabo
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Georges Mairesse
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Juan Benezet Mazuecos
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Jens Cosedis Nielsen
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Francois Philippon
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Marco Proietti
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Christian Sticherling
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Jorge A Wong
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - David J Wright
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Ignatius G Zarraga
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Shelagh B Coutts
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Andrew Kaplan
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Marta Pombo
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Felix Ayala-Paredes
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Lizhen Xu
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Kim Simek
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Sandra Nevills
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Rajibul Mian
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
| | - Stuart J Connolly
- From the Population Health Research Institute, McMaster University, Hamilton, ON (J.S.H., W.F.M., D.C., J.A.W., L.X., K.S., S.N., R.M., S.J.C.), the Montreal Heart Institute, University of Montreal, Montreal (L.R.), the University of Ottawa Heart Institute, Ottawa (D.H.B.), Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, QC (F.P.), the Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB (S.B.C.), and the Université de Sherbrooke, Sherbrooke, QC (F.A.-P.) - all in Canada; the Duke Clinical Research Institute, Duke University, Durham, NC (R.D.L., C.B.G.); Amphia Ziekenhuis, Breda, the Netherlands (M.A.); Oslo University Hospital and the University of Oslo, Oslo (D.A.); the University of Modena and Reggio Emilia, Modena (G.B.), and the Department of Clinical Sciences and Community Health, University of Milan, and the Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan (M. Proietti) - all in Italy; St. George's, University of London, London (A.J.C.), and Liverpool Heart and Chest Hospital, Liverpool (D.J.W.) - both in the United Kingdom; J.W. Goethe University, University Hospital Department of Cardiology, Frankfurt, Germany (J.W.E., S.H.H.); the Medical University of South Carolina, Charleston (M.R.G.); Michigan State University, Lansing (J.I.); the Institute for Clinical and Experimental Medicine, Prague, Czech Republic (J.K.); the University of Rochester, Rochester, NY (V.K.); Semmelweis University, Budapest, Hungary (V.K.); Karolinska Institutet and the Heart, Vascular, and Neurology Theme, Karolinska University Hospital, Stockholm (C.L.); the University of Rennes, Rennes, France (P.M.); Cliniques du Sud-Luxembourg, Arlon, Belgium (G.M.); Hospital Universitario La Luz, Madrid (J.B.M.), and Hospital Costa del Sol, Marbella (M. Pombo) - both in Spain; Aarhus University Hospital and Aarhus University, Aarhus, Denmark (J.C.N.); University Hospital Basel, University of Basel, Basel, Switzerland (C.S.); the Veterans Affairs Portland Health Care System, Portland, OR (I.G.Z.); and Abrazo Arrowhead Hospital, Glendale, AZ (A.K.)
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Tanaka K, Coutts SB, Joundi RA, Singh N, Uehara T, Ohara T, Koga M, Koge J, Toyoda K, Penn AM, Balshaw RF, Bibok MMB, Votova K, Smith EE, Minematsu K, Demchuk AM. Presenting Symptoms and Diffusion-Weighted MRI Positivity by Time After Transient Neurologic Events: A Pooled Analysis of 3 Cohort Studies. Neurology 2024; 102:e207846. [PMID: 38165379 PMCID: PMC10834141 DOI: 10.1212/wnl.0000000000207846] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/27/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVE The association between focal vs nonfocal presenting symptom and diffusion-weighted imaging (DWI) positivity in relation to onset-to-imaging time in patients with transient neurologic events remains unclear. We hypothesize that episodes consisting of focal symptoms would have proportionally higher DWI-positive imaging at later onset-to-imaging times. METHODS Patients with transient neurologic symptoms and a normal neurologic examination who had DWI in the combined data set of 3 cohort studies were included. We used logistic regression models to evaluate the association between each type of presenting symptom (motor weakness, speech impairment, sensory symptoms, vision loss, diplopia, gait instability, dizziness, headache, presyncope, and amnesia) and DWI positivity after adjusting for clinical variables (age, sex, history of stroke, dyslipidemia, coronary artery disease, atrial fibrillation, symptoms duration [<10, 10-59, ≥60 minutes, or unclear], and study source). We stratified the results by onset-to-imaging time categories (<6 hours, 6-23 hours, and ≥24 hours). RESULTS Of the total 2,411 patients (1,345 male, median age 68 years), DWI-positive lesions were detected in 598 patients (24.8%). The prevalence of DWI positivity was highest in those with motor weakness (34.7%), followed by speech impairment (33.5%). In a multivariable analysis, the presence of motor weakness, speech impairment, and sensory symptoms was associated with DWI positivity, while vision loss and headache were associated with lower odds of DWI positivity, but nevertheless had 13.6% and 15.3% frequency of DWI positive. The odds of being DWI positive varied by onset-to-imaging time categories for motor weakness, with greater odds of being DWI positive at later imaging time (<6 hours: odds ratio [OR] 1.25, 95% confidence interval [CI] 0.84-1.87; 6-23 hours: OR 2.24, 95% CI 1.47-3.42; and ≥24 hours: OR 2.42, 95% CI 1.74-3.36; interaction p = 0.033). Associations of other symptoms with DWI positivity did not vary significantly by time categories. DISCUSSION We found that onset-to-imaging time influences the relationship between motor weakness and DWI positivity in patients with transient neurologic events. Compared with motor, speech, and sensory symptoms, visual or nonfocal symptoms carry a lower but still a substantive association with DWI positivity.
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Affiliation(s)
- Koji Tanaka
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Shelagh B Coutts
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Raed A Joundi
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Nishita Singh
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Tohiyuki Uehara
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Tomoyuki Ohara
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Masatoshi Koga
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Junpei Koge
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Kazunori Toyoda
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Andrew M Penn
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Robert F Balshaw
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Maximilian M B Bibok
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Kristine Votova
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Eric E Smith
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Kazuo Minematsu
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
| | - Andrew M Demchuk
- From the Department of Clinical Neurosciences (K. Tanaka, S.B.C., N.S., E.E.S., A.M.D.), Radiology (S.B.C., E.E.S., A.M.D), Community Health Sciences (S.B.C.), and Hotchikiss Brain Institute (S.B.C., E.E.S., A.M.D.), Cumming School of Medicine, University of Calgary, Calgary, Canada; Rady Faculty of Health Sciences (N.S.), University of Manitoba, Winnipeg, Canada; Division of Neurology (R.A.J.), Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, Canada; Department of Cerebrovascular Medicine (T.U., T.O., M.K., J.K., K. Toyoda, K.M.), National Cerebral and Cardiovascular Center, Suita, Japan; Stroke Rapid Assessment Unit (A.M.P.), Island Health, Victoria; George & Fay Yee Centre for Healthcare Innovation (R.F.B.), University of Manitoba, Winnipeg; Department of Research and Capacity Building (M.M.B.), Island Health, Victoria; Island Health Regional Health Authority, Division of Medical Sciences (K.V.), University of Victoria, Victoria, Canada
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Singh N, Almekhlafi MA, Bala F, Ademola A, Coutts SB, Deschaintre Y, Khosravani H, Buck B, Appireddy R, Moreau F, Gubitz G, Tkach A, Catanese L, Dowlatshahi D, Medvedev G, Mandzia J, Pikula A, Shankar JJ, Ghrooda E, Poppe AY, Williams H, Field TS, Manosalva A, Siddiqui MM, Zafar A, Imoukhoude O, Hunter G, Shamy M, Demchuk AM, Claggett BL, Hill MD, Sajobi TT, Swartz RH, Menon BK. Effect of Time to Thrombolysis on Clinical Outcomes in Patients With Acute Ischemic Stroke Treated With Tenecteplase Compared to Alteplase: Analysis From the AcT Randomized Controlled Trial. Stroke 2023; 54:2766-2775. [PMID: 37800372 DOI: 10.1161/strokeaha.123.044267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/23/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND The AcT (Alteplase Compared to Tenecteplase) randomized controlled trial showed that tenecteplase is noninferior to alteplase in treating patients with acute ischemic stroke within 4.5 hours of symptom onset. The effect of time to treatment on clinical outcomes with alteplase is well known; however, the nature of this relationship is yet to be described with tenecteplase. We assessed whether the association of time to thrombolysis treatment with clinical outcomes in patients with acute ischemic stroke differs by whether they receive intravenous tenecteplase versus alteplase. METHODS Patients included were from AcT, a pragmatic, registry-linked, phase 3 randomized controlled trial comparing intravenous tenecteplase to alteplase in patients with acute ischemic stroke. Eligible patients were >18 years old, with disabling neurological deficits, presenting within 4.5 hours of symptom onset, and eligible for thrombolysis. Primary outcome was modified Rankin Scale score 0 to 1 at 90 days. Safety outcomes included 24-hour symptomatic intracerebral hemorrhage and 90-day mortality rates. Mixed-effects logistic regression was used to assess the following: (a) the association of stroke symptom onset to needle time; (b) door (hospital arrival) to needle time with outcomes; and (c) if these associations were modified by type of thrombolytic administered (tenecteplase versus alteplase), after adjusting for age, sex, baseline stroke severity, and site of intracranial occlusion. RESULTS Of the 1538 patients included in this analysis, 1146 (74.5%; 591 tenecteplase and 555 alteplase) presented within 3 hours versus 392 (25.5%; 196: TNK and 196 alteplase) who presented within 3 to 4.5 hours of symptom onset. Baseline patient characteristics in the 0 to 3 hours versus 3- to 4.5-hour time window were similar, except patients in the 3- to 4.5-hour window had lower median baseline National Institutes of Health Stroke Severity Scale (10 versus 7, respectively) and lower proportion of patients with large vessel occlusion on baseline CT angiography (26.9% versus 18.7%, respectively). Type of thrombolytic agent (tenecteplase versus alteplase) did not modify the association between continuous onset to needle time (Pinteraction=0.161) or door-to-needle time (Pinteraction=0.972) and primary clinical outcome. Irrespective of the thrombolytic agent used, each 30-minute reduction in onset to needle time was associated with a 1.8% increase while every 10 minutes reduction in door-to-needle time was associated with a 0.2% increase in the probability of achieving 90-day modified Rankin Scale score 0 to 1, respectively. CONCLUSIONS The effect of time to tenecteplase administration on clinical outcomes is like that of alteplase, with faster administration resulting in better clinical outcomes. REGISTRATION URL: https://classic. CLINICALTRIALS gov; Unique identifier: NCT03889249.
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Affiliation(s)
- Nishita Singh
- Department of Neurosciences, Radiology and Community Health Sciences, University of Calgary, Canada (N.S., M.A.A., A.A., S.B.C., A.M.D., M.D.H., T.T.S., B.K.M.)
- Department of Internal Medicine (Neurology Division), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada (N.S., E.G.)
| | - Mohammed A Almekhlafi
- Department of Neurosciences, Radiology and Community Health Sciences, University of Calgary, Canada (N.S., M.A.A., A.A., S.B.C., A.M.D., M.D.H., T.T.S., B.K.M.)
- Department of Community Health Sciences, University of Calgary, Canada (M.A.A., A.A., S.B.C., M.D.H., T.T.S., B.K.M.)
- Department of Radiology, University of Calgary, Canada (M.A.A., F.B., S.B.C., M.D.H., B.K.M.)
| | - Fouzi Bala
- Department of Radiology, University of Calgary, Canada (M.A.A., F.B., S.B.C., M.D.H., B.K.M.)
- Diagnostic and Interventional Neuroradiology, Tours University Hospital, France (F.B.)
| | - Ayoola Ademola
- Department of Neurosciences, Radiology and Community Health Sciences, University of Calgary, Canada (N.S., M.A.A., A.A., S.B.C., A.M.D., M.D.H., T.T.S., B.K.M.)
- Department of Community Health Sciences, University of Calgary, Canada (M.A.A., A.A., S.B.C., M.D.H., T.T.S., B.K.M.)
| | - Shelagh B Coutts
- Department of Neurosciences, Radiology and Community Health Sciences, University of Calgary, Canada (N.S., M.A.A., A.A., S.B.C., A.M.D., M.D.H., T.T.S., B.K.M.)
- Department of Community Health Sciences, University of Calgary, Canada (M.A.A., A.A., S.B.C., M.D.H., T.T.S., B.K.M.)
- Department of Radiology, University of Calgary, Canada (M.A.A., F.B., S.B.C., M.D.H., B.K.M.)
| | - Yan Deschaintre
- Department of Clinical Neurosciences, Université de Montréal, Canada (Y.D., A.Y.P.)
| | - Houman Khosravani
- Department of Medicine, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, Canada (H.K., R.H.S.)
| | - Brian Buck
- Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Canada (B.B.)
| | - Ramana Appireddy
- Department of Medicine, Division of Neurology, Queen's University, Kingston, ON, Canada (R.A.)
| | - Francois Moreau
- Department of Internal Medicine, Université de Sherbrooke, QC, Canada (F.M.)
| | - Gord Gubitz
- Queen Elizabeth Health Sciences Centre, Halifax, NS, Canada (G.G.)
| | - Aleksander Tkach
- Department of Neurosciences, Kelowna General Hospital, Canada (A.T.)
| | - Luciana Catanese
- Department of Medicine, McMaster University, Hamilton, Canada (L.C.)
| | - Dar Dowlatshahi
- Department of Medicine, and Ottawa Hospital Research Institute, University of Ottawa, Canada (D.D., M.S.)
| | - George Medvedev
- Department of Neurosciences, University of British Columbia, Vancouver, Canada (G.M., T.S.F.)
| | - Jennifer Mandzia
- London Health Sciences Centre and Western University, ON, Canada (J.M.)
| | - Aleksandra Pikula
- London Health Sciences Centre and Western University, ON, Canada (J.M.)
| | - Jai Jai Shankar
- Department of Radiology, Health Sciences Center, University of Manitoba, Winnipeg, Canada (J.J.S.)
| | - Esseeddeegg Ghrooda
- Department of Internal Medicine (Neurology Division), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada (N.S., E.G.)
| | - Alexandre Y Poppe
- Department of Clinical Neurosciences, Université de Montréal, Canada (Y.D., A.Y.P.)
| | - Heather Williams
- Department of Medicine, Queen Elizabeth Health Sciences Centre, Charlottetown, Canada (H.W.)
| | - Thalia S Field
- Department of Neurosciences, University of British Columbia, Vancouver, Canada (G.M., T.S.F.)
| | - Alejandro Manosalva
- Department of Medicine, Medicine Hat Regional Hospital, Calgary, Canada (A.M.)
| | | | - Atif Zafar
- St Michael's Hospital, Toronto, ON, Canada (A.Z.)
| | - Oje Imoukhoude
- Department of Medicine, Red Deer Regional Hospital, Calgary, Canada (O.I.)
| | - Gary Hunter
- Department of Medicine, University of Saskatoon, Canada (G.H.)
| | - Michel Shamy
- Department of Medicine, and Ottawa Hospital Research Institute, University of Ottawa, Canada (D.D., M.S.)
| | - Andrew M Demchuk
- Department of Neurosciences, Radiology and Community Health Sciences, University of Calgary, Canada (N.S., M.A.A., A.A., S.B.C., A.M.D., M.D.H., T.T.S., B.K.M.)
| | - Brian L Claggett
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA (B.L.C.)
| | - Michael D Hill
- Department of Neurosciences, Radiology and Community Health Sciences, University of Calgary, Canada (N.S., M.A.A., A.A., S.B.C., A.M.D., M.D.H., T.T.S., B.K.M.)
- Department of Community Health Sciences, University of Calgary, Canada (M.A.A., A.A., S.B.C., M.D.H., T.T.S., B.K.M.)
- Department of Radiology, University of Calgary, Canada (M.A.A., F.B., S.B.C., M.D.H., B.K.M.)
| | - Tolulope T Sajobi
- Department of Neurosciences, Radiology and Community Health Sciences, University of Calgary, Canada (N.S., M.A.A., A.A., S.B.C., A.M.D., M.D.H., T.T.S., B.K.M.)
- Department of Community Health Sciences, University of Calgary, Canada (M.A.A., A.A., S.B.C., M.D.H., T.T.S., B.K.M.)
| | - Richard H Swartz
- Department of Medicine, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, Canada (H.K., R.H.S.)
| | - Bijoy K Menon
- Department of Neurosciences, Radiology and Community Health Sciences, University of Calgary, Canada (N.S., M.A.A., A.A., S.B.C., A.M.D., M.D.H., T.T.S., B.K.M.)
- Department of Community Health Sciences, University of Calgary, Canada (M.A.A., A.A., S.B.C., M.D.H., T.T.S., B.K.M.)
- Department of Radiology, University of Calgary, Canada (M.A.A., F.B., S.B.C., M.D.H., B.K.M.)
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12
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Rebchuk AD, Hill MD, Goyal M, Demchuk A, Coutts SB, Asdaghi N, Dowlatshahi D, Holodinsky JK, Fainardi E, Shankar J, Najm M, Rubiera M, Khaw AV, Qiu W, Menon BK, Field TS. Exploring sex differences for acute ischemic stroke clinical, imaging and thrombus characteristics in the INTERRSeCT study. J Cereb Blood Flow Metab 2023; 43:1803-1809. [PMID: 37459107 PMCID: PMC10581233 DOI: 10.1177/0271678x231189908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 06/21/2023] [Accepted: 06/24/2023] [Indexed: 10/17/2023]
Abstract
Women, especially following menopause, are known to have worse outcomes following acute ischemic stroke. One primary postulated biological mechanism for worse outcomes in older women is a reduction in the vasculoprotective effects of estrogen. Using the INTERRseCT cohort, a multicentre international observational cohort studying recanalization in acute ischemic stroke, we explored the effects of sex, and modifying effects of age, on neuroradiological predictors of recanalization including robustness of leptomeningeal collaterals, thrombus burden and thrombus permeability. Ordinal regression analyses were used to examine the relationship between sex and each of the neuroradiological markers. Further, we explored both multiplicative and additive interactions between age and sex. All patients (n = 575) from INTERRseCT were included. Mean age was 70.2 years (SD: 13.1) and 48.5% were women. In the unadjusted model, female sex was associated with better collaterals (OR 1.37, 95% CIs: 1.01-1.85), however this relationship was not significant after adjusting for age and relevant comorbidities. There were no significant interactions between age and sex. In a large prospective international cohort, we found no association between sex and radiological predictors of recanalization including leptomeningeal collaterals, thrombus permeability and thrombus burden.
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Affiliation(s)
- Alexander D Rebchuk
- Division of Neurosurgery, University of British Columbia, Vancouver, BC, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Calgary Stroke Program, University of Calgary, Calgary, AB, Canada
| | - Mayank Goyal
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Calgary Stroke Program, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Andrew Demchuk
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Calgary Stroke Program, University of Calgary, Calgary, AB, Canada
| | - Shelagh B Coutts
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Calgary Stroke Program, University of Calgary, Calgary, AB, Canada
| | - Negar Asdaghi
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dar Dowlatshahi
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine (Neurology), University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jessalyn K Holodinsky
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Enrico Fainardi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Jai Shankar
- Department of Radiology, University of Manitoba, Winnipeg, MB, Canada
| | - Mohamed Najm
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marta Rubiera
- Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain
| | - Alexander V Khaw
- Department of Clinical Neurosciences, University of Western Ontario, London, ON, Canada
| | - Wu Qiu
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Bijoy K Menon
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Calgary Stroke Program, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Thalia S Field
- Division of Neurology, University of British Columbia, Vancouver, BC, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Vancouver Stroke Program, Vancouver, BC, Canada
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13
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Bala F, Singh N, Buck B, Ademola A, Coutts SB, Deschaintre Y, Khosravani H, Appireddy R, Moreau F, Phillips S, Gubitz G, Tkach A, Catanese L, Dowlatshahi D, Medvedev G, Mandzia J, Pikula A, Shankar JJ, Williams H, Field TS, Manosalva Alzate A, Siddiqui M, Zafar A, Imoukhoude O, Hunter G, Alhabli I, Benali F, Horn M, Hill MD, Shamy M, Sajobi TT, Swartz RH, Menon BK, Almekhlafi M. Safety and Efficacy of Tenecteplase Compared With Alteplase in Patients With Large Vessel Occlusion Stroke: A Prespecified Secondary Analysis of the ACT Randomized Clinical Trial. JAMA Neurol 2023; 80:824-832. [PMID: 37428494 PMCID: PMC10334294 DOI: 10.1001/jamaneurol.2023.2094] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/28/2023] [Indexed: 07/11/2023]
Abstract
Importance It is unknown whether intravenous thrombolysis using tenecteplase is noninferior or preferable compared with alteplase for patients with acute ischemic stroke. Objective To examine the safety and efficacy of tenecteplase compared to alteplase among patients with large vessel occlusion (LVO) stroke. Design, Setting, and Participants This was a prespecified analysis of the Intravenous Tenecteplase Compared With Alteplase for Acute Ischaemic Stroke in Canada (ACT) randomized clinical trial that enrolled patients from 22 primary and comprehensive stroke centers across Canada between December 10, 2019, and January 25, 2022. Patients 18 years and older with a disabling ischemic stroke within 4.5 hours of symptom onset were randomly assigned (1:1) to either intravenous tenecteplase or alteplase and were monitored for up to 120 days. Patients with baseline intracranial internal carotid artery (ICA), M1-middle cerebral artery (MCA), M2-MCA, and basilar occlusions were included in this analysis. A total of 1600 patients were enrolled, and 23 withdrew consent. Exposures Intravenous tenecteplase (0.25 mg/kg) vs intravenous alteplase (0.9 mg/kg). Main Outcomes and Measures The primary outcome was the proportion of modified Rankin scale (mRS) score 0-1 at 90 days. Secondary outcomes were an mRS score from 0 to 2, mortality, and symptomatic intracerebral hemorrhage. Angiographic outcomes were successful reperfusion (extended Thrombolysis in Cerebral Infarction scale score 2b-3) on first and final angiographic acquisitions. Multivariable analyses (adjusting for age, sex, National Institute of Health Stroke Scale score, onset-to-needle time, and occlusion location) were carried out. Results Among 1577 patients, 520 (33.0%) had LVO (median [IQR] age, 74 [64-83] years; 283 [54.4%] women): 135 (26.0%) with ICA occlusion, 237 (45.6%) with M1-MCA, 117 (22.5%) with M2-MCA, and 31 (6.0%) with basilar occlusions. The primary outcome (mRS score 0-1) was achieved in 86 participants (32.7%) in the tenecteplase group vs 76 (29.6%) in the alteplase group. Rates of mRS 0-2 (129 [49.0%] vs 131 [51.0%]), symptomatic intracerebral hemorrhage (16 [6.1%] vs 11 [4.3%]), and mortality (19.9% vs 18.1%) were similar in the tenecteplase and alteplase groups, respectively. No difference was noted in successful reperfusion rates in the first (19 [9.2%] vs 21 [10.5%]) and final angiogram (174 [84.5%] vs 177 [88.9%]) among 405 patients who underwent thrombectomy. Conclusions and Relevance The findings in this study indicate that intravenous tenecteplase conferred similar reperfusion, safety, and functional outcomes compared to alteplase among patients with LVO.
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Affiliation(s)
- Fouzi Bala
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France
| | - Nishita Singh
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Internal Medicine, Neurology Division, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brian Buck
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ayoola Ademola
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Shelagh B. Coutts
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Yan Deschaintre
- Department of Neurosciences, Université de Montréal, Montréal, Québec, Canada
- Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Houman Khosravani
- Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, Ontario, Canada
| | - Ramana Appireddy
- Division of Neurology, Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| | | | - Stephen Phillips
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Gord Gubitz
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | | | - Luciana Catanese
- Hamilton Health Sciences Centre and McMaster University, Hamilton, Ontario, Canada
| | - Dar Dowlatshahi
- Department of Medicine, University of Ottawa, and the Ottawa Heart Research Institute, Ottawa, Ontario, Canada
| | - George Medvedev
- University of British Columbia and the Fraser Health Authority, New Westminster, British Columbia, Canada
| | - Jennifer Mandzia
- London Health Sciences Centre and Western University, London, Ontario, Canada
| | - Aleksandra Pikula
- Toronto Western Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Jai Jai Shankar
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Heather Williams
- Queen Elizabeth Hospital, Charlottetown, Prince Edward Island, Canada
| | - Thalia S. Field
- Vancouver Stroke Program and the Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Atif Zafar
- St Michael’s Hospital, Toronto, Ontario, Canada
| | | | - Gary Hunter
- Division of Neurology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ibrahim Alhabli
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Faysal Benali
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - MacKenzie Horn
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael D. Hill
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Michel Shamy
- Department of Medicine, University of Ottawa, and the Ottawa Heart Research Institute, Ottawa, Ontario, Canada
| | - Tolulope T. Sajobi
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Richard H. Swartz
- Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, Ontario, Canada
| | - Bijoy K. Menon
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Mohammed Almekhlafi
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
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14
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Soo Y, Zietz A, Yiu B, Mok VCT, Polymeris AA, Seiffge D, Ambler G, Wilson D, Leung TWH, Tsang SF, Chu W, Abrigo J, Cheng C, Lee KJ, Lim JS, Shiozawa M, Koga M, Chabriat H, Hennerici M, Wong YK, Mak H, Collet R, Inamura S, Yoshifuji K, Arsava EM, Horstmann S, Purrucker J, Lam BYK, Wong A, Kim YD, Song TJ, Lemmens R, Eppinger S, Gattringer T, Uysal E, Demirelli DS, Bornstein NM, Assayag EB, Hallevi H, Molad J, Nishihara M, Tanaka J, Coutts SB, Kappelle LJ, Al-Shahi Salman R, Jager R, Lip GYH, Goeldlin MB, Panos LD, Mas JL, Legrand L, Karayiannis C, Phan T, Bellut M, Chappell F, Makin S, Hayden D, Williams D, van Dam-Nolen DHK, Nederkoorn PJ, Barbato C, Browning S, Wiegertjes K, Tuladhar AM, Mendyk AM, Köhler S, van Oostenburgge R, Zhou Y, Xu C, Hilal S, Gyanwali B, Chen C, Lou M, Staals J, Bordet R, Kandiah N, de Leeuw FE, Simister R, Hendrikse J, Wardlaw J, Kelly P, Fluri F, Srikanth V, Calvet D, Jung S, Kwa VIH, Smith EE, Hara H, Yakushiji Y, Orken DN, Fazekas F, Thijs V, Heo JH, Veltkamp R, Ay H, Imaizumi T, Lau KK, Jouvent E, Toyoda K, Yoshimura S, Bae HJ, Martí-Fàbregas J, Prats-Sánchez L, Lyrer P, Best J, Werring D, Engelter ST, Peters N. Impact of Cerebral Microbleeds in Stroke Patients with Atrial Fibrillation. Ann Neurol 2023; 94:61-74. [PMID: 36928609 DOI: 10.1002/ana.26642] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVES Cerebral microbleeds are associated with the risks of ischemic stroke and intracranial hemorrhage, causing clinical dilemmas for antithrombotic treatment decisions. We aimed to evaluate the risks of intracranial hemorrhage and ischemic stroke associated with microbleeds in patients with atrial fibrillation treated with vitamin K antagonists, direct oral anticoagulants, antiplatelets, and combination therapy (i.e. concurrent oral anticoagulant and antiplatelet). METHODS We included patients with documented atrial fibrillation from the pooled individual patient data analysis by the Microbleeds International Collaborative Network. Risks of subsequent intracranial hemorrhage and ischemic stroke were compared between patients with and without microbleeds, stratified by antithrombotic use. RESULTS A total of 7,839 patients were included. The presence of microbleeds was associated with an increased relative risk of intracranial hemorrhage (adjusted hazard ratio [aHR] = 2.74, 95% confidence interval = 1.76-4.26) and ischemic stroke (aHR = 1.29, 95% confidence interval = 1.04-1.59). For the entire cohort, the absolute incidence of ischemic stroke was higher than intracranial hemorrhage regardless of microbleed burden. However, for the subgroup of patients taking combination of anticoagulant and antiplatelet therapy, the absolute risk of intracranial hemorrhage exceeded that of ischemic stroke in those with 2 to 4 microbleeds (25 vs 12 per 1,000 patient-years) and ≥ 11 microbleeds (94 vs 48 per 1,000 patient-years). INTERPRETATION Patients with atrial fibrillation and high burden of microbleeds receiving combination therapy have a tendency of higher rate of intracranial hemorrhage than ischemic stroke, with potential for net harm. Further studies are needed to help optimize stroke preventive strategies in this high-risk group. ANN NEUROL 2023;94:61-74.
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Affiliation(s)
- Yannie Soo
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Annaelle Zietz
- Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Brian Yiu
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vincent C T Mok
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
- Gerald Choa Neuroscience Institute, Margaret K. L. Cheung Research Centre for Management of Parkinsonism, Therese Pei Fong Chow Research Centre for Prevention of Dementia, Lui Che Woo Institute of Innovative Medicine, Li Ka Shing Institute of Health Science, Lau Tat-chuen Research Centre of Brain Degenerative Diseases in Chinese, The Chinese University of Hong Kong, Hong Kong SAR, Hong Kong
| | - Alexandros A Polymeris
- Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Basel, Switzerland
| | - David Seiffge
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Duncan Wilson
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK, New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Thomas Wai Hong Leung
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Suk Fung Tsang
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Winnie Chu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jill Abrigo
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Cyrus Cheng
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Keon-Joo Lee
- Department of Neurology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jae-Sung Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Masayuki Shiozawa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan
| | - Hugues Chabriat
- APHP, Lariboisière Hospital, Translational Neurovascular Centre, F-75475 Paris, France, FHU NeuroVasc, Université de Paris and INSERM U1141, Paris, France
| | - Michael Hennerici
- Department of Neurology, University of Heidelberg/Mannheim Hospital, Mannheim, Germany
| | - Yuen Kwun Wong
- Division of Neurology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Henry Mak
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong, Hong Kong
| | - Roger Collet
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, Barcelona, Spain
| | - Shigeru Inamura
- Department of Neurosurgery, Kushiro City General Hospital, Kushiro, Japan
| | - Kazuhisa Yoshifuji
- Department of Neurosurgery, Kushiro City General Hospital, Kushiro, Japan
| | - Ethem Murat Arsava
- Departments of Neurology and Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Solveig Horstmann
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jan Purrucker
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Bonnie Y K Lam
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
- Gerald Choa Neuroscience Institute, Margaret K. L. Cheung Research Centre for Management of Parkinsonism, Therese Pei Fong Chow Research Centre for Prevention of Dementia, Lui Che Woo Institute of Innovative Medicine, Li Ka Shing Institute of Health Science, Lau Tat-chuen Research Centre of Brain Degenerative Diseases in Chinese, The Chinese University of Hong Kong, Hong Kong SAR, Hong Kong
| | - Adrian Wong
- Gerald Choa Neuroscience Institute, Margaret K. L. Cheung Research Centre for Management of Parkinsonism, Therese Pei Fong Chow Research Centre for Prevention of Dementia, Lui Che Woo Institute of Innovative Medicine, Li Ka Shing Institute of Health Science, Lau Tat-chuen Research Centre of Brain Degenerative Diseases in Chinese, The Chinese University of Hong Kong, Hong Kong SAR, Hong Kong
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Robin Lemmens
- Experimental Neurology, Department of Neurosciences, KU Leuven-University of Leuven, Leuven, Belgium
- VIB Center for Brain & Disease Research, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Sebastian Eppinger
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Ender Uysal
- Antalya Teaching and Research Hospital, Department of Radiology, University of Health Sciences Turkey, Antalya, Turkey
| | - Derya Selçuk Demirelli
- Sisli Hamidiye Etfal Teaching and Research Hospital, Department of Neurology, University of Health Sciences Turkey, Antalya, Turkey
| | - Natan M Bornstein
- Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Einor Ben Assayag
- Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hen Hallevi
- Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jeremy Molad
- Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Masashi Nishihara
- Department of Radiology, Saga University Faculty of Medicine, Saga, Japan
| | - Jun Tanaka
- Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan
| | - Shelagh B Coutts
- Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Rustam Al-Shahi Salman
- Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Rolf Jager
- Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Martina B Goeldlin
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Leonidas D Panos
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Jean-Louis Mas
- GHU-Paris Psychiatrie et Neurosciences, Neurology Department and Stroke Unit, Sainte-Anne Hospital, and Université de Paris Cité, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Laurence Legrand
- GHU-Paris Psychiatrie et Neurosciences, Neuroradiology Department, Sainte-Anne Hospital, and Université Paris Cité, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Chris Karayiannis
- Peninsula Clinical School, Peninsula Health, Monash University, Melbourne, Australia
| | - Thanh Phan
- Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Maximilian Bellut
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Francesca Chappell
- Centre for Clinical Brain Sciences, Edinburgh Imaging, Edinburgh, UK
- UK Dementia Institute at the University of Edinburgh, Edinburgh, UK
| | - Stephen Makin
- Centre for Rural Health, Institute for Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Derek Hayden
- Acute Medical Unit and Department of Age-related Healthcare, Tallaght University Hospital, Dublin, Ireland
| | - David Williams
- Department of Geriatric and Stroke Medicine, RCSI University of Medicine and Health Sciences Dublin, Ireland and Beaumont Hospital Dublin, Dublin, Ireland
| | - Dianne H K van Dam-Nolen
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Carmen Barbato
- Department of Neurology, University of Florence, Firenze, Italy
| | - Simone Browning
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Comprehensive Stroke Service, University College London Hospitals NHS Trust, London, UK
| | - Kim Wiegertjes
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anil Man Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anne-Marie Mendyk
- University of Lille, Inserm, CHU de Lille. Lille Neuroscience & Cognition, Lille, France
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
| | - Robert van Oostenburgge
- Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ying Zhou
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Chao Xu
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Saima Hilal
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Bibek Gyanwali
- Memory Aging & Cognition Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Christopher Chen
- Memory Aging & Cognition Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Min Lou
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Julie Staals
- Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Regis Bordet
- University of Lille, Inserm, CHU de Lille. Lille Neuroscience & Cognition, Lille, France
| | - Nagaendran Kandiah
- Dementia Research Centre (Singapore), Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert Simister
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Comprehensive Stroke Service, University College London Hospitals NHS Trust, London, UK
| | - Jeroen Hendrikse
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joanna Wardlaw
- Division of Neuroimaging Sciences, Edinburgh Imaging, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh and NHS Lothian, Edinburgh, UK
| | - Peter Kelly
- The Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin, Ireland
| | - Felix Fluri
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Velandai Srikanth
- Peninsula Clinical School, Peninsula Health, Monash University, Melbourne, Australia, National Centre for Healthy Ageing, Melbourne, Australia
| | - David Calvet
- GHU-Paris Psychiatrie et Neurosciences, Neurology Department and Stroke Unit, Sainte-Anne Hospital, and Université de Paris Cité, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Simon Jung
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | | | - Eric E Smith
- Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Hideo Hara
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan
| | - Yusuke Yakushiji
- Department of Neurology, Kansai Medical University, Hirakata, Japan
| | | | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
- A.A. Martinos Center for Biomedical Imaging, Departments of Neurology and Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ji-Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Roland Veltkamp
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Neurology, Austin Health, Heidelberg, Australia
| | - Hakan Ay
- Department of Brain Sciences, Imperial College London, London, UK
| | - Toshio Imaizumi
- Department of Neurosurgery, Kushiro City General Hospital, Kushiro, Japan
| | - Kui Kai Lau
- Division of Neurology, Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Shatin, Hong Kong
| | - Eric Jouvent
- Université de Paris-Assistance Publique Hôpitaux de Paris, Paris, France
- Département de Neurologie, Hôpital Lariboisière, FHU NeuroVasc, INSERM NeuroDiderot U1141, Paris, France
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan
| | - Sohei Yoshimura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Joan Martí-Fàbregas
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, Barcelona, Spain
| | - Luis Prats-Sánchez
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, Barcelona, Spain
| | - Philippe Lyrer
- Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jonathan Best
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Comprehensive Stroke Service, University College London Hospitals NHS Trust, London, UK
| | - David Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Comprehensive Stroke Service, University College London Hospitals NHS Trust, London, UK
| | - Stefan T Engelter
- Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Nils Peters
- Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
- Stroke Center, Klinik Hirslanden, Zürich, Switzerland
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15
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Alemseged F, Nguyen TN, Coutts SB, Cordonnier C, Schonewille WJ, Campbell BCV. Endovascular thrombectomy for basilar artery occlusion: translating research findings into clinical practice. Lancet Neurol 2023; 22:330-337. [PMID: 36780915 DOI: 10.1016/s1474-4422(22)00483-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/09/2022] [Accepted: 11/21/2022] [Indexed: 02/12/2023]
Abstract
BACKGROUND Basilar artery occlusion is a rare and severe condition. The effectiveness of endovascular thrombectomy in patients with basilar artery occlusion was unclear until recently, because these patients were excluded from most trials of endovascular thrombectomy for large-vessel occlusion ischaemic stroke. RECENT DEVELOPMENTS The Basilar Artery International Cooperation Study (BASICS) and the Basilar Artery Occlusion Endovascular Intervention versus Standard Medical Treatment (BEST) trials, specifically designed to investigate the benefit of thrombectomy in patients with basilar artery occlusion, did not find significant evidence of a benefit of endovascular thrombectomy in terms of disability outcomes at 3 months after stroke. However, these trials suggested a potential benefit of endovascular thrombectomy in patients presenting with moderate-to-severe symptoms. Subsequently, the Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) and the Basilar Artery Occlusion Chinese Endovascular (BAOCHE) trials, which compared endovascular thrombectomy versus medical therapy within 24 h of onset, showed clear benefit of endovascular thrombectomy in reducing disability and mortality, particularly in patients with moderate-to-severe symptoms. The risk of intracranial haemorrhage with endovascular thrombectomy was similar to the risk in anterior circulation stroke. Thrombectomy was beneficial regardless of age, baseline characteristics, the presence of intracranial atherosclerotic disease, and time from symptom onset to randomisation. Therefore, the question of whether endovascular thrombectomy is beneficial in basilar artery occlusion now appears to be settled in patients with moderate-to-severe symptoms, and endovascular thrombectomy should be offered to eligible patients. WHERE NEXT?: Key outstanding issues are the potential benefits of endovascular thrombectomy in patients with mild symptoms, the use of intravenous thrombolysis in an extended time window (ie, after 4·5 h of symptom onset), and the optimal endovascular technique for thrombectomy. Dedicated training programmes and automated software to assist with the assessment of imaging prognostic markers could be useful in the selection of patients who might benefit from endovascular thrombectomy. Large international research networks should be built to address knowledge gaps in this field and allow the conduct of clinical trials with fast and consecutive enrolment and a diverse ethnic representation.
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Affiliation(s)
- Fana Alemseged
- Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Thanh N Nguyen
- Department of Neurology and Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Shelagh B Coutts
- Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Charlotte Cordonnier
- Université Lille, INSERM UMR-S1172, Centre Hospitalier Universitaire de Lille, Lille Neuroscience et Cognition, Lille, France
| | | | - Bruce C V Campbell
- Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia.
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16
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Jeerakathil TJ, Xin Yu AY, Choi PM, Fang S, Shuaib A, Majumdar SR, Demchuk AM, Butcher K, Watson TJ, Dean N, Gordon D, Hill MD, Edmond C, Coutts SB. Effects of a Province-wide Triaging System for TIA: The ASPIRE Intervention. Neurology 2023; 100:e2093-e2102. [PMID: 36977597 DOI: 10.1212/wnl.0000000000207201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 02/03/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Urgent transient ischemic attack (TIA) management to reduce stroke recurrence is challenging, particularly in rural and remote areas. In Alberta, Canada despite an organized stroke system, data from 1999-2000 suggested that stroke recurrence after TIA was as high as 9.5% at 90 days. Our objective was to determine if a multi-faceted population based intervention resulted in a reduction in recurrent stroke following TIA. METHODS In this quasi-experimental health services research intervention study we implemented a TIA management algorithm across the entire province, centered around a 24-hour physician's TIA Hotline as well as public and health provider education on TIA. From administrative databases we linked emergency department discharge abstracts to hospital discharge abstracts to identify incident TIAs and recurrent strokes at 90 days across a single payer system with validation of recurrent stroke events. The primary outcome was recurrent stroke; with a secondary composite outcome of recurrent stroke, acute coronary syndrome, and all cause death. We used an interrupted time series regression analysis of age and sex-adjusted stroke recurrence rates after TIA incorporating a two-year pre-implementation period (2007-2009), a 15 month implementation period, and a two-year post-implementation period (2010-2012). Logistic regression was used to examine outcomes that did not fit the time series model. RESULTS We assessed 6 715 patients pre- and 6 956 patients post-implementation. The 90-day stroke recurrence rate in the pre-ASPIRE period was 4.5% compared to 5.3% during the post-ASPIRE period. There was neither a step change (estimate 0.38; p=0.65) nor slope change (parameter estimate 0.30; p=0.12) in recurrent stroke rates associated with the ASPIRE intervention implementation period. Adjusted all-cause mortality (OR 0.71 95%CI [0.56, 0.89]) was significantly lower following the ASPIRE intervention. CONCLUSIONS The ASPIRE TIA triaging and management interventions did not further reduce stroke recurrence in the context of an organized stroke system. The apparent lower mortality post intervention may be related to improved surveillance following events identified as TIAs but secular trends cannot be excluded.
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Affiliation(s)
- Thomas J Jeerakathil
- Department of Medicine (Neurology), University of Alberta, Edmonton, AB, Canada
- Alberta Health Services, Edmonton, AB, Canada
| | - Amy Ying Xin Yu
- Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada
| | - Philip Mc Choi
- Department of Neurosciences, Monash University, Melbourne, Australia
| | | | - Ashfaq Shuaib
- Department of Medicine (Neurology), University of Alberta, Edmonton, AB, Canada
- Alberta Health Services, Edmonton, AB, Canada
| | - Sumit R Majumdar
- Division of General Internal Medicine, University of Alberta, Edmonton, AB, Canada
| | - Andrew M Demchuk
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Kenneth Butcher
- Neurology, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Tim J Watson
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Naeem Dean
- Division of General Internal Medicine, University of Alberta, Edmonton, AB, Canada
| | - Deb Gordon
- Alberta Health Services, Edmonton, AB, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | | | - Shelagh B Coutts
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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17
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Martí-Fàbregas J, Camps-Renom P, Best JG, Ramos-Pachon A, Guasch-Jiménez M, Martinez-Domeño A, Guisado-Alonso D, Gómez-Ansón BM, Ambler G, Wilson D, Lee KJ, Lim JS, Bae HJ, Shiozawa M, Koga M, Toyoda K, Hennerici MG, Chabriat H, Jouvent E, Wong DYK, Mak H, Lau KK, Kim YD, Song TJ, Heo JH, Eppinger S, Gattringer T, Uysal E, Demirelli DS, Bornstein N, Ben Assayag E, Hallevi H, Molad JA, Nishihara M, Tanaka J, Hara H, Yakushiji Y, Coutts SB, Smith E, Polymeris AA, Wagner B, Seiffge D, Lyrer PA, Peters N, Engelter ST, Al-Shahi Salman R, Jäger HR, Lip GYH, Goeldlin M, Panos L, Karayiannis CC, Phan TG, Srikanth VK, Christ N, Gunkel S, Fluri F, Leung TW, Soo YOY, Chu W, Abrigo J, Barbato C, Browning S, Simister R, Mendyk AM, Bordet R, Hilal S, Gyanwali B, Chen C, Jung S, Necioglu Orken D, Werring D, Prats-Sanchez L. Stroke Risk and Antithrombotic Treatment During Follow-up of Patients With Ischemic Stroke and Cortical Superficial Siderosis. Neurology 2023; 100:e1267-e1281. [PMID: 36535778 PMCID: PMC10033167 DOI: 10.1212/wnl.0000000000201723] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In patients with ischemic stroke (IS) or transient ischemic attack (TIA) and cortical superficial siderosis (cSS), there are few data regarding the risk of future cerebrovascular events and also about the benefits and safety of antithrombotic drugs for secondary prevention. We investigated the associations of cSS and stroke risk in patients with recent IS or TIA. METHODS We retrospectively analyzed the Microbleeds International Collaborative Network (MICON) database. We selected patients with IS or TIA from cohorts who had MRI-assessed cSS, available data on antithrombotic treatments, recurrent cerebrovascular events (intracranial hemorrhage [ICrH], IS, or any stroke [ICrH or IS]), and mortality. We calculated incidence rates (IRs) and performed univariable and multivariable Cox regression analyses. RESULTS Of 12,669 patients (mean age 70.4 ± 12.3 years, 57.3% men), cSS was detected in 273 (2.2%) patients. During a mean follow-up of 24 ± 17 months, IS was more frequent than ICrH in both cSS (IR 57.1 vs 14.6 per 1,000 patient-years) and non-cSS (33.7 vs 6.3 per 1,000 patient-years) groups. Compared with the non-cSS group, cSS was associated with any stroke on multivariable analysis {IR 83 vs 42 per 1,000 patient-years, adjusted hazard ratio [HR] for cSS 1.62 (95% CI: 1.14-2.28; p = 0.006)}. This association was not significant in subgroups of patients treated with antiplatelet drugs (n = 6,554) or with anticoagulants (n = 4,044). Patients with cSS who were treated with both antiplatelet drugs and anticoagulants (n = 1,569) had a higher incidence of ICrH (IR 107.5 vs 4.9 per 1,000 patient-years, adjusted HR 13.26; 95% CI: 2.90-60.63; p = 0.001) and of any stroke (IR 198.8 vs 34.7 per 1,000 patient-years, adjusted HR 5.03; 95% CI: 2.03-12.44; p < 0.001) compared with the non-cSS group. DISCUSSION Patients with IS or TIA with cSS are at increased risk of stroke (ICrH or IS) during follow-up; the risk of IS exceeds that of ICrH for patients receiving antiplatelet or anticoagulant treatment alone, but the risk of ICrH exceeds that of IS in patients receiving both treatments. The findings suggest that either antiplatelet or anticoagulant treatment alone should not be avoided in patients with cSS, but combined antithrombotic therapy might be hazardous. Our findings need to be confirmed by randomized clinical trials.
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Affiliation(s)
- Joan Martí-Fàbregas
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey.
| | - Pol Camps-Renom
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Jonathan G Best
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Anna Ramos-Pachon
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Marina Guasch-Jiménez
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Alejandro Martinez-Domeño
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Daniel Guisado-Alonso
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Beatriz M Gómez-Ansón
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Gareth Ambler
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Duncan Wilson
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Keon-Joo Lee
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Jae-Sung Lim
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Hee-Joon Bae
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Masayuki Shiozawa
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Masatoshi Koga
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Kazunori Toyoda
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Michael G Hennerici
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Hugues Chabriat
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Eric Jouvent
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Debbie Yuen Kwun Wong
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Henry Mak
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Kui Kai Lau
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Young Dae Kim
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Tae-Jin Song
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Ji-Hoe Heo
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Sebastian Eppinger
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Thomas Gattringer
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Ender Uysal
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Derya Selçuk Demirelli
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Natan Bornstein
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Einor Ben Assayag
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Hen Hallevi
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Jeremy A Molad
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Masashi Nishihara
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Jun Tanaka
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Hideo Hara
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Yusuke Yakushiji
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Shelagh B Coutts
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Eric Smith
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Alexandros A Polymeris
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Benjamin Wagner
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - David Seiffge
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Philippe A Lyrer
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Nils Peters
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Stefan T Engelter
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Rustam Al-Shahi Salman
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Hans Rudolf Jäger
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Gregory Y H Lip
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Martina Goeldlin
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Leonidas Panos
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Christopher Charles Karayiannis
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Thanh G Phan
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Velandai K Srikanth
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Nicolas Christ
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Sarah Gunkel
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Felix Fluri
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Thomas W Leung
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Yannie O Y Soo
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Winnie Chu
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Jill Abrigo
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Carmen Barbato
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Simone Browning
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Robert Simister
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Anne-Marie Mendyk
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Régis Bordet
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Saima Hilal
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Bibek Gyanwali
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Christopher Chen
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Simon Jung
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Dilek Necioglu Orken
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - David Werring
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
| | - Luis Prats-Sanchez
- From the Department of Neurology (J.M-F., P.C-R., A.R-P., M.G-J., A.M-D., D.G-A., L.P-S., L.P-S.), Neuroradiology Unit (B.M.G-A.), Department of Radiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, Barcelona, Spain; Department of Brain Repair and Rehabilitation (J.G.B., D.W., C.B., S.B., R.S., D.W.), UCL Stroke Research Centre, University College London Queen Square, Institute of Neurology, UK; Department of Statistical Science (G.A.), University College London, UK; Seoul National University College of Medicine Cerebrovascular Disease Center (K-J.L., H-J.B.); Department of Neurology (J-S.L.), Asan Medical Center University of Ulsan College of Medicine, South Korea; Department of Cerebrovascular Medicine (M.S., M.K., K.T.), National Cerebral and Cardiovascular Centre, Japan; Federation Universitätsmedizin Mannheim (M.G.H.), University of Heidelberg, Germany; Department of Neurology (H.C., E.J.), Translational Neurovascular Centre, Assistance Publique Hôpitaux de Paris, Lariboisière Hospital, France; Division of Neurology, Department of Medicine and Department of Diagnostic Radiology (D.Y.K.W., H.M., K.K.L.), The University of Hong Kong; Department of Neurology (Y.D.K., T-J.S., J-H.H.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (S.E., T.G.), Medical University of Graz, Austria; Department of Neurology (E.U., D.S.D.), Saglık Bilimleri University, Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey; Department of Neurology (N.B., E.B.A., H.H., J.A.M.), Tel-Aviv Sourasky Medical Center, Israel; Department of Radiology and Division of Neurology, Department of Internal Medicine (M.N., J.T., H.H., Y.Y.), Saga University Faculty of Medicine, Japan; Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C., E.S.), Hotchkiss Brain Institute, University of Calgary, Canada; Department of Neurology and Stroke Centre (A.A.P., B.W., D.S., P.A.L., N.P., S.T.E.), University Hospital Basel and University of Basel, Switzerland; Centre for Clinical Brain Sciences (R.A-S.S.), School of Clinical Sciences, University of Edinburgh; Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation (H.R.J.), University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool, UK; Department of Neurology (M.G., L.P., S.J.), Inselspital, Bern University Hospital and University of Bern, Switzerland; Peninsula Clinical School (C.C.K., T.G.P., V.K.S.), Peninsula Health and Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Department of Neurology (N.C., S.G., F.F.), University Hospital of Würzburg, Germany; Department of Medicine and Therapeutics (T.W.L., Y.O.Y.S., W.C., J.A.), Prince of Wales Hospital, The Chinese University of Hong Kong; Univ Lille (A-M.M., R.B.), Inserm, CHU de Lille. Lille Neuroscience & Cognition, Paris, France; Memory Aging & Cognition Centre (S.H., B.G., C.C.), Yong Loo Lin School of Medicine, National University of Singapore; Department of Neurology (D.N.O.), Istanbul Arel University, Turkey
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18
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Alrohimi A, Rose DZ, Burgin WS, Renati S, Hilker N, Deng W, Oliveira G, Beckie T, Labovitz AJ, Fradley MG, Tran N, Gioia L, Kate M, Ng KH, Dowlatshahi D, Field TS, Coutts SB, Siddiqui M, Hill MD, Miller J, Jickling GC, Shuaib A, Buck B, Sharma M, Butcher K. Risk of Hemorrhagic Transformation with Early Use of Direct Oral Anticoagulants after Acute Ischemic Stroke: A Pooled Analysis of Prospective Studies and Randomized Trials. Int J Stroke 2023:17474930231164891. [PMID: 36907985 DOI: 10.1177/17474930231164891] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
INTRODUCTION Precise risk of hemorrhagic transformation (HT) in acute ischemic stroke (AIS) remains unknown, leading to delays in anticoagulation initiation for secondary stroke prevention. We sought to assess the rate of HT associated with direct oral anticoagulant (DOAC) initiation within and beyond 48 hours post-AIS. METHODS A pooled analysis of DOAC initiation within 14 days of AIS or transient ischemic attack (TIA) was conducted with 6 studies (4 prospective open label treatment, blinded outcome studies and 2 randomized trials; NCT02295826 and NCT02283294). The primary endpoint was incident radiographic HT on follow-up imaging (day 7-30). Secondary endpoints included symptomatic HT, new parenchymal hemorrhage, recurrent ischemic events, extracranial hemorrhage, study-period mortality, and follow-up modified Rankin Scale score. The results were reported as odds ratio (OR) or hazard ratio (HR) with 95% confidence interval (CI). RESULTS We evaluated 509 patients; median infarct volume was 1.5 (0.1-7.8) ml, and median National Institutes of Health Stroke Scale was 2 (0-3). Incident radiographic HT was seen on follow-up scan in 34 (6.8%) patients. DOAC initiation within 48 hours from index event was not associated with incident HT (adjusted OR 0.67, [0.30 - 1.50] P=0.32). No patients developed symptomatic HT. Conversely, 31 (6.1%) patients developed recurrent ischemic events, 64% of which occurred within 14 days. Initiating a DOAC within 48 hours of onset was associated with similar recurrent ischemic event rates compared to those in which treatment was delayed (HR 0.42, [0.17 - 1.008] P=0.052). In contrast to HT, recurrent ischemic events were associated with poor functional outcomes (OR=6.8, [2.84 - 16.24], p<0.001). CONCLUSIONS In this pooled analysis, initiation of DOAC within 48 hours post-stroke was not associated with increased incident risk of HT, and none developed symptomatic HT. The analysis was underpowered to determine the effect of early DOAC use upon recurrent ischemic events.
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Affiliation(s)
- Anas Alrohimi
- University of Alberta, Medicine, Edmonton, Canada 3158.,King Saud University, Medicine, Riyadh, Saudi Arabia.,Cleveland Clinic, Cerebrovascular Canter, Cleveland, OH, USA
| | - David Z Rose
- University of South Florida, Neurology, Tampa, FL, USA 33697
| | | | - Swetha Renati
- University of South Florida, Neurology, Tampa, FL, USA 7831
| | | | - Wei Deng
- University of South Florida, Medicine, Tampa, FL, USA 7831
| | | | - Theresa Beckie
- University of South Florida, College of Nursing, Tampa, FL, USA 7831
| | | | | | - Nhi Tran
- University of South Florida, Medicine, Tampa, FL, USA 7831
| | - Laura Gioia
- University of Montreal, Neurology, Montreal, Canada 25443
| | - Mahesh Kate
- University of Alberta, Medicine, Edmonton, Canada 3158
| | - Kuan H Ng
- McMaster University, Medicine, Hamilton, Canada 3710
| | | | | | - Shelagh B Coutts
- University of Calgary, Department of Clinical Neurosciences, Calgary, Canada 2129
| | | | - Michael D Hill
- University of Calgary, Department of Clinical Neurosciences, Calgary, Canada 2129
| | - Jodi Miller
- McMaster University, Medicine, Hamilton, Canada 3710
| | | | - Ashfaq Shuaib
- University of Alberta, Medicine, Edmonton, Canada 3158
| | - Brian Buck
- University of Alberta, Medicine, Edmonton, Canada 25484
| | - Mukul Sharma
- McMaster University, Medicine, Hamilton, Canada 3710
| | - Kenneth Butcher
- University of Alberta, Medicine, Edmonton, Canada 6804.,University of New South Wales, Sydney, Australia
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19
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Joundi RA, Yu AYX, Smith EE, Zerna C, Penn AM, Balshaw RF, Votova K, Bibok MB, Penn M, Saly V, Hegedus J, Coutts SB, Yu AYX, Penn AM, Trivedi A, Cook J, Morrison J, Blackwood K, Richards K, Votova K, Nealis M, Bibok MB, Penn M, Beattyova P, Rosenberg P, Frost S, Grant C, Hedgedus J, Grant S, Watson T, Saly V, Sedgwick C, Lesperance ML, Croteau NS, Appireddy R, Balshaw RF, Field TS, Dubuc V, Demchuk AM, Jambula A, Le A, Menon BK, Calvert C, Kenney C, Zerna C, Nikneshan D, Smith EE, Klourfeld E, Wagner G, Klein G, Aram H, Desai J, Ryckborst K, Bilston L, Hill MD, Almekhlafi M, Godfrey N, Imoukheude O, Stys P, Barber PA, Couillard P, Eswaradas P, Rhandawa P, Coutts SB, Bal S, Peters S, Save S, Subramaniam S, Musuka T, Stewart T, Hong ZM. Association Between Duration of Transient Neurological Events and Diffusion-Weighted Brain Lesions. J Am Heart Assoc 2023; 12:e027861. [PMID: 36695298 PMCID: PMC9973650 DOI: 10.1161/jaha.122.027861] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background The relationship between duration of transient neurological events and presence of diffusion-weighted lesions by symptom type is unclear. Methods and Results This was a substudy of SpecTRA (Spectrometry for Transient Ischemic Attack Rapid Assessment), a multicenter prospective cohort of patients with minor ischemic cerebrovascular events or stroke mimics at academic emergency departments in Canada. For this study we included patients with resolved symptoms and determined the presence of diffusion-weighted imaging (DWI) lesion on magnetic resonance imaging within 7 days. Using logistic regression, we evaluated the association between symptom duration and DWI lesion, assessing for interaction with symptom type (focal only versus nonfocal/mixed), and adjusting for age, sex, education, comorbidities, and systolic blood pressure. Of 658 patients included, a DWI lesion was present in 232 (35.1%). There was a significant interaction between symptom duration and symptom type. For those with focal-only symptoms, there was a continuous increase in DWI probability up to 24 hours in duration (ranging from ≈40% to 80% probability). In stratified analyses, the increase in probability of DWI lesion with increased duration of focal symptoms was seen in women but not men. For those with nonfocal or mixed symptoms, predicted probability of DWI lesion was ≈35% and was greater in men, but did not increase with longer duration. Conclusions Increased duration of neurological deficits is associated with greater probability of DWI lesion in those with focal symptoms only. For individuals with nonfocal or mixed symptoms, about one-third had DWI lesions, but the probability did not increase with duration. These results may be important to improve risk stratification of transient neurological events.
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Affiliation(s)
- Raed A. Joundi
- Division of Neurology, Hamilton Health SciencesMcMaster University & Population Health Research InstituteHamiltonOntarioCanada
| | - Amy Y. X. Yu
- Division of Neurology, Department of MedicineUniversity of Toronto, Sunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Eric E. Smith
- Departments of Clinical Neurosciences and Community Health SciencesUniversity of CalgaryAlbertaCanada
| | - Charlotte Zerna
- Department of Clinical Neurosciences and Diagnostic ImagingUniversity of Calgary Cumming School of MedicineCalgaryAlbertaCanada
| | - Andrew M. Penn
- Stroke Rapid Assessment Unit, Island HealthVictoriaBritish ColumbiaCanada
| | - Robert F. Balshaw
- George & Fay Yee Centre for Healthcare InnovationUniversity of ManitobaWinnipegManitobaCanada
| | - Kristine Votova
- Island Health Regional Health Authority, Division of Medical SciencesUniversity of VictoriaVictoriaBritish ColumbiaCanada
| | - Maximilian B. Bibok
- Department of Research and Capacity Building, Island HealthVictoriaBritish ColumbiaCanada
| | - Melanie Penn
- Stroke Rapid Assessment Unit, Island HealthVictoriaBritish ColumbiaCanada
| | - Viera Saly
- Stroke Rapid Assessment Unit, Island HealthVictoriaBritish ColumbiaCanada
| | - Janka Hegedus
- Stroke Rapid Assessment Unit, Island HealthVictoriaBritish ColumbiaCanada
| | - Shelagh B. Coutts
- Departments of Clinical Neurosciences and Community Health SciencesUniversity of CalgaryAlbertaCanada
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20
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Coutts SB, Hill MD. Approche pratique en matière de prise en charge aiguë des cas probables d’ischémie cérébrale. CMAJ 2022; 194:E1669-E1671. [DOI: 10.1503/cmaj.221415-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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21
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Affiliation(s)
- Shelagh B Coutts
- Hotchkiss Brain Institute (Coutts, Hill), University of Calgary; Departments of Clinical Neurosciences (Coutts, Hill), Community Health Sciences (Coutts, Hill), Radiology (Hill) and Medicine (Hill), University of Calgary, Foothills Medical Centre, Calgary, Alta
| | - Michael D Hill
- Hotchkiss Brain Institute (Coutts, Hill), University of Calgary; Departments of Clinical Neurosciences (Coutts, Hill), Community Health Sciences (Coutts, Hill), Radiology (Hill) and Medicine (Hill), University of Calgary, Foothills Medical Centre, Calgary, Alta.
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22
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van de Munckhof A, Lindgren E, Kleinig TJ, Field TS, Cordonnier C, Krzywicka K, Poli S, Sánchez van Kammen M, Borhani-Haghighi A, Lemmens R, Scutelnic A, Ciccone A, Gattringer T, Wittstock M, Dizonno V, Devroye A, Elkady A, Günther A, Cervera A, Mengel A, Chew BLA, Buck B, Zanferrari C, Garcia-Esperon C, Jacobi C, Soriano C, Michalski D, Zamani Z, Blacquiere D, Johansson E, Cuadrado-Godia E, Vuillier F, Bode FJ, Caparros F, Maier F, Tsivgoulis G, Katzberg HD, Duan J, Burrow J, Pelz J, Mbroh J, Oen J, Schouten J, Zimmermann J, Ng K, Garambois K, Petruzzellis M, Carvalho Dias M, Ghiasian M, Romoli M, Miranda M, Wronski M, Skjelland M, Almasi-Dooghaee M, Cuisenier P, Murphy S, Timsit S, Coutts SB, Schönenberger S, Nagel S, Hiltunen S, Chatterton S, Cox T, Bartsch T, Shaygannejad V, Mirzaasgari Z, Middeldorp S, Levi MM, Kremer Hovinga JA, Jood K, Tatlisumak T, Putaala J, Heldner MR, Arnold M, Aguiar de Sousa D, Ferro JM, Coutinho JM. Outcomes of Cerebral Venous Thrombosis due to Vaccine-Induced Immune Thrombotic Thrombocytopenia After the Acute Phase. Stroke 2022; 53:3206-3210. [PMID: 36082668 PMCID: PMC9508952 DOI: 10.1161/strokeaha.122.039575] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cerebral venous thrombosis (CVT) due to vaccine-induced immune thrombotic thrombocytopenia (VITT) is a severe condition, with high in-hospital mortality rates. Here, we report clinical outcomes of patients with CVT-VITT after SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) vaccination who survived initial hospitalization. METHODS We used data from an international registry of patients who developed CVT within 28 days of SARS-CoV-2 vaccination, collected until February 10, 2022. VITT diagnosis was classified based on the Pavord criteria. Outcomes were mortality, functional independence (modified Rankin Scale score 0-2), VITT relapse, new thrombosis, and bleeding events (all after discharge from initial hospitalization). RESULTS Of 107 CVT-VITT cases, 43 (40%) died during initial hospitalization. Of the remaining 64 patients, follow-up data were available for 60 (94%) patients (37 definite VITT, 9 probable VITT, and 14 possible VITT). Median age was 40 years and 45/60 (75%) patients were women. Median follow-up time was 150 days (interquartile range, 94-194). Two patients died during follow-up (3% [95% CI, 1%-11%). Functional independence was achieved by 53/60 (88% [95% CI, 78%-94%]) patients. No new venous or arterial thrombotic events were reported. One patient developed a major bleeding during follow-up (fatal intracerebral bleed). CONCLUSIONS In contrast to the high mortality of CVT-VITT in the acute phase, mortality among patients who survived the initial hospitalization was low, new thrombotic events did not occur, and bleeding events were rare. Approximately 9 out of 10 CVT-VITT patients who survived the acute phase were functionally independent at follow-up.
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Affiliation(s)
- Anita van de Munckhof
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands. (A.v.d.M., K.K., M.S.v.K., J.M.C.)
| | - Erik Lindgren
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.L., K.J., T.T.).,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden (E.L., K.J., T.T.)
| | - Timothy J Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia (T.J.K.)
| | - Thalia S Field
- Division of Neurology, Vancouver Stroke Program, University of British Columbia, Vancouver, Canada (T.S.F., V.D.)
| | - Charlotte Cordonnier
- University Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, France (C.C., F.C.)
| | - Katarzyna Krzywicka
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands. (A.v.d.M., K.K., M.S.v.K., J.M.C.)
| | - Sven Poli
- Department of Neurology and Stroke, University Hospital Tuebingen, Eberhard-Karls University, Germany. (S.P., A.M., J.M.).,Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Germany. (S.P., J.M.)
| | - Mayte Sánchez van Kammen
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands. (A.v.d.M., K.K., M.S.v.K., J.M.C.)
| | | | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Belgium (R.L., A.D.)
| | - Adrian Scutelnic
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland. (A.S., M.R.H., M.A.)
| | - Alfonso Ciccone
- Department of Neurology, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale di Mantova, Mantua, Italy (A. Ciccone)
| | | | - Matthias Wittstock
- Department of Neurology, University Hospital Rostock, Germany (M. Wittstock)
| | - Vanessa Dizonno
- Division of Neurology, Vancouver Stroke Program, University of British Columbia, Vancouver, Canada (T.S.F., V.D.)
| | - Annemie Devroye
- Department of Neurology, University Hospitals Leuven, Belgium (R.L., A.D.)
| | - Ahmed Elkady
- Department of Neurology, Saudi German Hospital, Jeddah, Saudi Arabia (A.E.)
| | - Albrecht Günther
- Department of Neurology, Jena University Hospital, Germany (A.G.)
| | - Alvaro Cervera
- Royal Darwin Hospital, Darwin, Northern Territory, Australia (A. Cervera)
| | - Annerose Mengel
- Department of Neurology and Stroke, University Hospital Tuebingen, Eberhard-Karls University, Germany. (S.P., A.M., J.M.)
| | - Beng Lim Alvin Chew
- Department of Neurology, John Hunter Hospital, Newcastle, Australia (B.L.A.C., C.G.-E.)
| | - Brian Buck
- Division of Neurology, University of Alberta Hospital, Edmonton, Canada (B.B.)
| | - Carla Zanferrari
- Department of Neurology, Azienda Ospedaliera di Melegnano e della Martesana, Italy (C.Z.)
| | - Carlos Garcia-Esperon
- Department of Neurology, John Hunter Hospital, Newcastle, Australia (B.L.A.C., C.G.-E.)
| | - Christian Jacobi
- Department of Neurology, Krankenhaus Nordwest, Frankfurt am Main, Germany (C.J.)
| | - Cristina Soriano
- Department of Neurology, Hospital General de Castellón, Castelló, Spain (C.S.)
| | - Dominik Michalski
- Department of Neurology, Leipzig University Hospital, Germany (D.M., J. Pelz)
| | - Zohreh Zamani
- Department of Neurology, Firoozabadi Hospital, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran. (Z.Z.)
| | | | - Elias Johansson
- Department Clinical Science, Wallenberg Center for Molecular Medicine (WCMM), Umeå University, Sweden (E.J.)
| | - Elisa Cuadrado-Godia
- Department of Neurology, University Hospital del Mar, Barcelona, Spain (E.C.-G.)
| | | | - Felix J Bode
- Department of Neurology, Universitätsklinikum Bonn, Germany (F.J.B., J.Z.)
| | - François Caparros
- University Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, France (C.C., F.C.)
| | - Frank Maier
- Department of Neurology, Caritas Hospital Saarbrücken, Germany (F.M.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Greece (G.T.)
| | - Hans D Katzberg
- Department of Neuromuscular Medicine, Toronto General Hospital, Canada (H.D.K.)
| | - Jiangang Duan
- Department of Neurology and Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China (J.D.)
| | - Jim Burrow
- Department of Neurology, Royal Darwin Hospital, Tiwi, Australia (J.B.)
| | - Johann Pelz
- Department of Neurology, Leipzig University Hospital, Germany (D.M., J. Pelz)
| | - Joshua Mbroh
- Department of Neurology and Stroke, University Hospital Tuebingen, Eberhard-Karls University, Germany. (S.P., A.M., J.M.).,Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Germany. (S.P., J.M.)
| | - Joyce Oen
- Department of Neurology, Antonius Ziekenhuis, Sneek, the Netherlands (J.O.)
| | - Judith Schouten
- Department of Neurology, Rijnstate Hospital Arnhem, the Netherlands (J.S.)
| | - Julian Zimmermann
- Department of Neurology, Universitätsklinikum Bonn, Germany (F.J.B., J.Z.)
| | - Karl Ng
- Department of Neurology, Royal North Shore Hospital, Sydney, Australia (K.N., M. Wronski, S.C.)
| | - Katia Garambois
- Department of Neurology, CHU Grenoble Alpes, France (K.G., P.C.)
| | - Marco Petruzzellis
- Department of Neurology, AOU Consorziale Policlinico di Bari, Italy (M.P.)
| | - Mariana Carvalho Dias
- Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte, University of Lisbon, Portugal (M.C.D.)
| | - Masoud Ghiasian
- Department of Neurology, Sina Hospital, Hamadan University of Medical Science, Iran (M.G.)
| | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy (M.R.)
| | - Miguel Miranda
- Department of Neurology, Hospital de Cascais Dr. José de Almeida, Cascais, Portugal (M.M.)
| | - Miriam Wronski
- Department of Neurology, Royal North Shore Hospital, Sydney, Australia (K.N., M. Wronski, S.C.)
| | - Mona Skjelland
- Department of Neurology, Oslo University Hospital, Norway (M.S.)
| | | | | | - Seán Murphy
- Acute Stroke Service, Mater Misericordiae University Hospital, UCD School of Medicine and RCSI Medical School, Dublin, Ireland (S. Murphy)
| | - Serge Timsit
- Department of Neurology, Stroke Unit, Hôpital de la Cavale Blanche, CHRU de Brest (University Hospital), Université de Bretagne Occidentale, Inserm 1078, Brest, France (S.T.)
| | - Shelagh B Coutts
- Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Foothills Medical Centre, Calgary, Canada (S.B.C.)
| | | | - Simon Nagel
- Department of Neurology, Heidelberg University Hospital, Germany (S.S., S.N.)
| | - Sini Hiltunen
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Finland (S.H., T.T., J. Putaala)
| | - Sophie Chatterton
- Department of Neurology, Royal North Shore Hospital, Sydney, Australia (K.N., M. Wronski, S.C.)
| | - Thomas Cox
- Department of Neurology, University Hospital Southampton NHS Foundation Trust, United Kingdom (T.C.)
| | - Thorsten Bartsch
- Department of Neurology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany (T.B.)
| | - Vahid Shaygannejad
- Isfahan University of Medical Sciences (IUMS), Isfahan Neurosciences Research Center (INRC), Iran (V.S.).,Department of Internal (INRC), Iran (V.S.)
| | - Zahra Mirzaasgari
- Department of Neurology, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran. (M.A.-D., Z.M.)
| | - Saskia Middeldorp
- Department of Internal Medicine and Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands (S. Middeldorp)
| | - Marcel M Levi
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands. (M.M.L.).,National Institute for Health Research, University College London Hospitals (UCLH), Biomedical Research Centre, London, United Kingdom (M.M.L.)
| | - Johanna A Kremer Hovinga
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Switzerland. (J.A.K.H.)
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.L., K.J., T.T.).,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden (E.L., K.J., T.T.)
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (E.L., K.J., T.T.).,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden (E.L., K.J., T.T.).,Department of Neurology, Helsinki University Hospital, University of Helsinki, Finland (S.H., T.T., J. Putaala)
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Finland (S.H., T.T., J. Putaala)
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland. (A.S., M.R.H., M.A.)
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland. (A.S., M.R.H., M.A.)
| | - Diana Aguiar de Sousa
- Stroke Centre, Lisbon Central University Hospital Centre, Portugal (D.A.d.S.).,Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Portugal (D.A.d.S., J.M.F.)
| | - José M Ferro
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Portugal (D.A.d.S., J.M.F.)
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands. (A.v.d.M., K.K., M.S.v.K., J.M.C.)
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23
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Zhu A, Rajendram P, Tseng E, Coutts SB, Yu AYX. Alteplase or tenecteplase for thrombolysis in ischemic stroke: An illustrated review. Res Pract Thromb Haemost 2022; 6:e12795. [PMID: 36186106 PMCID: PMC9487449 DOI: 10.1002/rth2.12795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/21/2022] [Accepted: 07/22/2022] [Indexed: 11/09/2022] Open
Abstract
Intravenous thrombolysis is a standard of care treatment for patients with acute ischemic stroke. Tissue plasminogen activator (tPA) has been the main thrombolytic agent used since the publication of the seminal National Institutes of Neurological Disorders and Stroke trial in 1995. There is now mounting evidence to support the routine use of Tenecteplase (TNK) to treat acute ischemic stroke. TNK is a genetically modified tPA with higher fibrin specificity, longer half‐life, and reduced systemic coagulopathy. In this illustrated review, we compare the indications, doses, mechanisms of action, efficacy and safety of TNK and tPA. We provide an overview of published clinical trials studying TNK in acute ischemic stroke, including dose‐escalation studies and head‐to‐head comparisons with tPA. Finally, we summarize current acute stroke guideline recommendations and suggest treatment algorithms to manage the two main complications of intravenous thrombolysis: symptomatic intracerebral hemorrhage and angioedema.
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Affiliation(s)
- Annie Zhu
- Department of Medicine (Neurology) University of Toronto, Sunnybrook Health Sciences Centre Toronto Ontario Canada
| | - Phavalan Rajendram
- Department of Medicine (Neurology) University of Toronto, Sunnybrook Health Sciences Centre Toronto Ontario Canada
| | - Eric Tseng
- Department of Medicine (Hematology) University of Toronto, Unity Health Toronto Toronto Ontario Canada
| | - Shelagh B Coutts
- Department of Clinical Neurosciences, Radiology and Community Health Sciences Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary Calgary Alberta Canada
| | - Amy Y X Yu
- Department of Medicine (Neurology) University of Toronto, Sunnybrook Health Sciences Centre Toronto Ontario Canada
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24
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Menon BK, Buck BH, Singh N, Deschaintre Y, Almekhlafi MA, Coutts SB, Thirunavukkarasu S, Khosravani H, Appireddy R, Moreau F, Gubitz G, Tkach A, Catanese L, Dowlatshahi D, Medvedev G, Mandzia J, Pikula A, Shankar J, Williams H, Field TS, Manosalva A, Siddiqui M, Zafar A, Imoukhuede O, Hunter G, Demchuk AM, Mishra S, Gioia LC, Jalini S, Cayer C, Phillips S, Elamin E, Shoamanesh A, Subramaniam S, Kate M, Jacquin G, Camden MC, Benali F, Alhabli I, Bala F, Horn M, Stotts G, Hill MD, Gladstone DJ, Poppe A, Sehgal A, Zhang Q, Lethebe BC, Doram C, Ademola A, Shamy M, Kenney C, Sajobi TT, Swartz RH. Intravenous tenecteplase compared with alteplase for acute ischaemic stroke in Canada (AcT): a pragmatic, multicentre, open-label, registry-linked, randomised, controlled, non-inferiority trial. Lancet 2022; 400:161-169. [PMID: 35779553 DOI: 10.1016/s0140-6736(22)01054-6] [Citation(s) in RCA: 114] [Impact Index Per Article: 57.0] [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] [Received: 05/23/2022] [Revised: 05/30/2022] [Accepted: 06/08/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Intravenous thrombolysis with alteplase bolus followed by infusion is a global standard of care for patients with acute ischaemic stroke. We aimed to determine whether tenecteplase given as a single bolus might increase reperfusion compared with this standard of care. METHODS In this multicentre, open-label, parallel-group, registry-linked, randomised, controlled trial (AcT), patients were enrolled from 22 primary and comprehensive stroke centres across Canada. Patients were eligible for inclusion if they were aged 18 years or older, with a diagnosis of ischaemic stroke causing disabling neurological deficit, presenting within 4·5 h of symptom onset, and eligible for thrombolysis per Canadian guidelines. Eligible patients were randomly assigned (1:1), using a previously validated minimal sufficient balance algorithm to balance allocation by site and a secure real-time web-based server, to either intravenous tenecteplase (0·25 mg/kg to a maximum of 25 mg) or alteplase (0·9 mg/kg to a maximum of 90mg; 0·09 mg/kg as a bolus and then a 60 min infusion of the remaining 0·81 mg/kg). The primary outcome was the proportion of patients who had a modified Rankin Scale (mRS) score of 0-1 at 90-120 days after treatment, assessed via blinded review in the intention-to-treat (ITT) population (ie, all patients randomly assigned to treatment who did not withdraw consent). Non-inferiority was met if the lower 95% CI of the difference in the proportion of patients who met the primary outcome between the tenecteplase and alteplase groups was more than -5%. Safety was assessed in all patients who received any of either thrombolytic agent and who were reported as treated. The trial is registered with ClinicalTrials.gov, NCT03889249, and is closed to accrual. FINDINGS Between Dec 10, 2019, and Jan 25, 2022, 1600 patients were enrolled and randomly assigned to tenecteplase (n=816) or alteplase (n=784), of whom 1577 were included in the ITT population (n=806 tenecteplase; n=771 alteplase). The median age was 74 years (IQR 63-83), 755 (47·9%) of 1577 patients were female and 822 (52·1%) were male. As of data cutoff (Jan 21, 2022), 296 (36·9%) of 802 patients in the tenecteplase group and 266 (34·8%) of 765 in the alteplase group had an mRS score of 0-1 at 90-120 days (unadjusted risk difference 2·1% [95% CI - 2·6 to 6·9], meeting the prespecified non-inferiority threshold). In safety analyses, 27 (3·4%) of 800 patients in the tenecteplase group and 24 (3·2%) of 763 in the alteplase group had 24 h symptomatic intracerebral haemorrhage and 122 (15·3%) of 796 and 117 (15·4%) of 763 died within 90 days of starting treatment INTERPRETATION: Intravenous tenecteplase (0·25 mg/kg) is a reasonable alternative to alteplase for all patients presenting with acute ischaemic stroke who meet standard criteria for thrombolysis. FUNDING Canadian Institutes of Health Research, Alberta Strategy for Patient Oriented Research Support Unit.
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Affiliation(s)
- Bijoy K Menon
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Cumming School of Medicine and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Calgary, Canada.
| | - Brian H Buck
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Nishita Singh
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Yan Deschaintre
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada; Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Mohammed A Almekhlafi
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Cumming School of Medicine and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Calgary, Canada
| | - Shelagh B Coutts
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Cumming School of Medicine and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Calgary, Canada
| | - Sibi Thirunavukkarasu
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Houman Khosravani
- Department of Medicine (Division of Neurology), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Ramana Appireddy
- Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | | | - Gord Gubitz
- Queen Elizabeth Health Sciences Centre, Halifax, NS, Canada
| | | | - Luciana Catanese
- Hamilton Health Sciences Centre and McMaster University, Hamilton, ON, Canada
| | - Dar Dowlatshahi
- Department of Medicine, University of Ottawa and the Ottawa Heart Research Institute, Ottawa, ON, Canada
| | - George Medvedev
- University of British Columbia and the Fraser Health Authority, New Westminster, BC, Canada
| | - Jennifer Mandzia
- London Health Sciences Centre and Western University, London, ON, Canada
| | - Aleksandra Pikula
- Toronto Western Hospital and the University of Toronto, Toronto, ON, Canada
| | - Jai Shankar
- University of Manitoba, Winnipeg, MB, Canada
| | | | - Thalia S Field
- Vancouver Stroke Program and the Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Atif Zafar
- St Michael's Hospital, Toronto, ON, Canada
| | | | - Gary Hunter
- University of Saskatchewan, Saskatoon, SK, Canada
| | - Andrew M Demchuk
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Cumming School of Medicine and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Calgary, Canada
| | - Sachin Mishra
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Laura C Gioia
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada; Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Shirin Jalini
- Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Caroline Cayer
- Centre de recherche du CHUS, Centre intégré Universitaire de Santé et des Services Sociaux de l'Estrie, Sherbrooke, QC, Canada
| | | | | | - Ashkan Shoamanesh
- Hamilton Health Sciences Centre and McMaster University, Hamilton, ON, Canada
| | - Suresh Subramaniam
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Mahesh Kate
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Gregory Jacquin
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada; Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Marie-Christine Camden
- Enfant-Jésus Hospital, Centre Hospitalier Universitaire de Québec, Laval University, Québec City, QC, Canada
| | - Faysal Benali
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Ibrahim Alhabli
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Fouzi Bala
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - MacKenzie Horn
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Grant Stotts
- Department of Medicine, University of Ottawa and the Ottawa Heart Research Institute, Ottawa, ON, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Department of Radiology, University of Calgary, Calgary, AB, Canada; Cumming School of Medicine and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Calgary, Canada
| | - David J Gladstone
- Department of Medicine (Division of Neurology), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Alexandre Poppe
- Department of Neurosciences, Université de Montréal, Montreal, QC, Canada; Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Arshia Sehgal
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Qiao Zhang
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Brendan Cord Lethebe
- Cumming School of Medicine and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Craig Doram
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Ayoola Ademola
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Cumming School of Medicine and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Michel Shamy
- Department of Medicine, University of Ottawa and the Ottawa Heart Research Institute, Ottawa, ON, Canada
| | - Carol Kenney
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Tolulope T Sajobi
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Cumming School of Medicine and Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Richard H Swartz
- Department of Medicine (Division of Neurology), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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25
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Scutelnic A, Krzywicka K, Mbroh J, van de Munckhof A, van Kammen MS, de Sousa DA, Lindgren E, Jood K, Günther A, Hiltunen S, Putaala J, Tiede A, Maier F, Kern R, Bartsch T, Althaus K, Ciccone A, Wiedmann M, Skjelland M, Medina A, Cuadrado-Godia E, Cox T, Aujayeb A, Raposo N, Garambois K, Payen JF, Vuillier F, Franchineau G, Timsit S, Bougon D, Dubois MC, Tawa A, Tracol C, De Maistre E, Bonneville F, Vayne C, Mengel A, Michalski D, Pelz J, Wittstock M, Bode F, Zimmermann J, Schouten J, Buture A, Murphy S, Palma V, Negro A, Gutschalk A, Nagel S, Schoenenberger S, Frisullo G, Zanferrari C, Grillo F, Giammello F, Martin MM, Cervera A, Burrow J, Esperon CG, Chew BLA, Kleinig TJ, Soriano C, Zimatore DS, Petruzzellis M, Elkady A, Miranda MS, Fernandes J, Vogel ÅH, Johansson E, Philip AP, Coutts SB, Bal S, Buck B, Legault C, Blacquiere D, Katzberg HD, Field TS, Dizonno V, Gattringer T, Jacobi C, Devroye A, Lemmens R, Kristoffersen ES, di Poggio MB, Ghiasian M, Karapanayiotides T, Chatterton S, Wronski M, Ng K, Kahnis R, Geeraerts T, Reiner P, Cordonnier C, Middeldorp S, Levi M, van Gorp ECM, van de Beek D, Brodard J, Kremer Hovinga JA, Kruip MJHA, Tatlisumak T, Ferro JM, Coutinho JM, Arnold M, Poli S, Heldner MR. Management of Cerebral Venous Thrombosis Due to Adenoviral COVID-19 Vaccination. Ann Neurol 2022; 92:562-573. [PMID: 35689346 PMCID: PMC9349982 DOI: 10.1002/ana.26431] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/21/2022] [Accepted: 05/27/2022] [Indexed: 01/01/2023]
Abstract
Objective Cerebral venous thrombosis (CVT) caused by vaccine‐induced immune thrombotic thrombocytopenia (VITT) is a rare adverse effect of adenovirus‐based severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2) vaccines. In March 2021, after autoimmune pathogenesis of VITT was discovered, treatment recommendations were developed. These comprised immunomodulation, non‐heparin anticoagulants, and avoidance of platelet transfusion. The aim of this study was to evaluate adherence to these recommendations and its association with mortality. Methods We used data from an international prospective registry of patients with CVT after the adenovirus‐based SARS‐CoV‐2 vaccination. We analyzed possible, probable, or definite VITT‐CVT cases included until January 18, 2022. Immunomodulation entailed administration of intravenous immunoglobulins and/or plasmapheresis. Results Ninety‐nine patients with VITT‐CVT from 71 hospitals in 17 countries were analyzed. Five of 38 (13%), 11 of 24 (46%), and 28 of 37 (76%) of the patients diagnosed in March, April, and from May onward, respectively, were treated in‐line with VITT recommendations (p < 0.001). Overall, treatment according to recommendations had no statistically significant influence on mortality (14/44 [32%] vs 29/55 [52%], adjusted odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.16–1.19). However, patients who received immunomodulation had lower mortality (19/65 [29%] vs 24/34 [70%], adjusted OR = 0.19, 95% CI = 0.06–0.58). Treatment with non‐heparin anticoagulants instead of heparins was not associated with lower mortality (17/51 [33%] vs 13/35 [37%], adjusted OR = 0.70, 95% CI = 0.24–2.04). Mortality was also not significantly influenced by platelet transfusion (17/27 [63%] vs 26/72 [36%], adjusted OR = 2.19, 95% CI = 0.74–6.54). Conclusions In patients with VITT‐CVT, adherence to VITT treatment recommendations improved over time. Immunomodulation seems crucial for reducing mortality of VITT‐CVT. ANN NEUROL 2022;92:562–573
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Affiliation(s)
- Adrian Scutelnic
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Katarzyna Krzywicka
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Joshua Mbroh
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tuebingen, Germany.,Department of Neurology & Stroke, Eberhard-Karls University, Tuebingen, Germany
| | - Anita van de Munckhof
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Mayte Sánchez van Kammen
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Diana Aguiar de Sousa
- CEEM and Institute of Anatomy, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Erik Lindgren
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Gothenburg, Sweden
| | - Albrecht Günther
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Sini Hiltunen
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Andreas Tiede
- Clinic for Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Frank Maier
- Department of Neurology, Caritas Hospital Saarbrücken, Saarbrücken, Germany
| | - Rolf Kern
- Department of Neurology, Kempten Hospital, Kempten, Germany
| | - Thorsten Bartsch
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | | | - Alfonso Ciccone
- Department of Neurology, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale di Mantova, Mantua, Italy
| | - Markus Wiedmann
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Mona Skjelland
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Antonio Medina
- Department of Neurology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Thomas Cox
- Department of Neurology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Avinash Aujayeb
- Respiratory Department, Northumbria Healthcare NHS Foundation Trust, Cramlington, UK
| | - Nicolas Raposo
- Department of Neurology, Toulouse University Hospital, Toulouse, France
| | - Katia Garambois
- Stroke Unit, University Hospital of Grenoble, Grenoble, France
| | | | | | - Guillaume Franchineau
- Department of Intensive Care, Centre Hospitalier Intercommunal de Poissy Saint Germain en Laye, Poissy, France
| | - Serge Timsit
- Neurology and Stroke Unit, Centre Hospitalier Universitaire de Brest, CHU Brest, Brest, France
| | - David Bougon
- Department of Critical Care, Annecy Genevois Hospital, Annecy, France
| | - Marie-Cécile Dubois
- Department of Anesthesia and Intensive Care, University Hospital of Poitiers, Poitiers, France
| | - Audrey Tawa
- Department of Anesthesia and Intensive Care, University Hospital of Rennes, Rennes, France
| | | | | | - Fabrice Bonneville
- Department of Neuroradiology, Toulouse University Hospital, Toulouse, France
| | - Caroline Vayne
- Department of Hematology and Hemostasis, Tours University Hospital, Tours, France
| | - Annerose Mengel
- Department of Neurology and Stroke, Eberhard-Karls University, Tuebingen, Germany
| | - Dominik Michalski
- Department of Neurology, Leipzig University Hospital, Leipzig, Germany
| | - Johann Pelz
- Department of Neurology, Leipzig University Hospital, Leipzig, Germany
| | | | - Felix Bode
- Department of Neurology, Universitätsklinikum Bonn, Bonn, Germany
| | | | - Judith Schouten
- Department of Neurology, Rijnstate Hospital Arnhem, Arnhem, The Netherlands
| | - Alina Buture
- Acute Stroke Service, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sean Murphy
- Acute Stroke Service, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Vincenzo Palma
- Department of Neuroradiology, Ospedale del Mare, Naples, Italy
| | - Alberto Negro
- Department of Neuroradiology, Ospedale del Mare, Naples, Italy
| | - Alexander Gutschalk
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Simon Nagel
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Giovanni Frisullo
- Department of Neurology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carla Zanferrari
- Department of Neurology, Azienda Ospedaliera di Melegnano e della Martesana, Melegnano, Italy
| | - Francesco Grillo
- Stroke Unit, Department of Clinical and Experimental Medicine, University Hospital G. Martino, Messina, Italy
| | - Fabrizio Giammello
- Translational Molecular Medicine and Surgery, XXXV Cycle, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Mar Morin Martin
- Department of Neurology, Hospital Complex of Toledo, Toledo, Spain
| | - Alvaro Cervera
- Department of Neurology, Royal Darwin Hospital, Tiwi, Northern Territory, Australia
| | - Jim Burrow
- Department of Neurology, Royal Darwin Hospital, Tiwi, Northern Territory, Australia
| | - Carlos Garcia Esperon
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Beng Lim Alvin Chew
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Timothy J Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Cristina Soriano
- Department of Neurology, Hospital General de Castellón, Castelló, Spain
| | | | - Marco Petruzzellis
- Department of Neurology, AOU Consorziale Policlinico di Bari, Bari, Italy
| | - Ahmed Elkady
- Department of Neurology, Saudi German Hospital, Jeddah, Saudi Arabia
| | - Miguel S Miranda
- Department of Neurology, Hospital de Cascais Dr José de Almeida, Cascais, Portugal
| | - João Fernandes
- Department of Neurology, Norra Älvsborgs Länssjukhus, Trollhattan, Sweden
| | | | - Elias Johansson
- Clinical Science, Neurosciences, Umeå University, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine, Umeå, Sweden
| | | | - Shelagh B Coutts
- Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Simerpreet Bal
- Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Brian Buck
- Division of Neurology, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Catherine Legault
- Department of Neurology and Neurosurgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Dylan Blacquiere
- Division of Neurology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Hans D Katzberg
- Department of Neuromuscular Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - Thalia S Field
- Division of Neurology, University of British Columbia, Vancouver Stroke Program, Vancouver, British Columbia, Canada
| | - Vanessa Dizonno
- Division of Neurology, University of British Columbia, Vancouver Stroke Program, Vancouver, British Columbia, Canada
| | | | - Christian Jacobi
- Department of Neurology, Nordwest Hospital, Frankfurt am Main, Germany
| | - Annemie Devroye
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Masoud Ghiasian
- Department of Neurology, Sina Hospital, Hamadan University of Medical Science, Hamadan, Iran
| | | | - Sophie Chatterton
- Department of Neurology, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - Miriam Wronski
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Karl Ng
- Department of Neurology and Clinical Neurophysiology, Royal North Shore Hospital and The University of Sydney, Sydney, New South Wales, Australia
| | - Robert Kahnis
- Department of Neurology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | - Thomas Geeraerts
- Department of Anaesthesiology and Critical Care, University Toulouse 3-Paul-Sabatier, University Hospital of Toulouse, Hôpital Pierre-Paul Riquet, CHU Toulouse-Purpan, Toulouse, France
| | - Peggy Reiner
- Service de neurologie, hôpital Lariboisière Université Paris-7, AP-HP, Paris Cedex 10, France
| | - Charlotte Cordonnier
- University of Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, Lille, France
| | - Saskia Middeldorp
- Department of Internal Medicine & Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel Levi
- National Institute for Health Research University College London Hospitals (UCLH) Biomedical Research Centre, London, UK.,Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric C M van Gorp
- Department of Viroscience, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Diederik van de Beek
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Justine Brodard
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johanna A Kremer Hovinga
- Department of Hematology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marieke J H A Kruip
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Turgut Tatlisumak
- Department of Neurology & Stroke, Eberhard-Karls University, Tuebingen, Germany
| | - José M Ferro
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Poli
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tuebingen, Germany.,Department of Neurology & Stroke, Eberhard-Karls University, Tuebingen, Germany
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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26
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Faris H, Dewar B, Dowlatshahi D, Ramji A, Kenney C, Page S, Buck B, Hill MD, Coutts SB, Almekhlafi M, Sajobi T, Singh N, Sehgal A, Swartz RH, Menon BK, Shamy M. Ethical Justification for Deferral of Consent in the AcT Trial for Acute Ischemic Stroke. Stroke 2022; 53:2420-2423. [DOI: 10.1161/strokeaha.122.038760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The AcT trial (Alteplase Compared to Tenecteplase) compares alteplase or tenecteplase for patients with acute ischemic stroke. All eligible patients are enrolled by deferral of consent. Although the use of deferral of consent in the AcT trial meets the requirements of Canadian policy, we sought to provide a more explicit and rigorous approach to the justification of deferral of consent organized around 3 questions. Ultimately, the approach we outline here could become the foundation for a general justification for deferral of consent.
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Affiliation(s)
- Hannah Faris
- Department of Medicine, University of Ottawa and The Ottawa Hospital, Ontario, Canada (H.F., D.D., M.S.)
- Ottawa Hospital Research Institute, Ontario, Canada (H.F., B.D., D.D., M.S.)
| | - Brian Dewar
- Ottawa Hospital Research Institute, Ontario, Canada (H.F., B.D., D.D., M.S.)
| | - Dar Dowlatshahi
- Department of Medicine, University of Ottawa and The Ottawa Hospital, Ontario, Canada (H.F., D.D., M.S.)
- Ottawa Hospital Research Institute, Ontario, Canada (H.F., B.D., D.D., M.S.)
| | | | - Carol Kenney
- Calgary Stroke Program, University of Calgary and Foothills Hospital, Alberta, Canada (C.K., M.D.H., S.B.C., M.A., T.S., N.S., A.S., B.K.M.)
| | - Stacey Page
- Calgary Conjoint Health Research Ethics Board, Alberta, Canada (S.P.)
| | - Brian Buck
- University of Alberta and University Hospital, Edmonton, Canada (B.B.)
| | - Michael D. Hill
- Calgary Stroke Program, University of Calgary and Foothills Hospital, Alberta, Canada (C.K., M.D.H., S.B.C., M.A., T.S., N.S., A.S., B.K.M.)
| | - Shelagh B. Coutts
- Calgary Stroke Program, University of Calgary and Foothills Hospital, Alberta, Canada (C.K., M.D.H., S.B.C., M.A., T.S., N.S., A.S., B.K.M.)
| | - Mohammed Almekhlafi
- Calgary Stroke Program, University of Calgary and Foothills Hospital, Alberta, Canada (C.K., M.D.H., S.B.C., M.A., T.S., N.S., A.S., B.K.M.)
| | - Tolulope Sajobi
- Calgary Stroke Program, University of Calgary and Foothills Hospital, Alberta, Canada (C.K., M.D.H., S.B.C., M.A., T.S., N.S., A.S., B.K.M.)
| | - Nishita Singh
- Calgary Stroke Program, University of Calgary and Foothills Hospital, Alberta, Canada (C.K., M.D.H., S.B.C., M.A., T.S., N.S., A.S., B.K.M.)
| | - Arshia Sehgal
- Calgary Stroke Program, University of Calgary and Foothills Hospital, Alberta, Canada (C.K., M.D.H., S.B.C., M.A., T.S., N.S., A.S., B.K.M.)
| | - Richard H. Swartz
- University of Toronto and Sunnybrook Hospital, Ontario, Canada (R.H.S.)
| | - Bijoy K. Menon
- Calgary Stroke Program, University of Calgary and Foothills Hospital, Alberta, Canada (C.K., M.D.H., S.B.C., M.A., T.S., N.S., A.S., B.K.M.)
| | - Michel Shamy
- Department of Medicine, University of Ottawa and The Ottawa Hospital, Ontario, Canada (H.F., D.D., M.S.)
- Ottawa Hospital Research Institute, Ontario, Canada (H.F., B.D., D.D., M.S.)
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27
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Perera KS, de Sa Boasquevisque D, Rao-Melacini P, Taylor A, Cheng A, Hankey GJ, Lee S, Fabregas JM, Ameriso SF, Field TS, Arauz A, Coutts SB, Arnold M, Mikulik R, Toni D, Mandzia J, Veltkamp RC, Meseguer E, Haeusler KG, Hart RG. Evaluating Rates of Recurrent Ischemic Stroke Among Young Adults With Embolic Stroke of Undetermined Source: The Young ESUS Longitudinal Cohort Study. JAMA Neurol 2022; 79:450-458. [PMID: 35285869 PMCID: PMC8922202 DOI: 10.1001/jamaneurol.2022.0048] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance Cryptogenic strokes constitute approximately 40% of ischemic strokes in young adults, and most meet criteria for the embolic stroke of undetermined source (ESUS). Two randomized clinical trials, NAVIGATE ESUS and RESPECT ESUS, showed a high rate of stroke recurrence in older adults with ESUS but the prognosis and prognostic factors among younger individuals with ESUS is uncertain. Objective To determine rates of and factors associated with recurrent ischemic stroke and death and new-onset atrial fibrillation (AF) among young adults. Design, Setting, and Participants This multicenter longitudinal cohort study with enrollment from October 2017 to October 2019 and a mean follow-up period of 12 months ending in October 2020 included 41 stroke research centers in 13 countries. Consecutive patients 50 years and younger with a diagnosis of ESUS were included. Of 576 screened, 535 participants were enrolled after 1 withdrew consent, 41 were found to be ineligible, and 2 were excluded for other reasons. The final follow-up visit was completed by 520 patients. Main Outcomes and Measures Recurrent ischemic stroke and/or death, recurrent ischemic stroke, and prevalence of patent foramen ovale (PFO). Results The mean (SD) age of participants was 40.4 (7.3) years, and 297 (56%) participants were male. The most frequent vascular risk factors were tobacco use (240 patients [45%]), hypertension (118 patients [22%]), and dyslipidemia (109 patients [20%]). PFO was detected in 177 participants (50%) who had transthoracic echocardiograms with bubble studies. Following initial ESUS, 468 participants (88%) were receiving antiplatelet therapy, and 52 (10%) received anticoagulation. The recurrent ischemic stroke and death rate was 2.19 per 100 patient-years, and the ischemic stroke recurrence rate was 1.9 per 100 patient-years. Of the recurrent strokes, 9 (64%) were ESUS, 2 (14%) were cardioembolic, and 3 (21%) were of other determined cause. AF was detected in 15 participants (2.8%; 95% CI, 1.6-4.6). In multivariate analysis, the following were associated with recurrent ischemic stroke: history of stroke or transient ischemic attack (hazard ratio, 5.3; 95% CI, 1.8-15), presence of diabetes (hazard ratio, 4.4; 95% CI, 1.5-13), and history of coronary artery disease (hazard ratio, 10; 95% CI, 4.8-22). Conclusions and Relevance In this large cohort of young adult patients with ESUS, there was a relatively low rate of subsequent ischemic stroke and a low frequency of new-onset AF. Most recurrent strokes also met the criteria for ESUS, suggesting the need for future studies to improve our understanding of the underlying stroke mechanism in this population.
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Affiliation(s)
- Kanjana S Perera
- Department of Medicine, Neurology, McMaster University, Hamilton, Ontario, Canada.,Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Danielle de Sa Boasquevisque
- Department of Medicine, Neurology, McMaster University, Hamilton, Ontario, Canada.,Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Purnima Rao-Melacini
- Department of Medicine, Neurology, McMaster University, Hamilton, Ontario, Canada.,Department of Statistics, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Amanda Taylor
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Anna Cheng
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Graeme J Hankey
- Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia.,Department of Neurology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Sarah Lee
- Department of Neurology & Neurological Sciences, Stanford Stroke Center, Stanford, California.,Stanford Children's Health, Stanford, California
| | - Joan Marti Fabregas
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Thalia S Field
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Antonio Arauz
- National Institute of Neurology, La Fama, Tlalpan, México
| | - Shelagh B Coutts
- Department of Clinical Neurosciences, University of Calgary, Foothills Medical Calgary, Calgary, Alberta, Canada
| | - Marcel Arnold
- Department of Neurology, University Hospital Bern, Bern, Switzerland
| | - Robert Mikulik
- International Clinical Research Center and Neurology Department, St Anne's University Hospital, Brno, Czech Republic.,Masaryk University, Brno, Czech Republic
| | - Danilo Toni
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Jennifer Mandzia
- Department of Neurosciences, Western University, London, Ontario, Canada
| | - Roland C Veltkamp
- Division of Brain Sciences, Imperial College, The Hammersmith Hospital, London, United Kingdom
| | | | | | - Robert G Hart
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
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28
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Camps-Renom P, McCabe J, Martí-Fàbregas J, Giannotti N, Fernández-León A, McNulty JP, Baron JC, Barry M, Coutts SB, Cronin S, Delgado-Mederos R, Dolan E, Foley S, Guasch-Jiménez M, Guisado-Alonso D, Harbison JA, Horgan G, Kavanagh EC, Marnane M, Martinez-Domeño A, McDonnell C, Sharma VK, Williams D, Connell MO, Murphy S, Prats-Sanchez L, Kelly PJ. Association of Plaque Inflammation With Stroke Recurrence in Patients With Unproven Benefit From Carotid Revascularization. Neurology 2022; 99:e109-e118. [PMID: 35418461 DOI: 10.1212/wnl.0000000000200525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/01/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In pooled analyses of endarterectomy trials for symptomatic carotid stenosis, several subgroups experienced no net benefit from revascularization. The validated SCAIL score includes stenosis severity and inflammation measured by Positron-Emission Tomography (PET) and improves the identification of patients with recurrent stroke compared with lumen-stenosis alone. We investigated if the SCAIL score improves the identification of recurrent stroke in subgroups with uncertain benefit from revascularization in endarterectomy trials. METHODS We did an individual-participant data pooled analysis of three prospective cohort studies (DUCASS, 2008-2011; BIOVASC, 2014-2018; Barcelona Plaque Study, 2015-2018). Eligible patients had a recent non-severe (modified Rankin Score≤3) anterior circulation ischaemic stroke/TIA and either: ipsilateral mild carotid stenosis (<50%); ipsilateral moderate carotid stenosis (50-69%) plus at least one of female sex, age <65 years, diabetes mellitus, TIA, or delay >14 days to revascularization; or monocular loss of vision. Patients underwent co-registered carotid 18F-FDG PET/CT angiography (≤7 days from inclusion). The primary outcome was 90-day ipsilateral ischaemic stroke. Multivariable Cox regression modelling was performed. RESULTS We included 135 patients. All patients started optimal modern-era medical treatment at admission and 62 (45.9%) underwent carotid revascularization (36 within the first 14 days and 26 beyond). At 90 days, 18 (13.3%) patients had experienced at least one stroke recurrence. The risk of recurrence increased progressively according to the SCAIL score (0.0% in patients scoring 0-1, 15.1% scoring 2-3 and 26.7% scoring 4-5; p=0.04). The adjusted (age, smoking, hypertension, diabetes mellitus, carotid revascularization, antiplatelets and statins) Hazard Ratio for ipsilateral recurrent stroke per 1-point SCAIL increase was 2.16 (95% CI 1.32-3.53; p=0.002). A score ≥2 had a sensitivity of 100% for recurrence. DISCUSSION The SCAIL score improved the identification of early recurrent stroke in subgroups that did not experience benefit in endarterectomy trials. Randomized trials are needed to test if a combined stenosis-inflammation strategy will improve selection for carotid revascularization where benefit is currently uncertain. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in patients with recent anterior circulation ischemic stroke who do not benefit from carotid revascularization, the SCAIL score accurately distinguishes those at risk for recurrent ipsilateral ischemic stroke.
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Affiliation(s)
- Pol Camps-Renom
- Stroke Unit - Department of Neurology. Institute of Biomedical Research Sant Pau (IIB-Sant Pau). Hospital de la Santa Creu i Sant Pau. Barcelona. Spain
| | - John McCabe
- Health Research Board Stroke Clinical Trials Network Ireland, Dublin, Ireland.,Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin. Ireland
| | - Joan Martí-Fàbregas
- Stroke Unit - Department of Neurology. Institute of Biomedical Research Sant Pau (IIB-Sant Pau). Hospital de la Santa Creu i Sant Pau. Barcelona. Spain
| | - Nicola Giannotti
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin. Ireland.,Discipline of Medical Imaging Science, School of Health Sciences, Faculty of Medicine and Health, University of Sydney
| | | | - Jonathan P McNulty
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin. Ireland
| | - Jean-Claude Baron
- Department of Neurology, Université de Paris, Hopital Sainte-Anne. Paris, France
| | - Mary Barry
- Department of Vascular Surgery, St Vincent's University Hospital, and University College Dublin Ireland
| | - Shelagh B Coutts
- Departments of Clinical Neurosciences, Radiology and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Simon Cronin
- Health Research Board Stroke Clinical Trials Network Ireland, Dublin, Ireland.,Department of Neurology, Cork University Hospital, and Department of Clinical Neuroscience, College of Medicine and Health, University College Cork, Ireland
| | - Raquel Delgado-Mederos
- Stroke Unit - Department of Neurology. Institute of Biomedical Research Sant Pau (IIB-Sant Pau). Hospital de la Santa Creu i Sant Pau. Barcelona. Spain
| | - Eamon Dolan
- Health Research Board Stroke Clinical Trials Network Ireland, Dublin, Ireland.,Connolly Hospital Dublin and Royal College of Surgeons Ireland
| | - Shane Foley
- Radiography & Diagnostic Imaging, School of Medicine, University College Dublin. Ireland
| | - Marina Guasch-Jiménez
- Stroke Unit - Department of Neurology. Institute of Biomedical Research Sant Pau (IIB-Sant Pau). Hospital de la Santa Creu i Sant Pau. Barcelona. Spain
| | - Daniel Guisado-Alonso
- Stroke Unit - Department of Neurology. Institute of Biomedical Research Sant Pau (IIB-Sant Pau). Hospital de la Santa Creu i Sant Pau. Barcelona. Spain
| | - Joseph A Harbison
- Health Research Board Stroke Clinical Trials Network Ireland, Dublin, Ireland.,Stroke Service, Department of Geriatric Medicine, St James' Hospital and Trinity College Dublin Ireland
| | - Gillian Horgan
- Health Research Board Stroke Clinical Trials Network Ireland, Dublin, Ireland.,Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin. Ireland
| | - Eoin C Kavanagh
- Department of Radiology, Mater University Hospital and University College Dublin Ireland
| | - Michael Marnane
- Health Research Board Stroke Clinical Trials Network Ireland, Dublin, Ireland.,Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin. Ireland
| | - Alejandro Martinez-Domeño
- Stroke Unit - Department of Neurology. Institute of Biomedical Research Sant Pau (IIB-Sant Pau). Hospital de la Santa Creu i Sant Pau. Barcelona. Spain
| | - Ciaran McDonnell
- Department of Vascular Surgery, Mater University Hospital, and University College Dublin Ireland
| | - Vijay K Sharma
- Division of Neurology, National University Health System, and Yong Loo Lin School of Medicine, National University of Singapore
| | - David Williams
- Department of Geriatric and Stroke Medicine, RCSI University of Medicine and Health Sciences/Beaumont Hospital Dublin Ireland
| | - Martin O Connell
- Department of Radiology, Mater University Hospital and University College Dublin Ireland
| | - Sean Murphy
- Health Research Board Stroke Clinical Trials Network Ireland, Dublin, Ireland.,Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin. Ireland
| | - Luis Prats-Sanchez
- Stroke Unit - Department of Neurology. Institute of Biomedical Research Sant Pau (IIB-Sant Pau). Hospital de la Santa Creu i Sant Pau. Barcelona. Spain
| | - Peter J Kelly
- Health Research Board Stroke Clinical Trials Network Ireland, Dublin, Ireland.,Neurovascular Clinical Science Unit, Stroke Service and Department of Neurology, Mater University Hospital/University College Dublin. Ireland
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29
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Almekhlafi MA, Coutts SB. Anti-thrombotics cause harm in the setting of stroke thrombectomy. Lancet 2022; 399:1025-1026. [PMID: 35240045 DOI: 10.1016/s0140-6736(22)00335-x] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/27/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Mohammed A Almekhlafi
- Department of Clinical Neurosciences, Department of Radiology, and Department of Community Health Sciences, Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Shelagh B Coutts
- Department of Clinical Neurosciences, Department of Radiology, and Department of Community Health Sciences, Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada.
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30
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Alrohimi A, Gioia LC, Kate MP, Ng K, Dowlatshahi D, Field TS, Coutts SB, Siddiqui M, Hill MD, Miller J, HART RG, Jickling G, Shuaib A, Buck BH, Sharma MA, Butcher K. Abstract TP197: Early Direct Oral Anticoagulants Therapy After Ischemic Stroke In Patients With And Without Atrial Fibrillation:A Pooled Analysis Of Five Studies. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tp197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Early anticoagulation after acute ischemic stroke is usually avoided due to the risk of hemorrhagic transformation (HT). We aimed to assess the rate of radiological HT associated with direct oral anticoagulant (DOAC) initiation within 48 hours vs. > 48 hours in the post-stroke period.
Methods:
A pooled analysis of five studies of DOAC initiation within 14 days of ischemic stroke onset was conducted. The primary endpoint was incident radiographic HT on follow-up imaging. Secondary endpoints included symptomatic HT, new parenchymal hemorrhage (PH1 or asymptomatic PH2), recurrent systemic events, systemic hemorrhagic complications, mortality within the study period, final modified Rankin Scale score. The results were reported as odds ratio (OR) with 95% confidence interval (CI).
Results:
A total of 468 patients were enrolled. Median infarct volume was 1.35 (0-7.5) ml, and National Institutes of Health Stroke Scale was 1 (0-3). Incident radiographic HT was seen on follow-up scan in 29 patients. DOAC initiation within 48 hours from index event onset was not associated with incident HT (adjusted OR 0.67, [0.31 - 1.50]
P
=0.34). No patients developed symptomatic HT. Conversely, 25 patients developed recurrent ischemic events, 64% of which occurred within 14 days. Initiating DOAC within 48 hours of onset was not associated with a reduction in the risk of recurrent ischemic events (OR 0.47, [0.19 - 1.20]
P
=0.12). In contrast to HT, recurrent ischemic events were associated with poor functional outcomes (OR=6.8, [2.95 - 15.63], p<0.0001).
Conclusions:
Early DOAC initiation after stroke was not associated with increased incident HT risk. Recurrent ischemic events were common and associated with poor outcomes. These data may be useful for estimating outcome rates and sample size calculations in future trials of early versus late DOAC initiation after AF-related stroke.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jodi Miller
- Population Health Rsch Institut, hamilton, Canada
| | | | | | | | | | | | - Ken Butcher
- UNIVERSITY of New South Wales, Randwick, Australia
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31
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Lau HL, Gardener H, Coutts SB, Saini V, Field TS, Dowlatshahi D, Smith EE, Hill MD, Romano JG, Demchuk AM, Menon BK, Asdaghi N. Radiographic Characteristics of Mild Ischemic Stroke Patients With Visible Intracranial Occlusion: The INTERRSeCT Study. Stroke 2021; 53:913-920. [PMID: 34753303 DOI: 10.1161/strokeaha.120.030380] [Citation(s) in RCA: 1] [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: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Early neurological deterioration occurs in one-third of mild strokes primarily due to the presence of a relevant intracranial occlusion. We studied vascular occlusive patterns, thrombus characteristics, and recanalization rates in these patients. METHODS Among patients enrolled in INTERRSeCT (Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography), a multicenter prospective study of acute ischemic strokes with a visible intracranial occlusion, we compared characteristics of mild (National Institutes of Health Stroke Scale score, ≤5) to moderate/severe strokes. RESULTS Among 575 patients, 12.9% had a National Institutes of Health Stroke Scale score ≤5 (median age, 70.5 [63-79]; 58% male; median National Institutes of Health Stroke Scale score, 4 [2-4]). Demographics and vascular risk factors were similar between the two groups. As compared with those with a National Institutes of Health Stroke Scale score >5, mild patients had longer symptom onset to assessment times (onset to computed tomography [240 versus 167 minutes] and computed tomography angiography [246 versus 172 minutes]), more distal occlusions (M3, anterior cerebral artery and posterior cerebral artery; 22% versus 6%), higher clot burden score (median, 9 [6-9] versus 6 [4-9]), similar favorable thrombus permeability (residual flow grades I-II, 21% versus 19%), higher collateral flow (9.1 versus 7.6), and lower intravenous alteplase treatment rates (55% versus 85%). Mild patients were more likely to recanalize (revised arterial occlusion scale score 2b/3, 45%; 49% with alteplase) compared with moderate/severe strokes (26%; 29% with alteplase). In an adjusted model for sex, alteplase, residual flow, and time between the two vessel imagings, intravenous alteplase use (odds ratio, 3.80 [95% CI, 1.11-13.00]) and residual flow grade (odds ratio, 8.70 [95% CI, 1.26-60.13]) were associated with successful recanalization among mild patients. CONCLUSIONS Mild strokes with visible intracranial occlusions have different vascular occlusive patterns but similar thrombus permeability compared with moderate/severe strokes. Higher thrombus permeability and alteplase use were associated with successful recanalization, although the majority do not recanalize. Randomized controlled trials are needed to assess the efficacy of new thrombolytics and endovascular therapy in this population.
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Affiliation(s)
- H Lee Lau
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL (H.L.L., H.G., V.S., J.G.R., N.A.)
| | - Hannah Gardener
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL (H.L.L., H.G., V.S., J.G.R., N.A.)
| | - Shelagh B Coutts
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada. (S.B.C., E.E.S., M.D.H., A.M.D., B.K.M.).,Department of Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada. (S.B.C., E.E.S., M.D.H., A.M.D., B.K.M.).,Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada. (S.B.C., E.E.S., M.D.H., A.M.D., B.K.M.)
| | - Vasu Saini
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL (H.L.L., H.G., V.S., J.G.R., N.A.)
| | - Thalia S Field
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada (T.S.F.)
| | - Dar Dowlatshahi
- Department of Neuroscience, Ottawa Hospital Research Institute, Ontario, Canada (D.D.).,Department of Epidemiology, Ottawa Hospital Research Institute, Ontario, Canada (D.D.)
| | - Eric E Smith
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada. (S.B.C., E.E.S., M.D.H., A.M.D., B.K.M.).,Department of Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada. (S.B.C., E.E.S., M.D.H., A.M.D., B.K.M.).,Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada. (S.B.C., E.E.S., M.D.H., A.M.D., B.K.M.)
| | - Michael D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada. (S.B.C., E.E.S., M.D.H., A.M.D., B.K.M.).,Department of Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada. (S.B.C., E.E.S., M.D.H., A.M.D., B.K.M.).,Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada. (S.B.C., E.E.S., M.D.H., A.M.D., B.K.M.)
| | - Jose G Romano
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL (H.L.L., H.G., V.S., J.G.R., N.A.)
| | - Andrew M Demchuk
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada. (S.B.C., E.E.S., M.D.H., A.M.D., B.K.M.).,Department of Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada. (S.B.C., E.E.S., M.D.H., A.M.D., B.K.M.).,Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada. (S.B.C., E.E.S., M.D.H., A.M.D., B.K.M.)
| | - Bijoy K Menon
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada. (S.B.C., E.E.S., M.D.H., A.M.D., B.K.M.).,Department of Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada. (S.B.C., E.E.S., M.D.H., A.M.D., B.K.M.).,Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada. (S.B.C., E.E.S., M.D.H., A.M.D., B.K.M.)
| | - Negar Asdaghi
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL (H.L.L., H.G., V.S., J.G.R., N.A.)
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Sharma M, Smith EE, Pearce LA, Shoamanesh A, Perera KS, Coutts SB, Damgaard D, Ameriso SF, Rha JH, Modrau B, Yoon BW, Romano M, Messé SR, Barlinn J, Lambeck J, Saad F, Berkowitz SD, Mundl H, Connolly SJ, Hart RG. Frequency and Patterns of Brain Infarction in Patients With Embolic Stroke of Undetermined Source: NAVIGATE ESUS Trial. Stroke 2021; 53:45-52. [PMID: 34538089 DOI: 10.1161/strokeaha.120.032976] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE The spectrum of brain infarction in patients with embolic stroke of undetermined source (ESUS) has not been well characterized. Our objective was to define the frequency and pattern of brain infarcts detected by magnetic resonance imaging (MRI) among patients with recent ESUS participating in a clinical trial. METHODS In the NAVIGATE ESUS trial (New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial Versus ASA to Prevent Embolism in Embolic Stroke of Undetermined Source), an MRI substudy was carried out at 87 sites in 15 countries. Participants underwent an MRI using a specified protocol near randomization. Images were interpreted centrally by those unaware of clinical characteristics. RESULTS Among the 918 substudy cohort participants, the mean age was 67 years and 60% were men with a median (interquartile range) of 64 (26-115) days between the qualifying ischemic stroke and MRI. On MRI, 855 (93%) had recent or chronic brain infarcts that were multiple in 646 (70%) and involved multiple arterial territories in 62% (401/646). Multiple brain infarcts were present in 68% (510/755) of those without a history of stroke or transient ischemic attack before the qualifying ESUS. Prior stroke/transient ischemic attack (P<0.001), modified Rankin Scale score >0 (P<0.001), and current tobacco use (P=0.01) were associated with multiple infarcts. Topographically, large and/or cortical infarcts were present in 89% (757/855) of patients with infarcts, while in 11% (98/855) infarcts were exclusively small and subcortical. Among those with multiple large and/or cortical infarcts, 57% (251/437) had one or more involving a different vascular territory from the qualifying ESUS. CONCLUSIONS Most patients with ESUS, including those without prior clinical stroke or transient ischemic attack, had multiple large and/or cortical brain infarcts detected by MRI, reflecting a substantial burden of clinical stroke and covert brain infarction. Infarcts most frequently involved multiple vascular territories. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02313909.
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Affiliation(s)
- Mukul Sharma
- Department of Medicine (Neurology), McMaster University/Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada (M.S, A.S., K.S.P.)
| | - Eric E Smith
- Department of Clinical Neurosciences, University of Calgary, Alberta, Canada (E.E.S.)
| | - Lesly A Pearce
- Biostatistics Consultant, St. Catharines, Ontario, Canada (L.A.P.)
| | - Ashkan Shoamanesh
- Department of Medicine (Neurology), McMaster University/Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada (M.S, A.S., K.S.P.)
| | - Kanjana S Perera
- Department of Medicine (Neurology), McMaster University/Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada (M.S, A.S., K.S.P.)
| | - Shelagh B Coutts
- Department of Clinical Neurosciences, Radiology, and Community Health Sciences, University of Calgary, Alberta, Canada. (S.B.C.)
| | - Dorte Damgaard
- Department of Neurology, Aarhus University Hospital, Denmark (D.D.)
| | | | - Joung-Ho Rha
- Inha University Hospital, Incheon, Korea (J.-H.R.)
| | - Boris Modrau
- Department of Neurology, Aalborg University Hospital, Denmark (B.M.)
| | - Byung-Woo Yoon
- Department of Neurology, Seoul National University Hospital, Korea (B.-W.Y.)
| | - Marina Romano
- Department of Neurology, Centro Estudios Medicos e Invest. Clinicas "Dr. N. Quirno", Buenos Aires, Argentina (M.R.)
| | - Steven R Messé
- Department of Neurology, University of Pennsylvania, Philadelphia (S.R.M.)
| | - Jessica Barlinn
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universitat Dresden, Germany (J.B.)
| | - Johann Lambeck
- Department of Neurology and Clinical Neurophysiology, Universitätsklinikum Freiburg, Germany (J.L.)
| | - Feryal Saad
- Department of Clinical Neurosciences, University of Calgary, Alberta, Canada. (F.S.)
| | | | | | - Stuart J Connolly
- Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (R.G.H., S.J.C.)
| | - Robert G Hart
- Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (R.G.H., S.J.C.)
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Affiliation(s)
- Shelagh B Coutts
- Departments of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, AB, Canada (S.B.C.)
| | - Diogo C Haussen
- Emory University School of Medicine/Grady Memorial Hospital, Atlanta, GA (D.C.H.)
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Buck BH, Hill MD, Quinn FR, Butcher KS, Menon BK, Gulamhusein S, Siddiqui M, Coutts SB, Jeerakathil T, Smith EE, Khan K, Barber PA, Jickling G, Reyes L, Save S, Fairall P, Piquette L, Kamal N, Chew DS, Demchuk AM, Shuaib A, Exner DV. Effect of Implantable vs Prolonged External Electrocardiographic Monitoring on Atrial Fibrillation Detection in Patients With Ischemic Stroke: The PER DIEM Randomized Clinical Trial. JAMA 2021; 325:2160-2168. [PMID: 34061146 PMCID: PMC8170545 DOI: 10.1001/jama.2021.6128] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [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: 12/12/2022]
Abstract
IMPORTANCE The relative rates of detection of atrial fibrillation (AF) or atrial flutter from evaluating patients with prolonged electrocardiographic monitoring with an external loop recorder or implantable loop recorder after an ischemic stroke are unknown. OBJECTIVE To determine, in patients with a recent ischemic stroke, whether 12 months of implantable loop recorder monitoring detects more occurrences of AF compared with conventional external loop recorder monitoring for 30 days. DESIGN, SETTING, AND PARTICIPANTS Investigator-initiated, open-label, randomized clinical trial conducted at 2 university hospitals and 1 community hospital in Alberta, Canada, including 300 patients within 6 months of ischemic stroke and without known AF from May 2015 through November 2017; final follow-up was in December 2018. INTERVENTIONS Participants were randomly assigned 1:1 to prolonged electrocardiographic monitoring with either an implantable loop recorder (n = 150) or an external loop recorder (n = 150) with follow-up visits at 30 days, 6 months, and 12 months. MAIN OUTCOMES AND MEASURES The primary outcome was the development of definite AF or highly probable AF (adjudicated new AF lasting ≥2 minutes within 12 months of randomization). There were 8 prespecified secondary outcomes including time to event analysis of new AF, recurrent ischemic stroke, intracerebral hemorrhage, death, and device-related serious adverse events within 12 months. RESULTS Among the 300 patients who were randomized (median age, 64.1 years [interquartile range, 56.1 to 73.7 years]; 121 were women [40.3%]; and 66.3% had a stroke of undetermined etiology with a median CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 years, diabetes, stroke or transient ischemic attack, vascular disease, age 65 to 74 years, sex category] score of 4 [interquartile range, 3 to 5]), 273 (91.0%) completed cardiac monitoring lasting 24 hours or longer and 259 (86.3%) completed both the assigned monitoring and 12-month follow-up visit. The primary outcome was observed in 15.3% (23/150) of patients in the implantable loop recorder group and 4.7% (7/150) of patients in the external loop recorder group (between-group difference, 10.7% [95% CI, 4.0% to 17.3%]; risk ratio, 3.29 [95% CI, 1.45 to 7.42]; P = .003). Of the 8 specified secondary outcomes, 6 were not significantly different. There were 5 patients (3.3%) in the implantable loop recorder group who had recurrent ischemic stroke vs 8 patients (5.3%) in the external loop recorder group (between-group difference, -2.0% [95% CI, -6.6% to 2.6%]), 1 (0.7%) vs 1 (0.7%), respectively, who had intracerebral hemorrhage (between-group difference, 0% [95% CI, -1.8% to 1.8%]), 3 (2.0%) vs 3 (2.0%) who died (between-group difference, 0% [95% CI, -3.2% to 3.2%]), and 1 (0.7%) vs 0 (0%) who had device-related serious adverse events. CONCLUSIONS AND RELEVANCE Among patients with ischemic stroke and no prior evidence of AF, implantable electrocardiographic monitoring for 12 months, compared with prolonged external monitoring for 30 days, resulted in a significantly greater proportion of patients with AF detected over 12 months. Further research is needed to compare clinical outcomes associated with these monitoring strategies and relative cost-effectiveness. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02428140.
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Affiliation(s)
- Brian H. Buck
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Michael D. Hill
- Departments of Clinical Neurosciences, Radiology, Medicine, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - F. Russell Quinn
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Ken S. Butcher
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Bijoy K. Menon
- Departments of Clinical Neurosciences, Radiology, Medicine, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Sajad Gulamhusein
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Muzaffar Siddiqui
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Shelagh B. Coutts
- Departments of Clinical Neurosciences, Radiology, Medicine, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Thomas Jeerakathil
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Eric E. Smith
- Departments of Clinical Neurosciences, Radiology, Medicine, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Khurshid Khan
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Phillip A. Barber
- Departments of Clinical Neurosciences, Radiology, Medicine, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Glen Jickling
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Lucy Reyes
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Supriya Save
- Departments of Clinical Neurosciences, Radiology, Medicine, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Paige Fairall
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Lori Piquette
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Noreen Kamal
- Departments of Clinical Neurosciences, Radiology, Medicine, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Derek S. Chew
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Andrew M. Demchuk
- Departments of Clinical Neurosciences, Radiology, Medicine, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Ashfaq Shuaib
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Derek V. Exner
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
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Ospel JM, Menon BK, Qiu W, Kashani N, Mayank A, Singh N, Cimflova P, Marko M, Nogueira RG, McTaggart RA, Demchuk AM, Poppe AY, Zerna C, Joshi M, Almekhlafi MA, Haussen D, Cutting S, Coutts SB, Roy D, Rohr A, Iancu D, Tymianski M, Hill MD, Goyal M. A Detailed Analysis of Infarct Patterns and Volumes at 24-hour Noncontrast CT and Diffusion-weighted MRI in Acute Ischemic Stroke Due to Large Vessel Occlusion: Results from the ESCAPE-NA1 Trial. Radiology 2021; 300:152-159. [PMID: 33973838 DOI: 10.1148/radiol.2021203964] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background The effect of infarct pattern on functional outcome in acute ischemic stroke is incompletely understood. Purpose To investigate the association of qualitative and quantitative infarct variables at 24-hour follow-up noncontrast CT and diffusion-weighted MRI with 90-day clinical outcome. Materials and Methods The Safety and Efficacy of Nerinetide in Subjects Undergoing Endovascular Thrombectomy for Stroke, or ESCAPE-NA1, randomized controlled trial enrolled patients with large-vessel-occlusion stroke undergoing mechanical thrombectomy from March 1, 2017, to August 12, 2019. In this post hoc analysis of the trial, qualitative infarct variables (predominantly gray [vs gray and white] matter involvement, corticospinal tract involvement, infarct structure [scattered vs territorial]) and total infarct volume were assessed at 24-hour follow-up noncontrast CT or diffusion-weighted MRI. White and gray matter infarct volumes were assessed in patients by using follow-up diffusion-weighted MRI. Infarct variables were compared between patients with and those without good outcome, defined as a modified Rankin Scale score of 0-2 at 90 days. The association of infarct variables with good outcome was determined with use of multivariable logistic regression. Separate regression models were used to report effect size estimates with adjustment for total infarct volume. Results Qualitative infarct variables were assessed in 1026 patients (mean age ± standard deviation, 69 years ± 13; 522 men) and quantitative infarct variables were assessed in a subgroup of 358 of 1026 patients (mean age, 67 years ± 13; 190 women). Patients with gray and white matter involvement (odds ratio [OR] after multivariable adjustment, 0.19; 95% CI: 0.14, 0.25; P < .001), corticospinal tract involvement (OR after multivariable adjustment, 0.06; 95% CI: 0.04, 0.10; P < .001), and territorial infarcts (OR after multivariable adjustment, 0.22; 95% CI: 0.14, 0.32; P < .001) were less likely to achieve good outcome, independent of total infarct volume. Conclusion Infarct confinement to the gray matter, corticospinal tract sparing, and scattered infarct structure at 24-hour noncontrast CT and diffusion-weighted MRI were highly predictive of good 90-day clinical outcome, independent of total infarct volume. Clinical trial registration no. NCT02930018 © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Mossa-Basha in this issue.
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Affiliation(s)
- Johanna M Ospel
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., B.K.M., W.Q., N.K., A.M., N.S., P.C., M.M., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (B.K.M., N.K., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Medical Imaging, St Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic (P.C.); International Clinical Research Center, St Anne's University Hospital Brno, Czech Republic (P.C.); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.A.M.); Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (A.Y.P., D.R., D.I.); Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (S.C.); Department of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (A.R.); and NoNo, Toronto, Ontario, Canada (M.T.)
| | - Bijoy K Menon
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., B.K.M., W.Q., N.K., A.M., N.S., P.C., M.M., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (B.K.M., N.K., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Medical Imaging, St Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic (P.C.); International Clinical Research Center, St Anne's University Hospital Brno, Czech Republic (P.C.); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.A.M.); Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (A.Y.P., D.R., D.I.); Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (S.C.); Department of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (A.R.); and NoNo, Toronto, Ontario, Canada (M.T.)
| | - Wu Qiu
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., B.K.M., W.Q., N.K., A.M., N.S., P.C., M.M., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (B.K.M., N.K., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Medical Imaging, St Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic (P.C.); International Clinical Research Center, St Anne's University Hospital Brno, Czech Republic (P.C.); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.A.M.); Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (A.Y.P., D.R., D.I.); Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (S.C.); Department of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (A.R.); and NoNo, Toronto, Ontario, Canada (M.T.)
| | - Nima Kashani
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., B.K.M., W.Q., N.K., A.M., N.S., P.C., M.M., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (B.K.M., N.K., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Medical Imaging, St Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic (P.C.); International Clinical Research Center, St Anne's University Hospital Brno, Czech Republic (P.C.); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.A.M.); Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (A.Y.P., D.R., D.I.); Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (S.C.); Department of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (A.R.); and NoNo, Toronto, Ontario, Canada (M.T.)
| | - Arnuv Mayank
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., B.K.M., W.Q., N.K., A.M., N.S., P.C., M.M., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (B.K.M., N.K., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Medical Imaging, St Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic (P.C.); International Clinical Research Center, St Anne's University Hospital Brno, Czech Republic (P.C.); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.A.M.); Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (A.Y.P., D.R., D.I.); Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (S.C.); Department of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (A.R.); and NoNo, Toronto, Ontario, Canada (M.T.)
| | - Nishita Singh
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., B.K.M., W.Q., N.K., A.M., N.S., P.C., M.M., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (B.K.M., N.K., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Medical Imaging, St Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic (P.C.); International Clinical Research Center, St Anne's University Hospital Brno, Czech Republic (P.C.); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.A.M.); Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (A.Y.P., D.R., D.I.); Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (S.C.); Department of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (A.R.); and NoNo, Toronto, Ontario, Canada (M.T.)
| | - Petra Cimflova
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., B.K.M., W.Q., N.K., A.M., N.S., P.C., M.M., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (B.K.M., N.K., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Medical Imaging, St Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic (P.C.); International Clinical Research Center, St Anne's University Hospital Brno, Czech Republic (P.C.); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.A.M.); Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (A.Y.P., D.R., D.I.); Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (S.C.); Department of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (A.R.); and NoNo, Toronto, Ontario, Canada (M.T.)
| | - Martha Marko
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., B.K.M., W.Q., N.K., A.M., N.S., P.C., M.M., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (B.K.M., N.K., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Medical Imaging, St Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic (P.C.); International Clinical Research Center, St Anne's University Hospital Brno, Czech Republic (P.C.); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.A.M.); Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (A.Y.P., D.R., D.I.); Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (S.C.); Department of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (A.R.); and NoNo, Toronto, Ontario, Canada (M.T.)
| | - Raul G Nogueira
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., B.K.M., W.Q., N.K., A.M., N.S., P.C., M.M., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (B.K.M., N.K., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Medical Imaging, St Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic (P.C.); International Clinical Research Center, St Anne's University Hospital Brno, Czech Republic (P.C.); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.A.M.); Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (A.Y.P., D.R., D.I.); Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (S.C.); Department of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (A.R.); and NoNo, Toronto, Ontario, Canada (M.T.)
| | - Ryan A McTaggart
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., B.K.M., W.Q., N.K., A.M., N.S., P.C., M.M., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (B.K.M., N.K., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Medical Imaging, St Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic (P.C.); International Clinical Research Center, St Anne's University Hospital Brno, Czech Republic (P.C.); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.A.M.); Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (A.Y.P., D.R., D.I.); Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (S.C.); Department of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (A.R.); and NoNo, Toronto, Ontario, Canada (M.T.)
| | - Andrew M Demchuk
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., B.K.M., W.Q., N.K., A.M., N.S., P.C., M.M., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (B.K.M., N.K., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Medical Imaging, St Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic (P.C.); International Clinical Research Center, St Anne's University Hospital Brno, Czech Republic (P.C.); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.A.M.); Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (A.Y.P., D.R., D.I.); Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (S.C.); Department of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (A.R.); and NoNo, Toronto, Ontario, Canada (M.T.)
| | - Alexandre Y Poppe
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., B.K.M., W.Q., N.K., A.M., N.S., P.C., M.M., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (B.K.M., N.K., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Medical Imaging, St Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic (P.C.); International Clinical Research Center, St Anne's University Hospital Brno, Czech Republic (P.C.); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.A.M.); Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (A.Y.P., D.R., D.I.); Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (S.C.); Department of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (A.R.); and NoNo, Toronto, Ontario, Canada (M.T.)
| | - Charlotte Zerna
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., B.K.M., W.Q., N.K., A.M., N.S., P.C., M.M., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (B.K.M., N.K., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Medical Imaging, St Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic (P.C.); International Clinical Research Center, St Anne's University Hospital Brno, Czech Republic (P.C.); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.A.M.); Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (A.Y.P., D.R., D.I.); Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (S.C.); Department of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (A.R.); and NoNo, Toronto, Ontario, Canada (M.T.)
| | - Manish Joshi
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., B.K.M., W.Q., N.K., A.M., N.S., P.C., M.M., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (B.K.M., N.K., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Medical Imaging, St Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic (P.C.); International Clinical Research Center, St Anne's University Hospital Brno, Czech Republic (P.C.); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.A.M.); Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (A.Y.P., D.R., D.I.); Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (S.C.); Department of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (A.R.); and NoNo, Toronto, Ontario, Canada (M.T.)
| | - Mohammed A Almekhlafi
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., B.K.M., W.Q., N.K., A.M., N.S., P.C., M.M., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (B.K.M., N.K., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Medical Imaging, St Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic (P.C.); International Clinical Research Center, St Anne's University Hospital Brno, Czech Republic (P.C.); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.A.M.); Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (A.Y.P., D.R., D.I.); Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (S.C.); Department of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (A.R.); and NoNo, Toronto, Ontario, Canada (M.T.)
| | - Diogo Haussen
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., B.K.M., W.Q., N.K., A.M., N.S., P.C., M.M., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (B.K.M., N.K., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Medical Imaging, St Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic (P.C.); International Clinical Research Center, St Anne's University Hospital Brno, Czech Republic (P.C.); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.A.M.); Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (A.Y.P., D.R., D.I.); Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (S.C.); Department of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (A.R.); and NoNo, Toronto, Ontario, Canada (M.T.)
| | - Shawna Cutting
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., B.K.M., W.Q., N.K., A.M., N.S., P.C., M.M., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (B.K.M., N.K., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Medical Imaging, St Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic (P.C.); International Clinical Research Center, St Anne's University Hospital Brno, Czech Republic (P.C.); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.A.M.); Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (A.Y.P., D.R., D.I.); Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (S.C.); Department of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (A.R.); and NoNo, Toronto, Ontario, Canada (M.T.)
| | - Shelagh B Coutts
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., B.K.M., W.Q., N.K., A.M., N.S., P.C., M.M., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (B.K.M., N.K., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Medical Imaging, St Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic (P.C.); International Clinical Research Center, St Anne's University Hospital Brno, Czech Republic (P.C.); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.A.M.); Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (A.Y.P., D.R., D.I.); Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (S.C.); Department of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (A.R.); and NoNo, Toronto, Ontario, Canada (M.T.)
| | - Daniel Roy
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., B.K.M., W.Q., N.K., A.M., N.S., P.C., M.M., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (B.K.M., N.K., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Medical Imaging, St Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic (P.C.); International Clinical Research Center, St Anne's University Hospital Brno, Czech Republic (P.C.); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.A.M.); Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (A.Y.P., D.R., D.I.); Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (S.C.); Department of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (A.R.); and NoNo, Toronto, Ontario, Canada (M.T.)
| | - Axel Rohr
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., B.K.M., W.Q., N.K., A.M., N.S., P.C., M.M., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (B.K.M., N.K., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Medical Imaging, St Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic (P.C.); International Clinical Research Center, St Anne's University Hospital Brno, Czech Republic (P.C.); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.A.M.); Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (A.Y.P., D.R., D.I.); Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (S.C.); Department of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (A.R.); and NoNo, Toronto, Ontario, Canada (M.T.)
| | - Dana Iancu
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., B.K.M., W.Q., N.K., A.M., N.S., P.C., M.M., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (B.K.M., N.K., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Medical Imaging, St Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic (P.C.); International Clinical Research Center, St Anne's University Hospital Brno, Czech Republic (P.C.); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.A.M.); Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (A.Y.P., D.R., D.I.); Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (S.C.); Department of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (A.R.); and NoNo, Toronto, Ontario, Canada (M.T.)
| | - Michael Tymianski
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., B.K.M., W.Q., N.K., A.M., N.S., P.C., M.M., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (B.K.M., N.K., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Medical Imaging, St Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic (P.C.); International Clinical Research Center, St Anne's University Hospital Brno, Czech Republic (P.C.); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.A.M.); Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (A.Y.P., D.R., D.I.); Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (S.C.); Department of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (A.R.); and NoNo, Toronto, Ontario, Canada (M.T.)
| | - Michael D Hill
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., B.K.M., W.Q., N.K., A.M., N.S., P.C., M.M., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (B.K.M., N.K., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Medical Imaging, St Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic (P.C.); International Clinical Research Center, St Anne's University Hospital Brno, Czech Republic (P.C.); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.A.M.); Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (A.Y.P., D.R., D.I.); Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (S.C.); Department of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (A.R.); and NoNo, Toronto, Ontario, Canada (M.T.)
| | - Mayank Goyal
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., B.K.M., W.Q., N.K., A.M., N.S., P.C., M.M., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (B.K.M., N.K., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Medical Imaging, St Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic (P.C.); International Clinical Research Center, St Anne's University Hospital Brno, Czech Republic (P.C.); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.A.M.); Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (A.Y.P., D.R., D.I.); Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (S.C.); Department of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (A.R.); and NoNo, Toronto, Ontario, Canada (M.T.)
| | -
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., B.K.M., W.Q., N.K., A.M., N.S., P.C., M.M., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Alberta, Canada (B.K.M., N.K., A.M.D., C.Z., M.J., M.A.A., S.B.C., M.D.H., M.G.); Department of Medical Imaging, St Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic (P.C.); International Clinical Research Center, St Anne's University Hospital Brno, Czech Republic (P.C.); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.A.M.); Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada (A.Y.P., D.R., D.I.); Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (S.C.); Department of Neuroradiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada (A.R.); and NoNo, Toronto, Ontario, Canada (M.T.)
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Best JG, Ambler G, Wilson D, Lee KJ, Lim JS, Shiozawa M, Koga M, Li L, Lovelock C, Chabriat H, Hennerici M, Wong YK, Mak HKF, Prats-Sanchez L, Martínez-Domeño A, Inamura S, Yoshifuji K, Arsava EM, Horstmann S, Purrucker J, Lam BYK, Wong A, Kim YD, Song TJ, Lemmens R, Eppinger S, Gattringer T, Uysal E, Tanriverdi Z, Bornstein NM, Ben Assayag E, Hallevi H, Molad J, Nishihara M, Tanaka J, Coutts SB, Polymeris A, Wagner B, Seiffge DJ, Lyrer P, Algra A, Kappelle LJ, Al-Shahi Salman R, Jäger HR, Lip GYH, Fischer U, El-Koussy M, Mas JL, Legrand L, Karayiannis C, Phan T, Gunkel S, Christ N, Abrigo J, Leung T, Chu W, Chappell F, Makin S, Hayden D, Williams DJ, Mess WH, Nederkoorn PJ, Barbato C, Browning S, Wiegertjes K, Tuladhar AM, Maaijwee N, Guevarra AC, Yatawara C, Mendyk AM, Delmaire C, Köhler S, van Oostenbrugge R, Zhou Y, Xu C, Hilal S, Gyanwali B, Chen C, Lou M, Staals J, Bordet R, Kandiah N, de Leeuw FE, Simister R, Hendrikse J, Kelly PJ, Wardlaw J, Soo Y, Fluri F, Srikanth V, Calvet D, Jung S, Kwa VIH, Engelter ST, Peters N, Smith EE, Hara H, Yakushiji Y, Orken DN, Fazekas F, Thijs V, Heo JH, Mok V, Veltkamp R, Ay H, Imaizumi T, Gomez-Anson B, Lau KK, Jouvent E, Rothwell PM, Toyoda K, Bae HJ, Marti-Fabregas J, Werring DJ. Development of imaging-based risk scores for prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotic therapy after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies. Lancet Neurol 2021; 20:294-303. [PMID: 33743239 DOI: 10.1016/s1474-4422(21)00024-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 12/16/2020] [Accepted: 01/08/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Balancing the risks of recurrent ischaemic stroke and intracranial haemorrhage is important for patients treated with antithrombotic therapy after ischaemic stroke or transient ischaemic attack. However, existing predictive models offer insufficient performance, particularly for assessing the risk of intracranial haemorrhage. We aimed to develop new risk scores incorporating clinical variables and cerebral microbleeds, an MRI biomarker of intracranial haemorrhage and ischaemic stroke risk. METHODS We did a pooled analysis of individual-patient data from the Microbleeds International Collaborative Network (MICON), which includes 38 hospital-based prospective cohort studies from 18 countries. All studies recruited participants with previous ischaemic stroke or transient ischaemic attack, acquired baseline MRI allowing quantification of cerebral microbleeds, and followed-up participants for ischaemic stroke and intracranial haemorrhage. Participants not taking antithrombotic drugs were excluded. We developed Cox regression models to predict the 5-year risks of intracranial haemorrhage and ischaemic stroke, selecting candidate predictors on biological relevance and simplifying models using backward elimination. We derived integer risk scores for clinical use. We assessed model performance in internal validation, adjusted for optimism using bootstrapping. The study is registered on PROSPERO, CRD42016036602. FINDINGS The included studies recruited participants between Aug 28, 2001, and Feb 4, 2018. 15 766 participants had follow-up for intracranial haemorrhage, and 15 784 for ischaemic stroke. Over a median follow-up of 2 years, 184 intracranial haemorrhages and 1048 ischaemic strokes were reported. The risk models we developed included cerebral microbleed burden and simple clinical variables. Optimism-adjusted c indices were 0·73 (95% CI 0·69-0·77) with a calibration slope of 0·94 (0·81-1·06) for the intracranial haemorrhage model and 0·63 (0·62-0·65) with a calibration slope of 0·97 (0·87-1·07) for the ischaemic stroke model. There was good agreement between predicted and observed risk for both models. INTERPRETATION The MICON risk scores, incorporating clinical variables and cerebral microbleeds, offer predictive value for the long-term risks of intracranial haemorrhage and ischaemic stroke in patients prescribed antithrombotic therapy for secondary stroke prevention; external validation is warranted. FUNDING British Heart Foundation and Stroke Association.
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Affiliation(s)
- Jonathan G Best
- UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, Gower Street, London, UK
| | - Duncan Wilson
- UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK; New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Keon-Joo Lee
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Jae-Sung Lim
- Department of Neurology, Hallym Neurological Institute, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Masayuki Shiozawa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan
| | - Linxin Li
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Caroline Lovelock
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Hugues Chabriat
- Assistance Publique - Hôpitaux de Paris, Lariboisière Hospital, Department of Neurology, Paris, France; Federation Hospitalo-Universitaire NeuroVasc, Université de Paris, Paris, France; INSERM U1141, Paris, France
| | - Michael Hennerici
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Yuen Kwun Wong
- Division of Neurology, Department of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Henry Ka Fung Mak
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Luis Prats-Sanchez
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, Barcelona, Spain
| | - Alejandro Martínez-Domeño
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, Barcelona, Spain
| | - Shigeru Inamura
- Department of Neurosurgery, Kushiro City General Hospital, Kushiro, Japan
| | - Kazuhisa Yoshifuji
- Department of Neurosurgery, Kushiro City General Hospital, Kushiro, Japan
| | - Ethem Murat Arsava
- A A Martinos Center for Biomedial Imaging, Department of Neurology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Solveig Horstmann
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jan Purrucker
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Bonnie Yin Ka Lam
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Adrian Wong
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Robin Lemmens
- Experimental Neurology, Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium; Vlaams Instituut voor Biotechnologie, Center for Brain & Disease Research; Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Ender Uysal
- Department of Radiology, Saglık Bilimleri University, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Zeynep Tanriverdi
- Department of Neurology, İzmir Katip Çelebi University Atatürk Education and Research Hospital, İzmir Turkey
| | - Natan M Bornstein
- Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Einor Ben Assayag
- Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hen Hallevi
- Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jeremy Molad
- Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Masashi Nishihara
- Department of Radiology, Saga University Faculty of Medicine, Saga, Japan
| | - Jun Tanaka
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan
| | - Shelagh B Coutts
- Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Alexandros Polymeris
- Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Switzerland
| | - Benjamin Wagner
- Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Switzerland
| | - David J Seiffge
- UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK; Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Switzerland; Department of Neurology, University Hospital Inselspital Bern, University of Bern, Bern, Switzerland
| | - Philippe Lyrer
- Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Switzerland
| | - Ale Algra
- Julius Centre for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands; Department of Neurology and Neurosurgery, Utrecht University, Utrecht, The Netherlands
| | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, Utrecht University, Utrecht, The Netherlands
| | - Rustam Al-Shahi Salman
- Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Hans R Jäger
- Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK; Liverpool Heart & Chest Hospital, Liverpool, UK; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Urs Fischer
- Department of Neurology, University Hospital Inselspital Bern, University of Bern, Bern, Switzerland
| | - Marwan El-Koussy
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Inselspital Bern, University of Bern, Bern, Switzerland
| | - Jean-Louis Mas
- Department of Neurology, Sainte-Anne Hospital, Institut de Psychiatrie et Neurosciences de Paris, INSERM, Université de Paris, Paris, France
| | - Laurence Legrand
- Department of Neuroradiology, Sainte-Anne Hospital, Institut de Psychiatrie et Neurosciences de Paris, INSERM, Université de Paris, Paris, France
| | | | - Thanh Phan
- Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Sarah Gunkel
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Nicolas Christ
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Jill Abrigo
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Special Administrative Region, China
| | - Thomas Leung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Special Administrative Region, China
| | - Winnie Chu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Special Administrative Region, China
| | - Francesca Chappell
- Centre for Clinical Brain Sciences, Edinburgh Imaging, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Stephen Makin
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Derek Hayden
- The Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin, Ireland; Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - David J Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences Dublin, Ireland; Department of Geriatric and Stroke Medicine, Beaumont Hospital Dublin, Ireland
| | - Werner H Mess
- Department of Clinical Neurophysiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam University Medical Centres, Netherlands
| | - Carmen Barbato
- UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK; Comprehensive Stroke Service, University College London Hospitals NHS Trust, London, UK
| | - Simone Browning
- UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK; Comprehensive Stroke Service, University College London Hospitals NHS Trust, London, UK
| | - Kim Wiegertjes
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Noortje Maaijwee
- Department for Neurology and Neurorehabilitation, Neurocenter, Lucerne State Hospital, Lucerne, Switzerland
| | | | | | - Anne-Marie Mendyk
- Degenerative and vascular cognitive disorders, University of Lille, INSERM, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Christine Delmaire
- Degenerative and vascular cognitive disorders, University of Lille, INSERM, Centre Hospitalier Universitaire de Lille, Lille, France; Department of Radiology, Fondation A de Rothschild, Paris, France
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, The Netherlands
| | - Robert van Oostenbrugge
- Department of Neurology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, The Netherlands
| | - Ying Zhou
- Department of Neurology, The 2nd affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Chao Xu
- Department of Neurology, The 2nd affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Saima Hilal
- Memory Aging & Cognition Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bibek Gyanwali
- Memory Aging & Cognition Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Christopher Chen
- Memory Aging & Cognition Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Min Lou
- Department of Neurology, The 2nd affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Julie Staals
- Department of Neurology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, The Netherlands
| | - Régis Bordet
- Degenerative and vascular cognitive disorders, University of Lille, INSERM, Centre Hospitalier Universitaire de Lille, Lille, France
| | | | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robert Simister
- UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK; Comprehensive Stroke Service, University College London Hospitals NHS Trust, London, UK
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Peter J Kelly
- The Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin, Ireland
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences, Edinburgh Imaging, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Yannie Soo
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Special Administrative Region, China
| | - Felix Fluri
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Velandai Srikanth
- Peninsula Clinical School, Peninsula Health, Monash University, Melbourne, Australia
| | - David Calvet
- Department of Neurology, Sainte-Anne Hospital, Institut de Psychiatrie et Neurosciences de Paris, INSERM, Université de Paris, Paris, France
| | - Simon Jung
- Department of Neurology, University Hospital Inselspital Bern, University of Bern, Bern, Switzerland
| | - Vincent I H Kwa
- Department of Neurology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Stefan T Engelter
- Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Switzerland; Neurology and Neurorehabilitation, Department of Geriatric Medicine FELIX PLATTER, University of Basel, Switzerland
| | - Nils Peters
- Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Switzerland; Neurology and Neurorehabilitation, Department of Geriatric Medicine FELIX PLATTER, University of Basel, Switzerland
| | - Eric E Smith
- Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Hideo Hara
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan
| | - Yusuke Yakushiji
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan; Department of Neurology, Kansai Medical University, Osaka, Japan
| | | | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia; Department of Neurology, Austin Health, Heidelberg, VIC, Australia
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Vincent Mok
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Roland Veltkamp
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany; Department of Brain Sciences, Imperial College London, London, UK
| | - Hakan Ay
- A A Martinos Center for Biomedial Imaging, Department of Neurology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA; Takeda, Cambridge, MA, USA
| | - Toshio Imaizumi
- Department of Neurosurgery, Kushiro City General Hospital, Kushiro, Japan
| | - Beatriz Gomez-Anson
- Unit of Neuroradiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, Barcelona, Spain
| | - Kui Kai Lau
- Division of Neurology, Department of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Eric Jouvent
- Assistance Publique - Hôpitaux de Paris, Lariboisière Hospital, Department of Neurology, Paris, France; Federation Hospitalo-Universitaire NeuroVasc, Université de Paris, Paris, France; INSERM U1141, Paris, France
| | - Peter M Rothwell
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Joan Marti-Fabregas
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, Barcelona, Spain
| | - David J Werring
- UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK.
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Wein T, Lindsay MP, Gladstone DJ, Poppe A, Bell A, Casaubon LK, Foley N, Coutts SB, Cox J, Douketis J, Field T, Gioia L, Habert J, Lang E, Mehta SR, Papoushek C, Semchuk W, Sharma M, Udell JA, Lawrence S, Mountain A, Gubitz G, Dowlatshahi D, Simard A, de Jong A, Smith EE. Canadian Stroke Best Practice Recommendations, seventh edition: acetylsalicylic acid for prevention of vascular events. CMAJ 2020; 192:E302-E311. [PMID: 32392513 DOI: 10.1503/cmaj.191599] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Theodore Wein
- Department of Neurology and Neurosurgery (Wein), McGill University, Montréal, Que.; the Heart and Stroke Foundation of Canada (Lindsay, Lawrence, Simard, de Jong); Division of Neurology (Gladstone, Casaubon), Department of Medicine, University of Toronto; Division of Neurology (Gladstone), Department of Medicine, Regional Stroke Centre; Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Gladstone); Toronto, Ont.; Centre hospitalier de l'Université de Montréal (CHUM) (Poppe, Gioia), Hôpital Notre-Dame, Montréal, Que.; Department of Family Medicine (Bell, Habert), University of Toronto; Toronto Western Hospital Stroke Program (Casaubon), University Health Network, Toronto, Ont.; workHORSE Consulting Ltd. (Foley), London, Ont.; Department of Clinical Neurosciences (Coutts, Smith), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine (Cardiology) (Cox), Dalhousie University, Halifax, NS; Department of Medicine (Douketis), McMaster University, Hamilton, Ont.; Division of Neurology (Field), Department of Medicine, University of British Columbia; Vancouver, BC; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Mehta), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Papoushek), Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.; College of Pharmacy (Semchuk), University of Saskatchewan, Saskatoon, Sask.; Division of Neurology (Sharma), Department of Medicine, McMaster University, Hamilton, Ont.; Cardiovascular Division (Udell), Department of Medicine Women's College Hospital; Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Divisions Physical Medicine and Rehabilitation) (Mountain) and Neurology (Gubitz), Department of Medicine, Dalhousie University; Division of Neurology (Dowlatshahi), Faculty of Medicine, University of Ottawa, Ottawa, Ont
| | - M Patrice Lindsay
- Department of Neurology and Neurosurgery (Wein), McGill University, Montréal, Que.; the Heart and Stroke Foundation of Canada (Lindsay, Lawrence, Simard, de Jong); Division of Neurology (Gladstone, Casaubon), Department of Medicine, University of Toronto; Division of Neurology (Gladstone), Department of Medicine, Regional Stroke Centre; Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Gladstone); Toronto, Ont.; Centre hospitalier de l'Université de Montréal (CHUM) (Poppe, Gioia), Hôpital Notre-Dame, Montréal, Que.; Department of Family Medicine (Bell, Habert), University of Toronto; Toronto Western Hospital Stroke Program (Casaubon), University Health Network, Toronto, Ont.; workHORSE Consulting Ltd. (Foley), London, Ont.; Department of Clinical Neurosciences (Coutts, Smith), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine (Cardiology) (Cox), Dalhousie University, Halifax, NS; Department of Medicine (Douketis), McMaster University, Hamilton, Ont.; Division of Neurology (Field), Department of Medicine, University of British Columbia; Vancouver, BC; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Mehta), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Papoushek), Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.; College of Pharmacy (Semchuk), University of Saskatchewan, Saskatoon, Sask.; Division of Neurology (Sharma), Department of Medicine, McMaster University, Hamilton, Ont.; Cardiovascular Division (Udell), Department of Medicine Women's College Hospital; Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Divisions Physical Medicine and Rehabilitation) (Mountain) and Neurology (Gubitz), Department of Medicine, Dalhousie University; Division of Neurology (Dowlatshahi), Faculty of Medicine, University of Ottawa, Ottawa, Ont.
| | - David J Gladstone
- Department of Neurology and Neurosurgery (Wein), McGill University, Montréal, Que.; the Heart and Stroke Foundation of Canada (Lindsay, Lawrence, Simard, de Jong); Division of Neurology (Gladstone, Casaubon), Department of Medicine, University of Toronto; Division of Neurology (Gladstone), Department of Medicine, Regional Stroke Centre; Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Gladstone); Toronto, Ont.; Centre hospitalier de l'Université de Montréal (CHUM) (Poppe, Gioia), Hôpital Notre-Dame, Montréal, Que.; Department of Family Medicine (Bell, Habert), University of Toronto; Toronto Western Hospital Stroke Program (Casaubon), University Health Network, Toronto, Ont.; workHORSE Consulting Ltd. (Foley), London, Ont.; Department of Clinical Neurosciences (Coutts, Smith), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine (Cardiology) (Cox), Dalhousie University, Halifax, NS; Department of Medicine (Douketis), McMaster University, Hamilton, Ont.; Division of Neurology (Field), Department of Medicine, University of British Columbia; Vancouver, BC; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Mehta), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Papoushek), Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.; College of Pharmacy (Semchuk), University of Saskatchewan, Saskatoon, Sask.; Division of Neurology (Sharma), Department of Medicine, McMaster University, Hamilton, Ont.; Cardiovascular Division (Udell), Department of Medicine Women's College Hospital; Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Divisions Physical Medicine and Rehabilitation) (Mountain) and Neurology (Gubitz), Department of Medicine, Dalhousie University; Division of Neurology (Dowlatshahi), Faculty of Medicine, University of Ottawa, Ottawa, Ont
| | - Alexandre Poppe
- Department of Neurology and Neurosurgery (Wein), McGill University, Montréal, Que.; the Heart and Stroke Foundation of Canada (Lindsay, Lawrence, Simard, de Jong); Division of Neurology (Gladstone, Casaubon), Department of Medicine, University of Toronto; Division of Neurology (Gladstone), Department of Medicine, Regional Stroke Centre; Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Gladstone); Toronto, Ont.; Centre hospitalier de l'Université de Montréal (CHUM) (Poppe, Gioia), Hôpital Notre-Dame, Montréal, Que.; Department of Family Medicine (Bell, Habert), University of Toronto; Toronto Western Hospital Stroke Program (Casaubon), University Health Network, Toronto, Ont.; workHORSE Consulting Ltd. (Foley), London, Ont.; Department of Clinical Neurosciences (Coutts, Smith), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine (Cardiology) (Cox), Dalhousie University, Halifax, NS; Department of Medicine (Douketis), McMaster University, Hamilton, Ont.; Division of Neurology (Field), Department of Medicine, University of British Columbia; Vancouver, BC; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Mehta), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Papoushek), Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.; College of Pharmacy (Semchuk), University of Saskatchewan, Saskatoon, Sask.; Division of Neurology (Sharma), Department of Medicine, McMaster University, Hamilton, Ont.; Cardiovascular Division (Udell), Department of Medicine Women's College Hospital; Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Divisions Physical Medicine and Rehabilitation) (Mountain) and Neurology (Gubitz), Department of Medicine, Dalhousie University; Division of Neurology (Dowlatshahi), Faculty of Medicine, University of Ottawa, Ottawa, Ont
| | - Alan Bell
- Department of Neurology and Neurosurgery (Wein), McGill University, Montréal, Que.; the Heart and Stroke Foundation of Canada (Lindsay, Lawrence, Simard, de Jong); Division of Neurology (Gladstone, Casaubon), Department of Medicine, University of Toronto; Division of Neurology (Gladstone), Department of Medicine, Regional Stroke Centre; Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Gladstone); Toronto, Ont.; Centre hospitalier de l'Université de Montréal (CHUM) (Poppe, Gioia), Hôpital Notre-Dame, Montréal, Que.; Department of Family Medicine (Bell, Habert), University of Toronto; Toronto Western Hospital Stroke Program (Casaubon), University Health Network, Toronto, Ont.; workHORSE Consulting Ltd. (Foley), London, Ont.; Department of Clinical Neurosciences (Coutts, Smith), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine (Cardiology) (Cox), Dalhousie University, Halifax, NS; Department of Medicine (Douketis), McMaster University, Hamilton, Ont.; Division of Neurology (Field), Department of Medicine, University of British Columbia; Vancouver, BC; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Mehta), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Papoushek), Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.; College of Pharmacy (Semchuk), University of Saskatchewan, Saskatoon, Sask.; Division of Neurology (Sharma), Department of Medicine, McMaster University, Hamilton, Ont.; Cardiovascular Division (Udell), Department of Medicine Women's College Hospital; Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Divisions Physical Medicine and Rehabilitation) (Mountain) and Neurology (Gubitz), Department of Medicine, Dalhousie University; Division of Neurology (Dowlatshahi), Faculty of Medicine, University of Ottawa, Ottawa, Ont
| | - Leanne K Casaubon
- Department of Neurology and Neurosurgery (Wein), McGill University, Montréal, Que.; the Heart and Stroke Foundation of Canada (Lindsay, Lawrence, Simard, de Jong); Division of Neurology (Gladstone, Casaubon), Department of Medicine, University of Toronto; Division of Neurology (Gladstone), Department of Medicine, Regional Stroke Centre; Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Gladstone); Toronto, Ont.; Centre hospitalier de l'Université de Montréal (CHUM) (Poppe, Gioia), Hôpital Notre-Dame, Montréal, Que.; Department of Family Medicine (Bell, Habert), University of Toronto; Toronto Western Hospital Stroke Program (Casaubon), University Health Network, Toronto, Ont.; workHORSE Consulting Ltd. (Foley), London, Ont.; Department of Clinical Neurosciences (Coutts, Smith), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine (Cardiology) (Cox), Dalhousie University, Halifax, NS; Department of Medicine (Douketis), McMaster University, Hamilton, Ont.; Division of Neurology (Field), Department of Medicine, University of British Columbia; Vancouver, BC; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Mehta), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Papoushek), Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.; College of Pharmacy (Semchuk), University of Saskatchewan, Saskatoon, Sask.; Division of Neurology (Sharma), Department of Medicine, McMaster University, Hamilton, Ont.; Cardiovascular Division (Udell), Department of Medicine Women's College Hospital; Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Divisions Physical Medicine and Rehabilitation) (Mountain) and Neurology (Gubitz), Department of Medicine, Dalhousie University; Division of Neurology (Dowlatshahi), Faculty of Medicine, University of Ottawa, Ottawa, Ont
| | - Norine Foley
- Department of Neurology and Neurosurgery (Wein), McGill University, Montréal, Que.; the Heart and Stroke Foundation of Canada (Lindsay, Lawrence, Simard, de Jong); Division of Neurology (Gladstone, Casaubon), Department of Medicine, University of Toronto; Division of Neurology (Gladstone), Department of Medicine, Regional Stroke Centre; Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Gladstone); Toronto, Ont.; Centre hospitalier de l'Université de Montréal (CHUM) (Poppe, Gioia), Hôpital Notre-Dame, Montréal, Que.; Department of Family Medicine (Bell, Habert), University of Toronto; Toronto Western Hospital Stroke Program (Casaubon), University Health Network, Toronto, Ont.; workHORSE Consulting Ltd. (Foley), London, Ont.; Department of Clinical Neurosciences (Coutts, Smith), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine (Cardiology) (Cox), Dalhousie University, Halifax, NS; Department of Medicine (Douketis), McMaster University, Hamilton, Ont.; Division of Neurology (Field), Department of Medicine, University of British Columbia; Vancouver, BC; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Mehta), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Papoushek), Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.; College of Pharmacy (Semchuk), University of Saskatchewan, Saskatoon, Sask.; Division of Neurology (Sharma), Department of Medicine, McMaster University, Hamilton, Ont.; Cardiovascular Division (Udell), Department of Medicine Women's College Hospital; Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Divisions Physical Medicine and Rehabilitation) (Mountain) and Neurology (Gubitz), Department of Medicine, Dalhousie University; Division of Neurology (Dowlatshahi), Faculty of Medicine, University of Ottawa, Ottawa, Ont
| | - Shelagh B Coutts
- Department of Neurology and Neurosurgery (Wein), McGill University, Montréal, Que.; the Heart and Stroke Foundation of Canada (Lindsay, Lawrence, Simard, de Jong); Division of Neurology (Gladstone, Casaubon), Department of Medicine, University of Toronto; Division of Neurology (Gladstone), Department of Medicine, Regional Stroke Centre; Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Gladstone); Toronto, Ont.; Centre hospitalier de l'Université de Montréal (CHUM) (Poppe, Gioia), Hôpital Notre-Dame, Montréal, Que.; Department of Family Medicine (Bell, Habert), University of Toronto; Toronto Western Hospital Stroke Program (Casaubon), University Health Network, Toronto, Ont.; workHORSE Consulting Ltd. (Foley), London, Ont.; Department of Clinical Neurosciences (Coutts, Smith), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine (Cardiology) (Cox), Dalhousie University, Halifax, NS; Department of Medicine (Douketis), McMaster University, Hamilton, Ont.; Division of Neurology (Field), Department of Medicine, University of British Columbia; Vancouver, BC; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Mehta), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Papoushek), Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.; College of Pharmacy (Semchuk), University of Saskatchewan, Saskatoon, Sask.; Division of Neurology (Sharma), Department of Medicine, McMaster University, Hamilton, Ont.; Cardiovascular Division (Udell), Department of Medicine Women's College Hospital; Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Divisions Physical Medicine and Rehabilitation) (Mountain) and Neurology (Gubitz), Department of Medicine, Dalhousie University; Division of Neurology (Dowlatshahi), Faculty of Medicine, University of Ottawa, Ottawa, Ont
| | - Jafna Cox
- Department of Neurology and Neurosurgery (Wein), McGill University, Montréal, Que.; the Heart and Stroke Foundation of Canada (Lindsay, Lawrence, Simard, de Jong); Division of Neurology (Gladstone, Casaubon), Department of Medicine, University of Toronto; Division of Neurology (Gladstone), Department of Medicine, Regional Stroke Centre; Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Gladstone); Toronto, Ont.; Centre hospitalier de l'Université de Montréal (CHUM) (Poppe, Gioia), Hôpital Notre-Dame, Montréal, Que.; Department of Family Medicine (Bell, Habert), University of Toronto; Toronto Western Hospital Stroke Program (Casaubon), University Health Network, Toronto, Ont.; workHORSE Consulting Ltd. (Foley), London, Ont.; Department of Clinical Neurosciences (Coutts, Smith), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine (Cardiology) (Cox), Dalhousie University, Halifax, NS; Department of Medicine (Douketis), McMaster University, Hamilton, Ont.; Division of Neurology (Field), Department of Medicine, University of British Columbia; Vancouver, BC; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Mehta), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Papoushek), Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.; College of Pharmacy (Semchuk), University of Saskatchewan, Saskatoon, Sask.; Division of Neurology (Sharma), Department of Medicine, McMaster University, Hamilton, Ont.; Cardiovascular Division (Udell), Department of Medicine Women's College Hospital; Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Divisions Physical Medicine and Rehabilitation) (Mountain) and Neurology (Gubitz), Department of Medicine, Dalhousie University; Division of Neurology (Dowlatshahi), Faculty of Medicine, University of Ottawa, Ottawa, Ont
| | - James Douketis
- Department of Neurology and Neurosurgery (Wein), McGill University, Montréal, Que.; the Heart and Stroke Foundation of Canada (Lindsay, Lawrence, Simard, de Jong); Division of Neurology (Gladstone, Casaubon), Department of Medicine, University of Toronto; Division of Neurology (Gladstone), Department of Medicine, Regional Stroke Centre; Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Gladstone); Toronto, Ont.; Centre hospitalier de l'Université de Montréal (CHUM) (Poppe, Gioia), Hôpital Notre-Dame, Montréal, Que.; Department of Family Medicine (Bell, Habert), University of Toronto; Toronto Western Hospital Stroke Program (Casaubon), University Health Network, Toronto, Ont.; workHORSE Consulting Ltd. (Foley), London, Ont.; Department of Clinical Neurosciences (Coutts, Smith), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine (Cardiology) (Cox), Dalhousie University, Halifax, NS; Department of Medicine (Douketis), McMaster University, Hamilton, Ont.; Division of Neurology (Field), Department of Medicine, University of British Columbia; Vancouver, BC; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Mehta), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Papoushek), Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.; College of Pharmacy (Semchuk), University of Saskatchewan, Saskatoon, Sask.; Division of Neurology (Sharma), Department of Medicine, McMaster University, Hamilton, Ont.; Cardiovascular Division (Udell), Department of Medicine Women's College Hospital; Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Divisions Physical Medicine and Rehabilitation) (Mountain) and Neurology (Gubitz), Department of Medicine, Dalhousie University; Division of Neurology (Dowlatshahi), Faculty of Medicine, University of Ottawa, Ottawa, Ont
| | - Thalia Field
- Department of Neurology and Neurosurgery (Wein), McGill University, Montréal, Que.; the Heart and Stroke Foundation of Canada (Lindsay, Lawrence, Simard, de Jong); Division of Neurology (Gladstone, Casaubon), Department of Medicine, University of Toronto; Division of Neurology (Gladstone), Department of Medicine, Regional Stroke Centre; Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Gladstone); Toronto, Ont.; Centre hospitalier de l'Université de Montréal (CHUM) (Poppe, Gioia), Hôpital Notre-Dame, Montréal, Que.; Department of Family Medicine (Bell, Habert), University of Toronto; Toronto Western Hospital Stroke Program (Casaubon), University Health Network, Toronto, Ont.; workHORSE Consulting Ltd. (Foley), London, Ont.; Department of Clinical Neurosciences (Coutts, Smith), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine (Cardiology) (Cox), Dalhousie University, Halifax, NS; Department of Medicine (Douketis), McMaster University, Hamilton, Ont.; Division of Neurology (Field), Department of Medicine, University of British Columbia; Vancouver, BC; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Mehta), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Papoushek), Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.; College of Pharmacy (Semchuk), University of Saskatchewan, Saskatoon, Sask.; Division of Neurology (Sharma), Department of Medicine, McMaster University, Hamilton, Ont.; Cardiovascular Division (Udell), Department of Medicine Women's College Hospital; Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Divisions Physical Medicine and Rehabilitation) (Mountain) and Neurology (Gubitz), Department of Medicine, Dalhousie University; Division of Neurology (Dowlatshahi), Faculty of Medicine, University of Ottawa, Ottawa, Ont
| | - Laura Gioia
- Department of Neurology and Neurosurgery (Wein), McGill University, Montréal, Que.; the Heart and Stroke Foundation of Canada (Lindsay, Lawrence, Simard, de Jong); Division of Neurology (Gladstone, Casaubon), Department of Medicine, University of Toronto; Division of Neurology (Gladstone), Department of Medicine, Regional Stroke Centre; Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Gladstone); Toronto, Ont.; Centre hospitalier de l'Université de Montréal (CHUM) (Poppe, Gioia), Hôpital Notre-Dame, Montréal, Que.; Department of Family Medicine (Bell, Habert), University of Toronto; Toronto Western Hospital Stroke Program (Casaubon), University Health Network, Toronto, Ont.; workHORSE Consulting Ltd. (Foley), London, Ont.; Department of Clinical Neurosciences (Coutts, Smith), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine (Cardiology) (Cox), Dalhousie University, Halifax, NS; Department of Medicine (Douketis), McMaster University, Hamilton, Ont.; Division of Neurology (Field), Department of Medicine, University of British Columbia; Vancouver, BC; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Mehta), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Papoushek), Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.; College of Pharmacy (Semchuk), University of Saskatchewan, Saskatoon, Sask.; Division of Neurology (Sharma), Department of Medicine, McMaster University, Hamilton, Ont.; Cardiovascular Division (Udell), Department of Medicine Women's College Hospital; Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Divisions Physical Medicine and Rehabilitation) (Mountain) and Neurology (Gubitz), Department of Medicine, Dalhousie University; Division of Neurology (Dowlatshahi), Faculty of Medicine, University of Ottawa, Ottawa, Ont
| | - Jeffrey Habert
- Department of Neurology and Neurosurgery (Wein), McGill University, Montréal, Que.; the Heart and Stroke Foundation of Canada (Lindsay, Lawrence, Simard, de Jong); Division of Neurology (Gladstone, Casaubon), Department of Medicine, University of Toronto; Division of Neurology (Gladstone), Department of Medicine, Regional Stroke Centre; Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Gladstone); Toronto, Ont.; Centre hospitalier de l'Université de Montréal (CHUM) (Poppe, Gioia), Hôpital Notre-Dame, Montréal, Que.; Department of Family Medicine (Bell, Habert), University of Toronto; Toronto Western Hospital Stroke Program (Casaubon), University Health Network, Toronto, Ont.; workHORSE Consulting Ltd. (Foley), London, Ont.; Department of Clinical Neurosciences (Coutts, Smith), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine (Cardiology) (Cox), Dalhousie University, Halifax, NS; Department of Medicine (Douketis), McMaster University, Hamilton, Ont.; Division of Neurology (Field), Department of Medicine, University of British Columbia; Vancouver, BC; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Mehta), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Papoushek), Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.; College of Pharmacy (Semchuk), University of Saskatchewan, Saskatoon, Sask.; Division of Neurology (Sharma), Department of Medicine, McMaster University, Hamilton, Ont.; Cardiovascular Division (Udell), Department of Medicine Women's College Hospital; Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Divisions Physical Medicine and Rehabilitation) (Mountain) and Neurology (Gubitz), Department of Medicine, Dalhousie University; Division of Neurology (Dowlatshahi), Faculty of Medicine, University of Ottawa, Ottawa, Ont
| | - Eddy Lang
- Department of Neurology and Neurosurgery (Wein), McGill University, Montréal, Que.; the Heart and Stroke Foundation of Canada (Lindsay, Lawrence, Simard, de Jong); Division of Neurology (Gladstone, Casaubon), Department of Medicine, University of Toronto; Division of Neurology (Gladstone), Department of Medicine, Regional Stroke Centre; Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Gladstone); Toronto, Ont.; Centre hospitalier de l'Université de Montréal (CHUM) (Poppe, Gioia), Hôpital Notre-Dame, Montréal, Que.; Department of Family Medicine (Bell, Habert), University of Toronto; Toronto Western Hospital Stroke Program (Casaubon), University Health Network, Toronto, Ont.; workHORSE Consulting Ltd. (Foley), London, Ont.; Department of Clinical Neurosciences (Coutts, Smith), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine (Cardiology) (Cox), Dalhousie University, Halifax, NS; Department of Medicine (Douketis), McMaster University, Hamilton, Ont.; Division of Neurology (Field), Department of Medicine, University of British Columbia; Vancouver, BC; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Mehta), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Papoushek), Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.; College of Pharmacy (Semchuk), University of Saskatchewan, Saskatoon, Sask.; Division of Neurology (Sharma), Department of Medicine, McMaster University, Hamilton, Ont.; Cardiovascular Division (Udell), Department of Medicine Women's College Hospital; Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Divisions Physical Medicine and Rehabilitation) (Mountain) and Neurology (Gubitz), Department of Medicine, Dalhousie University; Division of Neurology (Dowlatshahi), Faculty of Medicine, University of Ottawa, Ottawa, Ont
| | - Shamir R Mehta
- Department of Neurology and Neurosurgery (Wein), McGill University, Montréal, Que.; the Heart and Stroke Foundation of Canada (Lindsay, Lawrence, Simard, de Jong); Division of Neurology (Gladstone, Casaubon), Department of Medicine, University of Toronto; Division of Neurology (Gladstone), Department of Medicine, Regional Stroke Centre; Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Gladstone); Toronto, Ont.; Centre hospitalier de l'Université de Montréal (CHUM) (Poppe, Gioia), Hôpital Notre-Dame, Montréal, Que.; Department of Family Medicine (Bell, Habert), University of Toronto; Toronto Western Hospital Stroke Program (Casaubon), University Health Network, Toronto, Ont.; workHORSE Consulting Ltd. (Foley), London, Ont.; Department of Clinical Neurosciences (Coutts, Smith), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine (Cardiology) (Cox), Dalhousie University, Halifax, NS; Department of Medicine (Douketis), McMaster University, Hamilton, Ont.; Division of Neurology (Field), Department of Medicine, University of British Columbia; Vancouver, BC; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Mehta), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Papoushek), Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.; College of Pharmacy (Semchuk), University of Saskatchewan, Saskatoon, Sask.; Division of Neurology (Sharma), Department of Medicine, McMaster University, Hamilton, Ont.; Cardiovascular Division (Udell), Department of Medicine Women's College Hospital; Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Divisions Physical Medicine and Rehabilitation) (Mountain) and Neurology (Gubitz), Department of Medicine, Dalhousie University; Division of Neurology (Dowlatshahi), Faculty of Medicine, University of Ottawa, Ottawa, Ont
| | - Christine Papoushek
- Department of Neurology and Neurosurgery (Wein), McGill University, Montréal, Que.; the Heart and Stroke Foundation of Canada (Lindsay, Lawrence, Simard, de Jong); Division of Neurology (Gladstone, Casaubon), Department of Medicine, University of Toronto; Division of Neurology (Gladstone), Department of Medicine, Regional Stroke Centre; Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Gladstone); Toronto, Ont.; Centre hospitalier de l'Université de Montréal (CHUM) (Poppe, Gioia), Hôpital Notre-Dame, Montréal, Que.; Department of Family Medicine (Bell, Habert), University of Toronto; Toronto Western Hospital Stroke Program (Casaubon), University Health Network, Toronto, Ont.; workHORSE Consulting Ltd. (Foley), London, Ont.; Department of Clinical Neurosciences (Coutts, Smith), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine (Cardiology) (Cox), Dalhousie University, Halifax, NS; Department of Medicine (Douketis), McMaster University, Hamilton, Ont.; Division of Neurology (Field), Department of Medicine, University of British Columbia; Vancouver, BC; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Mehta), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Papoushek), Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.; College of Pharmacy (Semchuk), University of Saskatchewan, Saskatoon, Sask.; Division of Neurology (Sharma), Department of Medicine, McMaster University, Hamilton, Ont.; Cardiovascular Division (Udell), Department of Medicine Women's College Hospital; Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Divisions Physical Medicine and Rehabilitation) (Mountain) and Neurology (Gubitz), Department of Medicine, Dalhousie University; Division of Neurology (Dowlatshahi), Faculty of Medicine, University of Ottawa, Ottawa, Ont
| | - William Semchuk
- Department of Neurology and Neurosurgery (Wein), McGill University, Montréal, Que.; the Heart and Stroke Foundation of Canada (Lindsay, Lawrence, Simard, de Jong); Division of Neurology (Gladstone, Casaubon), Department of Medicine, University of Toronto; Division of Neurology (Gladstone), Department of Medicine, Regional Stroke Centre; Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Gladstone); Toronto, Ont.; Centre hospitalier de l'Université de Montréal (CHUM) (Poppe, Gioia), Hôpital Notre-Dame, Montréal, Que.; Department of Family Medicine (Bell, Habert), University of Toronto; Toronto Western Hospital Stroke Program (Casaubon), University Health Network, Toronto, Ont.; workHORSE Consulting Ltd. (Foley), London, Ont.; Department of Clinical Neurosciences (Coutts, Smith), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine (Cardiology) (Cox), Dalhousie University, Halifax, NS; Department of Medicine (Douketis), McMaster University, Hamilton, Ont.; Division of Neurology (Field), Department of Medicine, University of British Columbia; Vancouver, BC; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Mehta), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Papoushek), Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.; College of Pharmacy (Semchuk), University of Saskatchewan, Saskatoon, Sask.; Division of Neurology (Sharma), Department of Medicine, McMaster University, Hamilton, Ont.; Cardiovascular Division (Udell), Department of Medicine Women's College Hospital; Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Divisions Physical Medicine and Rehabilitation) (Mountain) and Neurology (Gubitz), Department of Medicine, Dalhousie University; Division of Neurology (Dowlatshahi), Faculty of Medicine, University of Ottawa, Ottawa, Ont
| | - Mikul Sharma
- Department of Neurology and Neurosurgery (Wein), McGill University, Montréal, Que.; the Heart and Stroke Foundation of Canada (Lindsay, Lawrence, Simard, de Jong); Division of Neurology (Gladstone, Casaubon), Department of Medicine, University of Toronto; Division of Neurology (Gladstone), Department of Medicine, Regional Stroke Centre; Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Gladstone); Toronto, Ont.; Centre hospitalier de l'Université de Montréal (CHUM) (Poppe, Gioia), Hôpital Notre-Dame, Montréal, Que.; Department of Family Medicine (Bell, Habert), University of Toronto; Toronto Western Hospital Stroke Program (Casaubon), University Health Network, Toronto, Ont.; workHORSE Consulting Ltd. (Foley), London, Ont.; Department of Clinical Neurosciences (Coutts, Smith), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine (Cardiology) (Cox), Dalhousie University, Halifax, NS; Department of Medicine (Douketis), McMaster University, Hamilton, Ont.; Division of Neurology (Field), Department of Medicine, University of British Columbia; Vancouver, BC; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Mehta), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Papoushek), Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.; College of Pharmacy (Semchuk), University of Saskatchewan, Saskatoon, Sask.; Division of Neurology (Sharma), Department of Medicine, McMaster University, Hamilton, Ont.; Cardiovascular Division (Udell), Department of Medicine Women's College Hospital; Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Divisions Physical Medicine and Rehabilitation) (Mountain) and Neurology (Gubitz), Department of Medicine, Dalhousie University; Division of Neurology (Dowlatshahi), Faculty of Medicine, University of Ottawa, Ottawa, Ont
| | - Jacob A Udell
- Department of Neurology and Neurosurgery (Wein), McGill University, Montréal, Que.; the Heart and Stroke Foundation of Canada (Lindsay, Lawrence, Simard, de Jong); Division of Neurology (Gladstone, Casaubon), Department of Medicine, University of Toronto; Division of Neurology (Gladstone), Department of Medicine, Regional Stroke Centre; Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Gladstone); Toronto, Ont.; Centre hospitalier de l'Université de Montréal (CHUM) (Poppe, Gioia), Hôpital Notre-Dame, Montréal, Que.; Department of Family Medicine (Bell, Habert), University of Toronto; Toronto Western Hospital Stroke Program (Casaubon), University Health Network, Toronto, Ont.; workHORSE Consulting Ltd. (Foley), London, Ont.; Department of Clinical Neurosciences (Coutts, Smith), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine (Cardiology) (Cox), Dalhousie University, Halifax, NS; Department of Medicine (Douketis), McMaster University, Hamilton, Ont.; Division of Neurology (Field), Department of Medicine, University of British Columbia; Vancouver, BC; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Mehta), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Papoushek), Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.; College of Pharmacy (Semchuk), University of Saskatchewan, Saskatoon, Sask.; Division of Neurology (Sharma), Department of Medicine, McMaster University, Hamilton, Ont.; Cardiovascular Division (Udell), Department of Medicine Women's College Hospital; Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Divisions Physical Medicine and Rehabilitation) (Mountain) and Neurology (Gubitz), Department of Medicine, Dalhousie University; Division of Neurology (Dowlatshahi), Faculty of Medicine, University of Ottawa, Ottawa, Ont
| | - Stephanie Lawrence
- Department of Neurology and Neurosurgery (Wein), McGill University, Montréal, Que.; the Heart and Stroke Foundation of Canada (Lindsay, Lawrence, Simard, de Jong); Division of Neurology (Gladstone, Casaubon), Department of Medicine, University of Toronto; Division of Neurology (Gladstone), Department of Medicine, Regional Stroke Centre; Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Gladstone); Toronto, Ont.; Centre hospitalier de l'Université de Montréal (CHUM) (Poppe, Gioia), Hôpital Notre-Dame, Montréal, Que.; Department of Family Medicine (Bell, Habert), University of Toronto; Toronto Western Hospital Stroke Program (Casaubon), University Health Network, Toronto, Ont.; workHORSE Consulting Ltd. (Foley), London, Ont.; Department of Clinical Neurosciences (Coutts, Smith), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine (Cardiology) (Cox), Dalhousie University, Halifax, NS; Department of Medicine (Douketis), McMaster University, Hamilton, Ont.; Division of Neurology (Field), Department of Medicine, University of British Columbia; Vancouver, BC; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Mehta), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Papoushek), Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.; College of Pharmacy (Semchuk), University of Saskatchewan, Saskatoon, Sask.; Division of Neurology (Sharma), Department of Medicine, McMaster University, Hamilton, Ont.; Cardiovascular Division (Udell), Department of Medicine Women's College Hospital; Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Divisions Physical Medicine and Rehabilitation) (Mountain) and Neurology (Gubitz), Department of Medicine, Dalhousie University; Division of Neurology (Dowlatshahi), Faculty of Medicine, University of Ottawa, Ottawa, Ont
| | - Anita Mountain
- Department of Neurology and Neurosurgery (Wein), McGill University, Montréal, Que.; the Heart and Stroke Foundation of Canada (Lindsay, Lawrence, Simard, de Jong); Division of Neurology (Gladstone, Casaubon), Department of Medicine, University of Toronto; Division of Neurology (Gladstone), Department of Medicine, Regional Stroke Centre; Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Gladstone); Toronto, Ont.; Centre hospitalier de l'Université de Montréal (CHUM) (Poppe, Gioia), Hôpital Notre-Dame, Montréal, Que.; Department of Family Medicine (Bell, Habert), University of Toronto; Toronto Western Hospital Stroke Program (Casaubon), University Health Network, Toronto, Ont.; workHORSE Consulting Ltd. (Foley), London, Ont.; Department of Clinical Neurosciences (Coutts, Smith), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine (Cardiology) (Cox), Dalhousie University, Halifax, NS; Department of Medicine (Douketis), McMaster University, Hamilton, Ont.; Division of Neurology (Field), Department of Medicine, University of British Columbia; Vancouver, BC; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Mehta), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Papoushek), Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.; College of Pharmacy (Semchuk), University of Saskatchewan, Saskatoon, Sask.; Division of Neurology (Sharma), Department of Medicine, McMaster University, Hamilton, Ont.; Cardiovascular Division (Udell), Department of Medicine Women's College Hospital; Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Divisions Physical Medicine and Rehabilitation) (Mountain) and Neurology (Gubitz), Department of Medicine, Dalhousie University; Division of Neurology (Dowlatshahi), Faculty of Medicine, University of Ottawa, Ottawa, Ont
| | - Gord Gubitz
- Department of Neurology and Neurosurgery (Wein), McGill University, Montréal, Que.; the Heart and Stroke Foundation of Canada (Lindsay, Lawrence, Simard, de Jong); Division of Neurology (Gladstone, Casaubon), Department of Medicine, University of Toronto; Division of Neurology (Gladstone), Department of Medicine, Regional Stroke Centre; Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Gladstone); Toronto, Ont.; Centre hospitalier de l'Université de Montréal (CHUM) (Poppe, Gioia), Hôpital Notre-Dame, Montréal, Que.; Department of Family Medicine (Bell, Habert), University of Toronto; Toronto Western Hospital Stroke Program (Casaubon), University Health Network, Toronto, Ont.; workHORSE Consulting Ltd. (Foley), London, Ont.; Department of Clinical Neurosciences (Coutts, Smith), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine (Cardiology) (Cox), Dalhousie University, Halifax, NS; Department of Medicine (Douketis), McMaster University, Hamilton, Ont.; Division of Neurology (Field), Department of Medicine, University of British Columbia; Vancouver, BC; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Mehta), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Papoushek), Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.; College of Pharmacy (Semchuk), University of Saskatchewan, Saskatoon, Sask.; Division of Neurology (Sharma), Department of Medicine, McMaster University, Hamilton, Ont.; Cardiovascular Division (Udell), Department of Medicine Women's College Hospital; Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Divisions Physical Medicine and Rehabilitation) (Mountain) and Neurology (Gubitz), Department of Medicine, Dalhousie University; Division of Neurology (Dowlatshahi), Faculty of Medicine, University of Ottawa, Ottawa, Ont
| | - Dar Dowlatshahi
- Department of Neurology and Neurosurgery (Wein), McGill University, Montréal, Que.; the Heart and Stroke Foundation of Canada (Lindsay, Lawrence, Simard, de Jong); Division of Neurology (Gladstone, Casaubon), Department of Medicine, University of Toronto; Division of Neurology (Gladstone), Department of Medicine, Regional Stroke Centre; Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Gladstone); Toronto, Ont.; Centre hospitalier de l'Université de Montréal (CHUM) (Poppe, Gioia), Hôpital Notre-Dame, Montréal, Que.; Department of Family Medicine (Bell, Habert), University of Toronto; Toronto Western Hospital Stroke Program (Casaubon), University Health Network, Toronto, Ont.; workHORSE Consulting Ltd. (Foley), London, Ont.; Department of Clinical Neurosciences (Coutts, Smith), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine (Cardiology) (Cox), Dalhousie University, Halifax, NS; Department of Medicine (Douketis), McMaster University, Hamilton, Ont.; Division of Neurology (Field), Department of Medicine, University of British Columbia; Vancouver, BC; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Mehta), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Papoushek), Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.; College of Pharmacy (Semchuk), University of Saskatchewan, Saskatoon, Sask.; Division of Neurology (Sharma), Department of Medicine, McMaster University, Hamilton, Ont.; Cardiovascular Division (Udell), Department of Medicine Women's College Hospital; Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Divisions Physical Medicine and Rehabilitation) (Mountain) and Neurology (Gubitz), Department of Medicine, Dalhousie University; Division of Neurology (Dowlatshahi), Faculty of Medicine, University of Ottawa, Ottawa, Ont
| | - Anne Simard
- Department of Neurology and Neurosurgery (Wein), McGill University, Montréal, Que.; the Heart and Stroke Foundation of Canada (Lindsay, Lawrence, Simard, de Jong); Division of Neurology (Gladstone, Casaubon), Department of Medicine, University of Toronto; Division of Neurology (Gladstone), Department of Medicine, Regional Stroke Centre; Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Gladstone); Toronto, Ont.; Centre hospitalier de l'Université de Montréal (CHUM) (Poppe, Gioia), Hôpital Notre-Dame, Montréal, Que.; Department of Family Medicine (Bell, Habert), University of Toronto; Toronto Western Hospital Stroke Program (Casaubon), University Health Network, Toronto, Ont.; workHORSE Consulting Ltd. (Foley), London, Ont.; Department of Clinical Neurosciences (Coutts, Smith), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine (Cardiology) (Cox), Dalhousie University, Halifax, NS; Department of Medicine (Douketis), McMaster University, Hamilton, Ont.; Division of Neurology (Field), Department of Medicine, University of British Columbia; Vancouver, BC; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Mehta), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Papoushek), Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.; College of Pharmacy (Semchuk), University of Saskatchewan, Saskatoon, Sask.; Division of Neurology (Sharma), Department of Medicine, McMaster University, Hamilton, Ont.; Cardiovascular Division (Udell), Department of Medicine Women's College Hospital; Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Divisions Physical Medicine and Rehabilitation) (Mountain) and Neurology (Gubitz), Department of Medicine, Dalhousie University; Division of Neurology (Dowlatshahi), Faculty of Medicine, University of Ottawa, Ottawa, Ont
| | - Andrea de Jong
- Department of Neurology and Neurosurgery (Wein), McGill University, Montréal, Que.; the Heart and Stroke Foundation of Canada (Lindsay, Lawrence, Simard, de Jong); Division of Neurology (Gladstone, Casaubon), Department of Medicine, University of Toronto; Division of Neurology (Gladstone), Department of Medicine, Regional Stroke Centre; Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Gladstone); Toronto, Ont.; Centre hospitalier de l'Université de Montréal (CHUM) (Poppe, Gioia), Hôpital Notre-Dame, Montréal, Que.; Department of Family Medicine (Bell, Habert), University of Toronto; Toronto Western Hospital Stroke Program (Casaubon), University Health Network, Toronto, Ont.; workHORSE Consulting Ltd. (Foley), London, Ont.; Department of Clinical Neurosciences (Coutts, Smith), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine (Cardiology) (Cox), Dalhousie University, Halifax, NS; Department of Medicine (Douketis), McMaster University, Hamilton, Ont.; Division of Neurology (Field), Department of Medicine, University of British Columbia; Vancouver, BC; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Mehta), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Papoushek), Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.; College of Pharmacy (Semchuk), University of Saskatchewan, Saskatoon, Sask.; Division of Neurology (Sharma), Department of Medicine, McMaster University, Hamilton, Ont.; Cardiovascular Division (Udell), Department of Medicine Women's College Hospital; Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Divisions Physical Medicine and Rehabilitation) (Mountain) and Neurology (Gubitz), Department of Medicine, Dalhousie University; Division of Neurology (Dowlatshahi), Faculty of Medicine, University of Ottawa, Ottawa, Ont
| | - Eric E Smith
- Department of Neurology and Neurosurgery (Wein), McGill University, Montréal, Que.; the Heart and Stroke Foundation of Canada (Lindsay, Lawrence, Simard, de Jong); Division of Neurology (Gladstone, Casaubon), Department of Medicine, University of Toronto; Division of Neurology (Gladstone), Department of Medicine, Regional Stroke Centre; Hurvitz Brain Sciences Program (Gladstone), Sunnybrook Health Sciences Centre; Sunnybrook Research Institute (Gladstone); Toronto, Ont.; Centre hospitalier de l'Université de Montréal (CHUM) (Poppe, Gioia), Hôpital Notre-Dame, Montréal, Que.; Department of Family Medicine (Bell, Habert), University of Toronto; Toronto Western Hospital Stroke Program (Casaubon), University Health Network, Toronto, Ont.; workHORSE Consulting Ltd. (Foley), London, Ont.; Department of Clinical Neurosciences (Coutts, Smith), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Faculty of Medicine (Cardiology) (Cox), Dalhousie University, Halifax, NS; Department of Medicine (Douketis), McMaster University, Hamilton, Ont.; Division of Neurology (Field), Department of Medicine, University of British Columbia; Vancouver, BC; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Cardiology (Mehta), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Papoushek), Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ont.; College of Pharmacy (Semchuk), University of Saskatchewan, Saskatoon, Sask.; Division of Neurology (Sharma), Department of Medicine, McMaster University, Hamilton, Ont.; Cardiovascular Division (Udell), Department of Medicine Women's College Hospital; Peter Munk Cardiac Centre (Udell), Toronto General Hospital, University of Toronto, Toronto, Ont.; Divisions Physical Medicine and Rehabilitation) (Mountain) and Neurology (Gubitz), Department of Medicine, Dalhousie University; Division of Neurology (Dowlatshahi), Faculty of Medicine, University of Ottawa, Ottawa, Ont
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Coutts SB, Moreau F, Asdaghi N, Boulanger JM, Camden MC, Campbell BCV, Demchuk AM, Field TS, Goyal M, Krause M, Mandzia J, Menon BK, Mikulik R, Penn AM, Swartz RH, Hill MD. Rate and Prognosis of Brain Ischemia in Patients With Lower-Risk Transient or Persistent Minor Neurologic Events. JAMA Neurol 2020; 76:1439-1445. [PMID: 31545347 DOI: 10.1001/jamaneurol.2019.3063] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Early treatment of patients with transient ischemic attack (TIA) reduces the risk of stroke. However, many patients present with symptoms that have an uncertain diagnosis. Patients with motor, speech, or prolonged symptoms are at the highest risk for recurrent stroke and the most likely to undergo comprehensive investigations. Lower-risk patients are much more likely to be cursorily investigated. Objective To establish the frequency of acute infarct defined by diffusion restriction detected on diffusion-weighted imaging (DWI) magnetic resonance imaging (MRI) scan (DWI positive). Design, Setting, and Participants The Diagnosis of Uncertain-Origin Benign Transient Neurological Symptoms (DOUBT) study was a prospective, observational, international, multicenter cohort study of 1028 patients with low-risk transient or minor symptoms referred to neurology within 8 days of symptom onset. Patients were enrolled between June 1, 2010, and October 31, 2016. Included patients were 40 years or older and had experienced nonmotor or nonspeech minor focal neurologic events of any duration or motor or speech symptoms of short duration (≤5 minutes), with no previous stroke. Exposures Patients underwent a detailed neurologic assessment prior to undergoing a brain MRI within 8 days of symptom onset. Main Outcomes and Measures The primary outcome was restricted diffusion on a brain MRI scan (acute stroke). Results A total of 1028 patients (522 women and 506 men; mean [SD] age, 63.0 [11.6] years) were enrolled. A total of 139 patients (13.5%) had an acute stroke as defined by diffusion restriction detected on MRI scans (DWI positive). The final diagnosis was revised in 308 patients (30.0%) after undergoing brain MRI. There were 7 (0.7%) recurrent strokes at 1 year. A DWI-positive brain MRI scan was associated with an increased risk of recurrent stroke (relative risk, 6.4; 95% CI, 2.4-16.8) at 1 year. Absence of a DWI-positive lesion on a brain MRI scan had a 99.8% negative predictive value for recurrent stroke. Factors associated with MRI evidence of stroke in multivariable modeling were older age (odds ratio [OR], 1.02; 95% CI, 1.00-1.04), male sex (OR, 2.03; 95% CI, 1.39-2.96), motor or speech symptoms (OR, 2.12; 95% CI, 1.37-3.29), ongoing symptoms at assessment (OR, 1.97; 95% CI, 1.29-3.02), no prior identical symptomatic event (OR, 1.87; 95% CI, 1.12-3.11), and abnormal results of initial neurologic examination (OR, 1.71; 95% CI, 1.11-2.65). Conclusions and Relevance This study suggested that patients with transient ischemic attack and symptoms traditionally considered low risk carry a substantive risk of acute stroke as defined by diffusion restriction (DWI positive) on a brain MRI scan. Early MRI is required to make a definitive diagnosis.
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Affiliation(s)
- Shelagh B Coutts
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Francois Moreau
- Department of Medicine, Neurology, Centre intégré universitaire de santé et de services sociaux de l'Estrie-Centre hospitalier universitaire de Sherbrooke, Sherbrooke University, Sherbrooke, Quebec, Canada
| | - Negar Asdaghi
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Jean-Martin Boulanger
- Department of Neurology, Charles LeMoyne Hospital, Sherbrooke University, Longeuil, Quebec, Canada
| | - Marie-Christine Camden
- Department of Neurosciences, Enfant-Jésus Hospital, Laval University, Quebec City, Quebec, Canada
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Andrew M Demchuk
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Thalia S Field
- Vancouver Stroke Program, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mayank Goyal
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Martin Krause
- Northern Clinical School, University of Sydney, Royal North Shore Hospital, Sydney, Australia
| | - Jennifer Mandzia
- Department of Clinical Neurosciences, Western University, London, Ontario, Canada
| | - Bijoy K Menon
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Robert Mikulik
- International Clinical Research Center, Neurological Department, St Anne's University Hospital and Masaryk University, Brno, Czech Republic
| | - Andrew M Penn
- Division of Neurology, Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Richard H Swartz
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Yu AYX, Hill MD, Asdaghi N, Boulanger JM, Camden MC, Campbell BCV, Demchuk AM, Field TS, Goyal M, Krause M, Mandzia J, Menon BK, Mikulik R, Moreau F, Penn AM, Swartz RH, Coutts SB. Sex Differences in Diagnosis and Diagnostic Revision of Suspected Minor Cerebral Ischemic Events. Neurology 2020; 96:e732-e739. [PMID: 33184228 DOI: 10.1212/wnl.0000000000011212] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 09/21/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe sex differences in the presentation, diagnosis, and revision of diagnosis after early brain MRI in patients who present with acute transient or minor neurologic events. METHODS We performed a secondary analysis of a prospective multicenter cohort study of patients referred to neurology between 2010 and 2016 with a possible cerebrovascular event and evaluated with brain MRI within 8 days of symptom onset. Investigators documented the characteristics of the event, initial diagnosis, and final diagnosis. We used multivariable logistic regression analyses to evaluate the association between sex and outcomes. RESULTS Among 1,028 patients (51% women, median age 63 years), more women than men reported headaches and fewer reported chest pain, but there were no sex differences in other accompanying symptoms. Women were more likely than men to be initially diagnosed with stroke mimic (54% of women vs 42% of men, adjusted odds ratio (OR) 1.60, 95% confidence interval [CI] 1.24-2.07), and women were overall less likely to have ischemia on MRI (10% vs 17%, OR 0.52, 95% CI 0.36-0.76). Among 496 patients initially diagnosed with mimic, women were less likely than men to have their diagnosis revised to minor stroke or TIA (13% vs 20%, OR 0.53, 95% CI 0.32-0.88) but were equally likely to have acute ischemia on MRI (5% vs 8%, OR 0.56, 95% CI 0.26-1.21). CONCLUSIONS Stroke mimic was more frequently diagnosed in women than men, but diagnostic revisions were common in both. Early brain MRI is a useful addition to clinical evaluation in diagnosing transient or minor neurologic events.
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Affiliation(s)
- Amy Y X Yu
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada.
| | - Michael D Hill
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Negar Asdaghi
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Jean-Martin Boulanger
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Marie-Christine Camden
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Bruce C V Campbell
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Andrew M Demchuk
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Thalia S Field
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Mayank Goyal
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Martin Krause
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Jennifer Mandzia
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Bijoy K Menon
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Robert Mikulik
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Francois Moreau
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Andrew M Penn
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Richard H Swartz
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
| | - Shelagh B Coutts
- From the Department of Medicine (Neurology) (A.Y.X.Y., R.H.S.), University of Toronto, Ontario; Department of Clinical Neurosciences (M.D.H., A.M.D., M.G., B.K.M., S.B.C.), University of Calgary, Alberta, Canada; Department of Neurology (N.A.), University of Miami, FL; Department of Neurology (J.-M.B.), Sherbrooke University, Longueil; Department of Neurosciences (M.-C.C.), Laval University, Québec City, Québec, Canada; Department of Medicine and Neurology (B.C.V.C.), University of Melbourne, Parkville, Australia; Vancouver Stroke Program (T.S.F.), University of British Columbia, Vancouver, Canada; Northern Clinical School (M.K.), University of Sydney, Australia; Department of Clinical Neurosciences (J.M.), Western University, London, Ontario, Canada; Neurological Department (R.M.), St. Anne's University Hospital and Masaryk University, Brno, Czech Republic; Department of Medicine (F.M.), Neurology, Université de Sherbrooke, Québec; and Division of Neurology (A.M.P.), Vancouver Island Health Authority, Victoria, British Columbia, Canada
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Tariq S, Tsang A, Wang M, Reaume N, Carlson H, Sajobi TT, Longman RS, Smith EE, Frayne R, d’Esterre CD, Coutts SB, Barber PA. White matter tract microstructure and cognitive performance after transient ischemic attack. PLoS One 2020; 15:e0239116. [PMID: 33095770 PMCID: PMC7584182 DOI: 10.1371/journal.pone.0239116] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 07/13/2020] [Accepted: 08/31/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Patients with transient ischemic attack (TIA) show evidence of cognitive impairment but the reason is not clear. Measurement of microstructural changes in white matter (WM) using diffusion tensor imaging (DTI) may be a useful outcome measure. We report WM changes using DTI and the relationship with neuropsychological performance in a cohort of transient ischemic attack (TIA) and non-TIA subjects. METHODS Ninety-five TIA subjects and 51 non-TIA subjects were assessed using DTI and neuropsychological batteries. Fractional anisotropy (FA) and mean diffusivity (MD) maps were generated and measurements were collected from WM tracts. Adjusted mixed effects regression modelled the relationship between groups and DTI metrics. RESULTS Transient ischemic attack subjects had a mean age of 67.9 ± 9.4 years, and non-TIA subjects had a mean age 64.9 ± 9.9 years. The TIA group exhibited higher MD values in the fornix (0.36 units, P < 0.001) and lower FA in the superior longitudinal fasciculus (SLF) (-0.29 units, P = 0.001), genu (-0.22 units, P = 0.016), and uncinate fasciculus (UF) (-0.26 units, P = 0.004). Compared to non-TIA subjects, subjects with TIA scored lower on the Addenbrooke's Cognitive Assessment-Revised (median score 95 vs 91, P = 0.01) but showed no differences in scores on the Montreal Cognitive Assessment (median 27 vs 26) or the Mini-Mental State Examination (median 30). TIA subjects had lower scores in memory (median 44 vs 52, P < 0.01) and processing speed (median 45 vs 62, P < 0.01) but not executive function, when compared to non-TIA subjects. Lower FA and higher MD in the fornix, SLF, and UF were associated with poorer performance on tests of visual memory and executive function but not verbal memory. Lower FA in the UF and fornix were related to higher timed scores on the TMT-B (P < 0.01), and higher SLF MD was related to higher scores on TMT-B (P < 0.01), confirming worse executive performance in the TIA group. CONCLUSIONS DTI scans may be useful for detecting microstructural disease in TIA subjects before cognitive symptoms develop. DTI parameters, white matter hyperintensities, and vascular risk factors underly some of the altered neuropsychological measures in TIA subjects.
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Affiliation(s)
- Sana Tariq
- Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Room 1A10 Health Research Innovation Center, Calgary, AB, Canada
| | - Adrian Tsang
- Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Room 1A10 Health Research Innovation Center, Calgary, AB, Canada
| | - Meng Wang
- Department of Community Health Sciences & O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Noaah Reaume
- Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada
| | - Helen Carlson
- Calgary Pediatric Stroke Program, Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
| | - Tolulope T. Sajobi
- Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada
- Department of Community Health Sciences & O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Richard Stewart Longman
- Hotchkiss Brain Institute, University of Calgary, Room 1A10 Health Research Innovation Center, Calgary, AB, Canada
- Alberta Health Services, Neuropsychology Service, Foothills Medical Centre, Calgary, AB, Canada
| | - Eric E. Smith
- Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Room 1A10 Health Research Innovation Center, Calgary, AB, Canada
- Department of Clinical Neurosciences, Calgary Stroke Program, Foothills Medical Centre, Calgary, AB, Canada
| | - Richard Frayne
- Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Room 1A10 Health Research Innovation Center, Calgary, AB, Canada
- Department of Clinical Neurosciences, Calgary Stroke Program, Foothills Medical Centre, Calgary, AB, Canada
- Department of Radiology, Foothills Medical Centre, Calgary, AB, Canada
| | - Christopher D. d’Esterre
- Department of Clinical Neurosciences, Calgary Stroke Program, Foothills Medical Centre, Calgary, AB, Canada
| | - Shelagh B. Coutts
- Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Room 1A10 Health Research Innovation Center, Calgary, AB, Canada
- Department of Community Health Sciences & O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, Calgary Stroke Program, Foothills Medical Centre, Calgary, AB, Canada
- Department of Radiology, Foothills Medical Centre, Calgary, AB, Canada
| | - Philip A. Barber
- Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Room 1A10 Health Research Innovation Center, Calgary, AB, Canada
- Department of Community Health Sciences & O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, Calgary Stroke Program, Foothills Medical Centre, Calgary, AB, Canada
- Department of Radiology, Foothills Medical Centre, Calgary, AB, Canada
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Wein T, Lindsay MP, Gladstone DJ, Poppe A, Bell A, Casaubon LK, Foley N, Coutts SB, Cox J, Douketis J, Field T, Gioia L, Habert J, Lang E, Mehta SR, Papoushek C, Semchuk W, Sharma M, Udell JA, Lawrence S, Mountain A, Gubitz G, Dowlatshahi D, Simard A, de Jong A, Smith EE. Recommandations canadiennes pour les pratiques optimales de soins de l’AVC, septième édition : l’acide acétylsalicylique pour la prévention d’événements vasculaires. CMAJ 2020; 192:E1174-E1184. [PMID: 33020129 DOI: 10.1503/cmaj.191599-f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Theodore Wein
- Département de neurologie et neurochirurgie [Wein], Université McGill, Montréal (Qc); Fondation des maladies du cœur et de l'AVC du Canada [Lindsay, Lawrence, Simard, de Jong]; Division de neurologie [Gladstone, Casaubon], Département de médecine, Université de Toronto; Division de neurologie [Gladstone], Service de médecine, Centre régional de traitement des AVC; Programme de sciences neurologiques Hurvitz [Gladstone], Centre des sciences de la santé Sunnybrook; Institut de recherche Sunnybrook [Gladstone], Toronto (Ont.); Centre hospitalier de l'Université de Montréal (CHUM) [Poppe, Gioia], Hôpital Notre-Dame, Montréal (Qc); Département de médecine familiale [Bell, Habert], Université de Toronto; Programme de traitement des AVC de l'hôpital Toronto Western [Casaubon], Réseau universitaire de santé, Toronto (Ont.); workHORSE Consulting Ltd. [Foley], London (Ont.); Département de neurosciences cliniques [Coutts, Smith], École de médecine Cumming, Université de Calgary, Calgary (Alb.); Faculté de médecine (cardiologie) [Cox], Université Dalhousie, Halifax (N.-É.); Département de médecine [Douketis], Université McMaster, Hamilton (Ont.); Division de neurologie [Field], Département de médecine, Université de la Colombie-Britannique, Vancouver (C.-B.); Département de médecine d'urgence [Lang], École de médecine Cumming, Université de Calgary, Calgary Alb.); Division de cardiologie [Mehta], Département de médecine, Université McMaster, Hamilton (Ont.); Département de médecine familiale et communautaire [Papoushek], Faculté de pharmacie Leslie-Dan, Université de Toronto, Toronto (Ont.); École de pharmacie [Semchuk], Université de la Saskatchewan, Saskatoon (Sask.); Division de neurologie [Sharma], Département de médecine, Université McMaster, Hamilton (Ont.); Division cardiovasculaire [Udell], Service de médecine, Hôpital Women's College; Centre de cardiologie Peter-Munk [Udell], Hôpital général de Toronto, Université de Toronto, Toronto (Ont.); Divisions de physiatrie et réadaptation [Mountain] et de neurologie [Gubitz], Département de médecine, Université Dalhousie; Division de neurologie [Dowlatshahi], Faculté de médecine, Université d'Ottawa, Ottawa (Ont.)
| | - M Patrice Lindsay
- Département de neurologie et neurochirurgie [Wein], Université McGill, Montréal (Qc); Fondation des maladies du cœur et de l'AVC du Canada [Lindsay, Lawrence, Simard, de Jong]; Division de neurologie [Gladstone, Casaubon], Département de médecine, Université de Toronto; Division de neurologie [Gladstone], Service de médecine, Centre régional de traitement des AVC; Programme de sciences neurologiques Hurvitz [Gladstone], Centre des sciences de la santé Sunnybrook; Institut de recherche Sunnybrook [Gladstone], Toronto (Ont.); Centre hospitalier de l'Université de Montréal (CHUM) [Poppe, Gioia], Hôpital Notre-Dame, Montréal (Qc); Département de médecine familiale [Bell, Habert], Université de Toronto; Programme de traitement des AVC de l'hôpital Toronto Western [Casaubon], Réseau universitaire de santé, Toronto (Ont.); workHORSE Consulting Ltd. [Foley], London (Ont.); Département de neurosciences cliniques [Coutts, Smith], École de médecine Cumming, Université de Calgary, Calgary (Alb.); Faculté de médecine (cardiologie) [Cox], Université Dalhousie, Halifax (N.-É.); Département de médecine [Douketis], Université McMaster, Hamilton (Ont.); Division de neurologie [Field], Département de médecine, Université de la Colombie-Britannique, Vancouver (C.-B.); Département de médecine d'urgence [Lang], École de médecine Cumming, Université de Calgary, Calgary Alb.); Division de cardiologie [Mehta], Département de médecine, Université McMaster, Hamilton (Ont.); Département de médecine familiale et communautaire [Papoushek], Faculté de pharmacie Leslie-Dan, Université de Toronto, Toronto (Ont.); École de pharmacie [Semchuk], Université de la Saskatchewan, Saskatoon (Sask.); Division de neurologie [Sharma], Département de médecine, Université McMaster, Hamilton (Ont.); Division cardiovasculaire [Udell], Service de médecine, Hôpital Women's College; Centre de cardiologie Peter-Munk [Udell], Hôpital général de Toronto, Université de Toronto, Toronto (Ont.); Divisions de physiatrie et réadaptation [Mountain] et de neurologie [Gubitz], Département de médecine, Université Dalhousie; Division de neurologie [Dowlatshahi], Faculté de médecine, Université d'Ottawa, Ottawa (Ont.).
| | - David J Gladstone
- Département de neurologie et neurochirurgie [Wein], Université McGill, Montréal (Qc); Fondation des maladies du cœur et de l'AVC du Canada [Lindsay, Lawrence, Simard, de Jong]; Division de neurologie [Gladstone, Casaubon], Département de médecine, Université de Toronto; Division de neurologie [Gladstone], Service de médecine, Centre régional de traitement des AVC; Programme de sciences neurologiques Hurvitz [Gladstone], Centre des sciences de la santé Sunnybrook; Institut de recherche Sunnybrook [Gladstone], Toronto (Ont.); Centre hospitalier de l'Université de Montréal (CHUM) [Poppe, Gioia], Hôpital Notre-Dame, Montréal (Qc); Département de médecine familiale [Bell, Habert], Université de Toronto; Programme de traitement des AVC de l'hôpital Toronto Western [Casaubon], Réseau universitaire de santé, Toronto (Ont.); workHORSE Consulting Ltd. [Foley], London (Ont.); Département de neurosciences cliniques [Coutts, Smith], École de médecine Cumming, Université de Calgary, Calgary (Alb.); Faculté de médecine (cardiologie) [Cox], Université Dalhousie, Halifax (N.-É.); Département de médecine [Douketis], Université McMaster, Hamilton (Ont.); Division de neurologie [Field], Département de médecine, Université de la Colombie-Britannique, Vancouver (C.-B.); Département de médecine d'urgence [Lang], École de médecine Cumming, Université de Calgary, Calgary Alb.); Division de cardiologie [Mehta], Département de médecine, Université McMaster, Hamilton (Ont.); Département de médecine familiale et communautaire [Papoushek], Faculté de pharmacie Leslie-Dan, Université de Toronto, Toronto (Ont.); École de pharmacie [Semchuk], Université de la Saskatchewan, Saskatoon (Sask.); Division de neurologie [Sharma], Département de médecine, Université McMaster, Hamilton (Ont.); Division cardiovasculaire [Udell], Service de médecine, Hôpital Women's College; Centre de cardiologie Peter-Munk [Udell], Hôpital général de Toronto, Université de Toronto, Toronto (Ont.); Divisions de physiatrie et réadaptation [Mountain] et de neurologie [Gubitz], Département de médecine, Université Dalhousie; Division de neurologie [Dowlatshahi], Faculté de médecine, Université d'Ottawa, Ottawa (Ont.)
| | - Alexandre Poppe
- Département de neurologie et neurochirurgie [Wein], Université McGill, Montréal (Qc); Fondation des maladies du cœur et de l'AVC du Canada [Lindsay, Lawrence, Simard, de Jong]; Division de neurologie [Gladstone, Casaubon], Département de médecine, Université de Toronto; Division de neurologie [Gladstone], Service de médecine, Centre régional de traitement des AVC; Programme de sciences neurologiques Hurvitz [Gladstone], Centre des sciences de la santé Sunnybrook; Institut de recherche Sunnybrook [Gladstone], Toronto (Ont.); Centre hospitalier de l'Université de Montréal (CHUM) [Poppe, Gioia], Hôpital Notre-Dame, Montréal (Qc); Département de médecine familiale [Bell, Habert], Université de Toronto; Programme de traitement des AVC de l'hôpital Toronto Western [Casaubon], Réseau universitaire de santé, Toronto (Ont.); workHORSE Consulting Ltd. [Foley], London (Ont.); Département de neurosciences cliniques [Coutts, Smith], École de médecine Cumming, Université de Calgary, Calgary (Alb.); Faculté de médecine (cardiologie) [Cox], Université Dalhousie, Halifax (N.-É.); Département de médecine [Douketis], Université McMaster, Hamilton (Ont.); Division de neurologie [Field], Département de médecine, Université de la Colombie-Britannique, Vancouver (C.-B.); Département de médecine d'urgence [Lang], École de médecine Cumming, Université de Calgary, Calgary Alb.); Division de cardiologie [Mehta], Département de médecine, Université McMaster, Hamilton (Ont.); Département de médecine familiale et communautaire [Papoushek], Faculté de pharmacie Leslie-Dan, Université de Toronto, Toronto (Ont.); École de pharmacie [Semchuk], Université de la Saskatchewan, Saskatoon (Sask.); Division de neurologie [Sharma], Département de médecine, Université McMaster, Hamilton (Ont.); Division cardiovasculaire [Udell], Service de médecine, Hôpital Women's College; Centre de cardiologie Peter-Munk [Udell], Hôpital général de Toronto, Université de Toronto, Toronto (Ont.); Divisions de physiatrie et réadaptation [Mountain] et de neurologie [Gubitz], Département de médecine, Université Dalhousie; Division de neurologie [Dowlatshahi], Faculté de médecine, Université d'Ottawa, Ottawa (Ont.)
| | - Alan Bell
- Département de neurologie et neurochirurgie [Wein], Université McGill, Montréal (Qc); Fondation des maladies du cœur et de l'AVC du Canada [Lindsay, Lawrence, Simard, de Jong]; Division de neurologie [Gladstone, Casaubon], Département de médecine, Université de Toronto; Division de neurologie [Gladstone], Service de médecine, Centre régional de traitement des AVC; Programme de sciences neurologiques Hurvitz [Gladstone], Centre des sciences de la santé Sunnybrook; Institut de recherche Sunnybrook [Gladstone], Toronto (Ont.); Centre hospitalier de l'Université de Montréal (CHUM) [Poppe, Gioia], Hôpital Notre-Dame, Montréal (Qc); Département de médecine familiale [Bell, Habert], Université de Toronto; Programme de traitement des AVC de l'hôpital Toronto Western [Casaubon], Réseau universitaire de santé, Toronto (Ont.); workHORSE Consulting Ltd. [Foley], London (Ont.); Département de neurosciences cliniques [Coutts, Smith], École de médecine Cumming, Université de Calgary, Calgary (Alb.); Faculté de médecine (cardiologie) [Cox], Université Dalhousie, Halifax (N.-É.); Département de médecine [Douketis], Université McMaster, Hamilton (Ont.); Division de neurologie [Field], Département de médecine, Université de la Colombie-Britannique, Vancouver (C.-B.); Département de médecine d'urgence [Lang], École de médecine Cumming, Université de Calgary, Calgary Alb.); Division de cardiologie [Mehta], Département de médecine, Université McMaster, Hamilton (Ont.); Département de médecine familiale et communautaire [Papoushek], Faculté de pharmacie Leslie-Dan, Université de Toronto, Toronto (Ont.); École de pharmacie [Semchuk], Université de la Saskatchewan, Saskatoon (Sask.); Division de neurologie [Sharma], Département de médecine, Université McMaster, Hamilton (Ont.); Division cardiovasculaire [Udell], Service de médecine, Hôpital Women's College; Centre de cardiologie Peter-Munk [Udell], Hôpital général de Toronto, Université de Toronto, Toronto (Ont.); Divisions de physiatrie et réadaptation [Mountain] et de neurologie [Gubitz], Département de médecine, Université Dalhousie; Division de neurologie [Dowlatshahi], Faculté de médecine, Université d'Ottawa, Ottawa (Ont.)
| | - Leanne K Casaubon
- Département de neurologie et neurochirurgie [Wein], Université McGill, Montréal (Qc); Fondation des maladies du cœur et de l'AVC du Canada [Lindsay, Lawrence, Simard, de Jong]; Division de neurologie [Gladstone, Casaubon], Département de médecine, Université de Toronto; Division de neurologie [Gladstone], Service de médecine, Centre régional de traitement des AVC; Programme de sciences neurologiques Hurvitz [Gladstone], Centre des sciences de la santé Sunnybrook; Institut de recherche Sunnybrook [Gladstone], Toronto (Ont.); Centre hospitalier de l'Université de Montréal (CHUM) [Poppe, Gioia], Hôpital Notre-Dame, Montréal (Qc); Département de médecine familiale [Bell, Habert], Université de Toronto; Programme de traitement des AVC de l'hôpital Toronto Western [Casaubon], Réseau universitaire de santé, Toronto (Ont.); workHORSE Consulting Ltd. [Foley], London (Ont.); Département de neurosciences cliniques [Coutts, Smith], École de médecine Cumming, Université de Calgary, Calgary (Alb.); Faculté de médecine (cardiologie) [Cox], Université Dalhousie, Halifax (N.-É.); Département de médecine [Douketis], Université McMaster, Hamilton (Ont.); Division de neurologie [Field], Département de médecine, Université de la Colombie-Britannique, Vancouver (C.-B.); Département de médecine d'urgence [Lang], École de médecine Cumming, Université de Calgary, Calgary Alb.); Division de cardiologie [Mehta], Département de médecine, Université McMaster, Hamilton (Ont.); Département de médecine familiale et communautaire [Papoushek], Faculté de pharmacie Leslie-Dan, Université de Toronto, Toronto (Ont.); École de pharmacie [Semchuk], Université de la Saskatchewan, Saskatoon (Sask.); Division de neurologie [Sharma], Département de médecine, Université McMaster, Hamilton (Ont.); Division cardiovasculaire [Udell], Service de médecine, Hôpital Women's College; Centre de cardiologie Peter-Munk [Udell], Hôpital général de Toronto, Université de Toronto, Toronto (Ont.); Divisions de physiatrie et réadaptation [Mountain] et de neurologie [Gubitz], Département de médecine, Université Dalhousie; Division de neurologie [Dowlatshahi], Faculté de médecine, Université d'Ottawa, Ottawa (Ont.)
| | - Norine Foley
- Département de neurologie et neurochirurgie [Wein], Université McGill, Montréal (Qc); Fondation des maladies du cœur et de l'AVC du Canada [Lindsay, Lawrence, Simard, de Jong]; Division de neurologie [Gladstone, Casaubon], Département de médecine, Université de Toronto; Division de neurologie [Gladstone], Service de médecine, Centre régional de traitement des AVC; Programme de sciences neurologiques Hurvitz [Gladstone], Centre des sciences de la santé Sunnybrook; Institut de recherche Sunnybrook [Gladstone], Toronto (Ont.); Centre hospitalier de l'Université de Montréal (CHUM) [Poppe, Gioia], Hôpital Notre-Dame, Montréal (Qc); Département de médecine familiale [Bell, Habert], Université de Toronto; Programme de traitement des AVC de l'hôpital Toronto Western [Casaubon], Réseau universitaire de santé, Toronto (Ont.); workHORSE Consulting Ltd. [Foley], London (Ont.); Département de neurosciences cliniques [Coutts, Smith], École de médecine Cumming, Université de Calgary, Calgary (Alb.); Faculté de médecine (cardiologie) [Cox], Université Dalhousie, Halifax (N.-É.); Département de médecine [Douketis], Université McMaster, Hamilton (Ont.); Division de neurologie [Field], Département de médecine, Université de la Colombie-Britannique, Vancouver (C.-B.); Département de médecine d'urgence [Lang], École de médecine Cumming, Université de Calgary, Calgary Alb.); Division de cardiologie [Mehta], Département de médecine, Université McMaster, Hamilton (Ont.); Département de médecine familiale et communautaire [Papoushek], Faculté de pharmacie Leslie-Dan, Université de Toronto, Toronto (Ont.); École de pharmacie [Semchuk], Université de la Saskatchewan, Saskatoon (Sask.); Division de neurologie [Sharma], Département de médecine, Université McMaster, Hamilton (Ont.); Division cardiovasculaire [Udell], Service de médecine, Hôpital Women's College; Centre de cardiologie Peter-Munk [Udell], Hôpital général de Toronto, Université de Toronto, Toronto (Ont.); Divisions de physiatrie et réadaptation [Mountain] et de neurologie [Gubitz], Département de médecine, Université Dalhousie; Division de neurologie [Dowlatshahi], Faculté de médecine, Université d'Ottawa, Ottawa (Ont.)
| | - Shelagh B Coutts
- Département de neurologie et neurochirurgie [Wein], Université McGill, Montréal (Qc); Fondation des maladies du cœur et de l'AVC du Canada [Lindsay, Lawrence, Simard, de Jong]; Division de neurologie [Gladstone, Casaubon], Département de médecine, Université de Toronto; Division de neurologie [Gladstone], Service de médecine, Centre régional de traitement des AVC; Programme de sciences neurologiques Hurvitz [Gladstone], Centre des sciences de la santé Sunnybrook; Institut de recherche Sunnybrook [Gladstone], Toronto (Ont.); Centre hospitalier de l'Université de Montréal (CHUM) [Poppe, Gioia], Hôpital Notre-Dame, Montréal (Qc); Département de médecine familiale [Bell, Habert], Université de Toronto; Programme de traitement des AVC de l'hôpital Toronto Western [Casaubon], Réseau universitaire de santé, Toronto (Ont.); workHORSE Consulting Ltd. [Foley], London (Ont.); Département de neurosciences cliniques [Coutts, Smith], École de médecine Cumming, Université de Calgary, Calgary (Alb.); Faculté de médecine (cardiologie) [Cox], Université Dalhousie, Halifax (N.-É.); Département de médecine [Douketis], Université McMaster, Hamilton (Ont.); Division de neurologie [Field], Département de médecine, Université de la Colombie-Britannique, Vancouver (C.-B.); Département de médecine d'urgence [Lang], École de médecine Cumming, Université de Calgary, Calgary Alb.); Division de cardiologie [Mehta], Département de médecine, Université McMaster, Hamilton (Ont.); Département de médecine familiale et communautaire [Papoushek], Faculté de pharmacie Leslie-Dan, Université de Toronto, Toronto (Ont.); École de pharmacie [Semchuk], Université de la Saskatchewan, Saskatoon (Sask.); Division de neurologie [Sharma], Département de médecine, Université McMaster, Hamilton (Ont.); Division cardiovasculaire [Udell], Service de médecine, Hôpital Women's College; Centre de cardiologie Peter-Munk [Udell], Hôpital général de Toronto, Université de Toronto, Toronto (Ont.); Divisions de physiatrie et réadaptation [Mountain] et de neurologie [Gubitz], Département de médecine, Université Dalhousie; Division de neurologie [Dowlatshahi], Faculté de médecine, Université d'Ottawa, Ottawa (Ont.)
| | - Jafna Cox
- Département de neurologie et neurochirurgie [Wein], Université McGill, Montréal (Qc); Fondation des maladies du cœur et de l'AVC du Canada [Lindsay, Lawrence, Simard, de Jong]; Division de neurologie [Gladstone, Casaubon], Département de médecine, Université de Toronto; Division de neurologie [Gladstone], Service de médecine, Centre régional de traitement des AVC; Programme de sciences neurologiques Hurvitz [Gladstone], Centre des sciences de la santé Sunnybrook; Institut de recherche Sunnybrook [Gladstone], Toronto (Ont.); Centre hospitalier de l'Université de Montréal (CHUM) [Poppe, Gioia], Hôpital Notre-Dame, Montréal (Qc); Département de médecine familiale [Bell, Habert], Université de Toronto; Programme de traitement des AVC de l'hôpital Toronto Western [Casaubon], Réseau universitaire de santé, Toronto (Ont.); workHORSE Consulting Ltd. [Foley], London (Ont.); Département de neurosciences cliniques [Coutts, Smith], École de médecine Cumming, Université de Calgary, Calgary (Alb.); Faculté de médecine (cardiologie) [Cox], Université Dalhousie, Halifax (N.-É.); Département de médecine [Douketis], Université McMaster, Hamilton (Ont.); Division de neurologie [Field], Département de médecine, Université de la Colombie-Britannique, Vancouver (C.-B.); Département de médecine d'urgence [Lang], École de médecine Cumming, Université de Calgary, Calgary Alb.); Division de cardiologie [Mehta], Département de médecine, Université McMaster, Hamilton (Ont.); Département de médecine familiale et communautaire [Papoushek], Faculté de pharmacie Leslie-Dan, Université de Toronto, Toronto (Ont.); École de pharmacie [Semchuk], Université de la Saskatchewan, Saskatoon (Sask.); Division de neurologie [Sharma], Département de médecine, Université McMaster, Hamilton (Ont.); Division cardiovasculaire [Udell], Service de médecine, Hôpital Women's College; Centre de cardiologie Peter-Munk [Udell], Hôpital général de Toronto, Université de Toronto, Toronto (Ont.); Divisions de physiatrie et réadaptation [Mountain] et de neurologie [Gubitz], Département de médecine, Université Dalhousie; Division de neurologie [Dowlatshahi], Faculté de médecine, Université d'Ottawa, Ottawa (Ont.)
| | - James Douketis
- Département de neurologie et neurochirurgie [Wein], Université McGill, Montréal (Qc); Fondation des maladies du cœur et de l'AVC du Canada [Lindsay, Lawrence, Simard, de Jong]; Division de neurologie [Gladstone, Casaubon], Département de médecine, Université de Toronto; Division de neurologie [Gladstone], Service de médecine, Centre régional de traitement des AVC; Programme de sciences neurologiques Hurvitz [Gladstone], Centre des sciences de la santé Sunnybrook; Institut de recherche Sunnybrook [Gladstone], Toronto (Ont.); Centre hospitalier de l'Université de Montréal (CHUM) [Poppe, Gioia], Hôpital Notre-Dame, Montréal (Qc); Département de médecine familiale [Bell, Habert], Université de Toronto; Programme de traitement des AVC de l'hôpital Toronto Western [Casaubon], Réseau universitaire de santé, Toronto (Ont.); workHORSE Consulting Ltd. [Foley], London (Ont.); Département de neurosciences cliniques [Coutts, Smith], École de médecine Cumming, Université de Calgary, Calgary (Alb.); Faculté de médecine (cardiologie) [Cox], Université Dalhousie, Halifax (N.-É.); Département de médecine [Douketis], Université McMaster, Hamilton (Ont.); Division de neurologie [Field], Département de médecine, Université de la Colombie-Britannique, Vancouver (C.-B.); Département de médecine d'urgence [Lang], École de médecine Cumming, Université de Calgary, Calgary Alb.); Division de cardiologie [Mehta], Département de médecine, Université McMaster, Hamilton (Ont.); Département de médecine familiale et communautaire [Papoushek], Faculté de pharmacie Leslie-Dan, Université de Toronto, Toronto (Ont.); École de pharmacie [Semchuk], Université de la Saskatchewan, Saskatoon (Sask.); Division de neurologie [Sharma], Département de médecine, Université McMaster, Hamilton (Ont.); Division cardiovasculaire [Udell], Service de médecine, Hôpital Women's College; Centre de cardiologie Peter-Munk [Udell], Hôpital général de Toronto, Université de Toronto, Toronto (Ont.); Divisions de physiatrie et réadaptation [Mountain] et de neurologie [Gubitz], Département de médecine, Université Dalhousie; Division de neurologie [Dowlatshahi], Faculté de médecine, Université d'Ottawa, Ottawa (Ont.)
| | - Thalia Field
- Département de neurologie et neurochirurgie [Wein], Université McGill, Montréal (Qc); Fondation des maladies du cœur et de l'AVC du Canada [Lindsay, Lawrence, Simard, de Jong]; Division de neurologie [Gladstone, Casaubon], Département de médecine, Université de Toronto; Division de neurologie [Gladstone], Service de médecine, Centre régional de traitement des AVC; Programme de sciences neurologiques Hurvitz [Gladstone], Centre des sciences de la santé Sunnybrook; Institut de recherche Sunnybrook [Gladstone], Toronto (Ont.); Centre hospitalier de l'Université de Montréal (CHUM) [Poppe, Gioia], Hôpital Notre-Dame, Montréal (Qc); Département de médecine familiale [Bell, Habert], Université de Toronto; Programme de traitement des AVC de l'hôpital Toronto Western [Casaubon], Réseau universitaire de santé, Toronto (Ont.); workHORSE Consulting Ltd. [Foley], London (Ont.); Département de neurosciences cliniques [Coutts, Smith], École de médecine Cumming, Université de Calgary, Calgary (Alb.); Faculté de médecine (cardiologie) [Cox], Université Dalhousie, Halifax (N.-É.); Département de médecine [Douketis], Université McMaster, Hamilton (Ont.); Division de neurologie [Field], Département de médecine, Université de la Colombie-Britannique, Vancouver (C.-B.); Département de médecine d'urgence [Lang], École de médecine Cumming, Université de Calgary, Calgary Alb.); Division de cardiologie [Mehta], Département de médecine, Université McMaster, Hamilton (Ont.); Département de médecine familiale et communautaire [Papoushek], Faculté de pharmacie Leslie-Dan, Université de Toronto, Toronto (Ont.); École de pharmacie [Semchuk], Université de la Saskatchewan, Saskatoon (Sask.); Division de neurologie [Sharma], Département de médecine, Université McMaster, Hamilton (Ont.); Division cardiovasculaire [Udell], Service de médecine, Hôpital Women's College; Centre de cardiologie Peter-Munk [Udell], Hôpital général de Toronto, Université de Toronto, Toronto (Ont.); Divisions de physiatrie et réadaptation [Mountain] et de neurologie [Gubitz], Département de médecine, Université Dalhousie; Division de neurologie [Dowlatshahi], Faculté de médecine, Université d'Ottawa, Ottawa (Ont.)
| | - Laura Gioia
- Département de neurologie et neurochirurgie [Wein], Université McGill, Montréal (Qc); Fondation des maladies du cœur et de l'AVC du Canada [Lindsay, Lawrence, Simard, de Jong]; Division de neurologie [Gladstone, Casaubon], Département de médecine, Université de Toronto; Division de neurologie [Gladstone], Service de médecine, Centre régional de traitement des AVC; Programme de sciences neurologiques Hurvitz [Gladstone], Centre des sciences de la santé Sunnybrook; Institut de recherche Sunnybrook [Gladstone], Toronto (Ont.); Centre hospitalier de l'Université de Montréal (CHUM) [Poppe, Gioia], Hôpital Notre-Dame, Montréal (Qc); Département de médecine familiale [Bell, Habert], Université de Toronto; Programme de traitement des AVC de l'hôpital Toronto Western [Casaubon], Réseau universitaire de santé, Toronto (Ont.); workHORSE Consulting Ltd. [Foley], London (Ont.); Département de neurosciences cliniques [Coutts, Smith], École de médecine Cumming, Université de Calgary, Calgary (Alb.); Faculté de médecine (cardiologie) [Cox], Université Dalhousie, Halifax (N.-É.); Département de médecine [Douketis], Université McMaster, Hamilton (Ont.); Division de neurologie [Field], Département de médecine, Université de la Colombie-Britannique, Vancouver (C.-B.); Département de médecine d'urgence [Lang], École de médecine Cumming, Université de Calgary, Calgary Alb.); Division de cardiologie [Mehta], Département de médecine, Université McMaster, Hamilton (Ont.); Département de médecine familiale et communautaire [Papoushek], Faculté de pharmacie Leslie-Dan, Université de Toronto, Toronto (Ont.); École de pharmacie [Semchuk], Université de la Saskatchewan, Saskatoon (Sask.); Division de neurologie [Sharma], Département de médecine, Université McMaster, Hamilton (Ont.); Division cardiovasculaire [Udell], Service de médecine, Hôpital Women's College; Centre de cardiologie Peter-Munk [Udell], Hôpital général de Toronto, Université de Toronto, Toronto (Ont.); Divisions de physiatrie et réadaptation [Mountain] et de neurologie [Gubitz], Département de médecine, Université Dalhousie; Division de neurologie [Dowlatshahi], Faculté de médecine, Université d'Ottawa, Ottawa (Ont.)
| | - Jeffrey Habert
- Département de neurologie et neurochirurgie [Wein], Université McGill, Montréal (Qc); Fondation des maladies du cœur et de l'AVC du Canada [Lindsay, Lawrence, Simard, de Jong]; Division de neurologie [Gladstone, Casaubon], Département de médecine, Université de Toronto; Division de neurologie [Gladstone], Service de médecine, Centre régional de traitement des AVC; Programme de sciences neurologiques Hurvitz [Gladstone], Centre des sciences de la santé Sunnybrook; Institut de recherche Sunnybrook [Gladstone], Toronto (Ont.); Centre hospitalier de l'Université de Montréal (CHUM) [Poppe, Gioia], Hôpital Notre-Dame, Montréal (Qc); Département de médecine familiale [Bell, Habert], Université de Toronto; Programme de traitement des AVC de l'hôpital Toronto Western [Casaubon], Réseau universitaire de santé, Toronto (Ont.); workHORSE Consulting Ltd. [Foley], London (Ont.); Département de neurosciences cliniques [Coutts, Smith], École de médecine Cumming, Université de Calgary, Calgary (Alb.); Faculté de médecine (cardiologie) [Cox], Université Dalhousie, Halifax (N.-É.); Département de médecine [Douketis], Université McMaster, Hamilton (Ont.); Division de neurologie [Field], Département de médecine, Université de la Colombie-Britannique, Vancouver (C.-B.); Département de médecine d'urgence [Lang], École de médecine Cumming, Université de Calgary, Calgary Alb.); Division de cardiologie [Mehta], Département de médecine, Université McMaster, Hamilton (Ont.); Département de médecine familiale et communautaire [Papoushek], Faculté de pharmacie Leslie-Dan, Université de Toronto, Toronto (Ont.); École de pharmacie [Semchuk], Université de la Saskatchewan, Saskatoon (Sask.); Division de neurologie [Sharma], Département de médecine, Université McMaster, Hamilton (Ont.); Division cardiovasculaire [Udell], Service de médecine, Hôpital Women's College; Centre de cardiologie Peter-Munk [Udell], Hôpital général de Toronto, Université de Toronto, Toronto (Ont.); Divisions de physiatrie et réadaptation [Mountain] et de neurologie [Gubitz], Département de médecine, Université Dalhousie; Division de neurologie [Dowlatshahi], Faculté de médecine, Université d'Ottawa, Ottawa (Ont.)
| | - Eddy Lang
- Département de neurologie et neurochirurgie [Wein], Université McGill, Montréal (Qc); Fondation des maladies du cœur et de l'AVC du Canada [Lindsay, Lawrence, Simard, de Jong]; Division de neurologie [Gladstone, Casaubon], Département de médecine, Université de Toronto; Division de neurologie [Gladstone], Service de médecine, Centre régional de traitement des AVC; Programme de sciences neurologiques Hurvitz [Gladstone], Centre des sciences de la santé Sunnybrook; Institut de recherche Sunnybrook [Gladstone], Toronto (Ont.); Centre hospitalier de l'Université de Montréal (CHUM) [Poppe, Gioia], Hôpital Notre-Dame, Montréal (Qc); Département de médecine familiale [Bell, Habert], Université de Toronto; Programme de traitement des AVC de l'hôpital Toronto Western [Casaubon], Réseau universitaire de santé, Toronto (Ont.); workHORSE Consulting Ltd. [Foley], London (Ont.); Département de neurosciences cliniques [Coutts, Smith], École de médecine Cumming, Université de Calgary, Calgary (Alb.); Faculté de médecine (cardiologie) [Cox], Université Dalhousie, Halifax (N.-É.); Département de médecine [Douketis], Université McMaster, Hamilton (Ont.); Division de neurologie [Field], Département de médecine, Université de la Colombie-Britannique, Vancouver (C.-B.); Département de médecine d'urgence [Lang], École de médecine Cumming, Université de Calgary, Calgary Alb.); Division de cardiologie [Mehta], Département de médecine, Université McMaster, Hamilton (Ont.); Département de médecine familiale et communautaire [Papoushek], Faculté de pharmacie Leslie-Dan, Université de Toronto, Toronto (Ont.); École de pharmacie [Semchuk], Université de la Saskatchewan, Saskatoon (Sask.); Division de neurologie [Sharma], Département de médecine, Université McMaster, Hamilton (Ont.); Division cardiovasculaire [Udell], Service de médecine, Hôpital Women's College; Centre de cardiologie Peter-Munk [Udell], Hôpital général de Toronto, Université de Toronto, Toronto (Ont.); Divisions de physiatrie et réadaptation [Mountain] et de neurologie [Gubitz], Département de médecine, Université Dalhousie; Division de neurologie [Dowlatshahi], Faculté de médecine, Université d'Ottawa, Ottawa (Ont.)
| | - Shamir R Mehta
- Département de neurologie et neurochirurgie [Wein], Université McGill, Montréal (Qc); Fondation des maladies du cœur et de l'AVC du Canada [Lindsay, Lawrence, Simard, de Jong]; Division de neurologie [Gladstone, Casaubon], Département de médecine, Université de Toronto; Division de neurologie [Gladstone], Service de médecine, Centre régional de traitement des AVC; Programme de sciences neurologiques Hurvitz [Gladstone], Centre des sciences de la santé Sunnybrook; Institut de recherche Sunnybrook [Gladstone], Toronto (Ont.); Centre hospitalier de l'Université de Montréal (CHUM) [Poppe, Gioia], Hôpital Notre-Dame, Montréal (Qc); Département de médecine familiale [Bell, Habert], Université de Toronto; Programme de traitement des AVC de l'hôpital Toronto Western [Casaubon], Réseau universitaire de santé, Toronto (Ont.); workHORSE Consulting Ltd. [Foley], London (Ont.); Département de neurosciences cliniques [Coutts, Smith], École de médecine Cumming, Université de Calgary, Calgary (Alb.); Faculté de médecine (cardiologie) [Cox], Université Dalhousie, Halifax (N.-É.); Département de médecine [Douketis], Université McMaster, Hamilton (Ont.); Division de neurologie [Field], Département de médecine, Université de la Colombie-Britannique, Vancouver (C.-B.); Département de médecine d'urgence [Lang], École de médecine Cumming, Université de Calgary, Calgary Alb.); Division de cardiologie [Mehta], Département de médecine, Université McMaster, Hamilton (Ont.); Département de médecine familiale et communautaire [Papoushek], Faculté de pharmacie Leslie-Dan, Université de Toronto, Toronto (Ont.); École de pharmacie [Semchuk], Université de la Saskatchewan, Saskatoon (Sask.); Division de neurologie [Sharma], Département de médecine, Université McMaster, Hamilton (Ont.); Division cardiovasculaire [Udell], Service de médecine, Hôpital Women's College; Centre de cardiologie Peter-Munk [Udell], Hôpital général de Toronto, Université de Toronto, Toronto (Ont.); Divisions de physiatrie et réadaptation [Mountain] et de neurologie [Gubitz], Département de médecine, Université Dalhousie; Division de neurologie [Dowlatshahi], Faculté de médecine, Université d'Ottawa, Ottawa (Ont.)
| | - Christine Papoushek
- Département de neurologie et neurochirurgie [Wein], Université McGill, Montréal (Qc); Fondation des maladies du cœur et de l'AVC du Canada [Lindsay, Lawrence, Simard, de Jong]; Division de neurologie [Gladstone, Casaubon], Département de médecine, Université de Toronto; Division de neurologie [Gladstone], Service de médecine, Centre régional de traitement des AVC; Programme de sciences neurologiques Hurvitz [Gladstone], Centre des sciences de la santé Sunnybrook; Institut de recherche Sunnybrook [Gladstone], Toronto (Ont.); Centre hospitalier de l'Université de Montréal (CHUM) [Poppe, Gioia], Hôpital Notre-Dame, Montréal (Qc); Département de médecine familiale [Bell, Habert], Université de Toronto; Programme de traitement des AVC de l'hôpital Toronto Western [Casaubon], Réseau universitaire de santé, Toronto (Ont.); workHORSE Consulting Ltd. [Foley], London (Ont.); Département de neurosciences cliniques [Coutts, Smith], École de médecine Cumming, Université de Calgary, Calgary (Alb.); Faculté de médecine (cardiologie) [Cox], Université Dalhousie, Halifax (N.-É.); Département de médecine [Douketis], Université McMaster, Hamilton (Ont.); Division de neurologie [Field], Département de médecine, Université de la Colombie-Britannique, Vancouver (C.-B.); Département de médecine d'urgence [Lang], École de médecine Cumming, Université de Calgary, Calgary Alb.); Division de cardiologie [Mehta], Département de médecine, Université McMaster, Hamilton (Ont.); Département de médecine familiale et communautaire [Papoushek], Faculté de pharmacie Leslie-Dan, Université de Toronto, Toronto (Ont.); École de pharmacie [Semchuk], Université de la Saskatchewan, Saskatoon (Sask.); Division de neurologie [Sharma], Département de médecine, Université McMaster, Hamilton (Ont.); Division cardiovasculaire [Udell], Service de médecine, Hôpital Women's College; Centre de cardiologie Peter-Munk [Udell], Hôpital général de Toronto, Université de Toronto, Toronto (Ont.); Divisions de physiatrie et réadaptation [Mountain] et de neurologie [Gubitz], Département de médecine, Université Dalhousie; Division de neurologie [Dowlatshahi], Faculté de médecine, Université d'Ottawa, Ottawa (Ont.)
| | - William Semchuk
- Département de neurologie et neurochirurgie [Wein], Université McGill, Montréal (Qc); Fondation des maladies du cœur et de l'AVC du Canada [Lindsay, Lawrence, Simard, de Jong]; Division de neurologie [Gladstone, Casaubon], Département de médecine, Université de Toronto; Division de neurologie [Gladstone], Service de médecine, Centre régional de traitement des AVC; Programme de sciences neurologiques Hurvitz [Gladstone], Centre des sciences de la santé Sunnybrook; Institut de recherche Sunnybrook [Gladstone], Toronto (Ont.); Centre hospitalier de l'Université de Montréal (CHUM) [Poppe, Gioia], Hôpital Notre-Dame, Montréal (Qc); Département de médecine familiale [Bell, Habert], Université de Toronto; Programme de traitement des AVC de l'hôpital Toronto Western [Casaubon], Réseau universitaire de santé, Toronto (Ont.); workHORSE Consulting Ltd. [Foley], London (Ont.); Département de neurosciences cliniques [Coutts, Smith], École de médecine Cumming, Université de Calgary, Calgary (Alb.); Faculté de médecine (cardiologie) [Cox], Université Dalhousie, Halifax (N.-É.); Département de médecine [Douketis], Université McMaster, Hamilton (Ont.); Division de neurologie [Field], Département de médecine, Université de la Colombie-Britannique, Vancouver (C.-B.); Département de médecine d'urgence [Lang], École de médecine Cumming, Université de Calgary, Calgary Alb.); Division de cardiologie [Mehta], Département de médecine, Université McMaster, Hamilton (Ont.); Département de médecine familiale et communautaire [Papoushek], Faculté de pharmacie Leslie-Dan, Université de Toronto, Toronto (Ont.); École de pharmacie [Semchuk], Université de la Saskatchewan, Saskatoon (Sask.); Division de neurologie [Sharma], Département de médecine, Université McMaster, Hamilton (Ont.); Division cardiovasculaire [Udell], Service de médecine, Hôpital Women's College; Centre de cardiologie Peter-Munk [Udell], Hôpital général de Toronto, Université de Toronto, Toronto (Ont.); Divisions de physiatrie et réadaptation [Mountain] et de neurologie [Gubitz], Département de médecine, Université Dalhousie; Division de neurologie [Dowlatshahi], Faculté de médecine, Université d'Ottawa, Ottawa (Ont.)
| | - Mikul Sharma
- Département de neurologie et neurochirurgie [Wein], Université McGill, Montréal (Qc); Fondation des maladies du cœur et de l'AVC du Canada [Lindsay, Lawrence, Simard, de Jong]; Division de neurologie [Gladstone, Casaubon], Département de médecine, Université de Toronto; Division de neurologie [Gladstone], Service de médecine, Centre régional de traitement des AVC; Programme de sciences neurologiques Hurvitz [Gladstone], Centre des sciences de la santé Sunnybrook; Institut de recherche Sunnybrook [Gladstone], Toronto (Ont.); Centre hospitalier de l'Université de Montréal (CHUM) [Poppe, Gioia], Hôpital Notre-Dame, Montréal (Qc); Département de médecine familiale [Bell, Habert], Université de Toronto; Programme de traitement des AVC de l'hôpital Toronto Western [Casaubon], Réseau universitaire de santé, Toronto (Ont.); workHORSE Consulting Ltd. [Foley], London (Ont.); Département de neurosciences cliniques [Coutts, Smith], École de médecine Cumming, Université de Calgary, Calgary (Alb.); Faculté de médecine (cardiologie) [Cox], Université Dalhousie, Halifax (N.-É.); Département de médecine [Douketis], Université McMaster, Hamilton (Ont.); Division de neurologie [Field], Département de médecine, Université de la Colombie-Britannique, Vancouver (C.-B.); Département de médecine d'urgence [Lang], École de médecine Cumming, Université de Calgary, Calgary Alb.); Division de cardiologie [Mehta], Département de médecine, Université McMaster, Hamilton (Ont.); Département de médecine familiale et communautaire [Papoushek], Faculté de pharmacie Leslie-Dan, Université de Toronto, Toronto (Ont.); École de pharmacie [Semchuk], Université de la Saskatchewan, Saskatoon (Sask.); Division de neurologie [Sharma], Département de médecine, Université McMaster, Hamilton (Ont.); Division cardiovasculaire [Udell], Service de médecine, Hôpital Women's College; Centre de cardiologie Peter-Munk [Udell], Hôpital général de Toronto, Université de Toronto, Toronto (Ont.); Divisions de physiatrie et réadaptation [Mountain] et de neurologie [Gubitz], Département de médecine, Université Dalhousie; Division de neurologie [Dowlatshahi], Faculté de médecine, Université d'Ottawa, Ottawa (Ont.)
| | - Jacob A Udell
- Département de neurologie et neurochirurgie [Wein], Université McGill, Montréal (Qc); Fondation des maladies du cœur et de l'AVC du Canada [Lindsay, Lawrence, Simard, de Jong]; Division de neurologie [Gladstone, Casaubon], Département de médecine, Université de Toronto; Division de neurologie [Gladstone], Service de médecine, Centre régional de traitement des AVC; Programme de sciences neurologiques Hurvitz [Gladstone], Centre des sciences de la santé Sunnybrook; Institut de recherche Sunnybrook [Gladstone], Toronto (Ont.); Centre hospitalier de l'Université de Montréal (CHUM) [Poppe, Gioia], Hôpital Notre-Dame, Montréal (Qc); Département de médecine familiale [Bell, Habert], Université de Toronto; Programme de traitement des AVC de l'hôpital Toronto Western [Casaubon], Réseau universitaire de santé, Toronto (Ont.); workHORSE Consulting Ltd. [Foley], London (Ont.); Département de neurosciences cliniques [Coutts, Smith], École de médecine Cumming, Université de Calgary, Calgary (Alb.); Faculté de médecine (cardiologie) [Cox], Université Dalhousie, Halifax (N.-É.); Département de médecine [Douketis], Université McMaster, Hamilton (Ont.); Division de neurologie [Field], Département de médecine, Université de la Colombie-Britannique, Vancouver (C.-B.); Département de médecine d'urgence [Lang], École de médecine Cumming, Université de Calgary, Calgary Alb.); Division de cardiologie [Mehta], Département de médecine, Université McMaster, Hamilton (Ont.); Département de médecine familiale et communautaire [Papoushek], Faculté de pharmacie Leslie-Dan, Université de Toronto, Toronto (Ont.); École de pharmacie [Semchuk], Université de la Saskatchewan, Saskatoon (Sask.); Division de neurologie [Sharma], Département de médecine, Université McMaster, Hamilton (Ont.); Division cardiovasculaire [Udell], Service de médecine, Hôpital Women's College; Centre de cardiologie Peter-Munk [Udell], Hôpital général de Toronto, Université de Toronto, Toronto (Ont.); Divisions de physiatrie et réadaptation [Mountain] et de neurologie [Gubitz], Département de médecine, Université Dalhousie; Division de neurologie [Dowlatshahi], Faculté de médecine, Université d'Ottawa, Ottawa (Ont.)
| | - Stephanie Lawrence
- Département de neurologie et neurochirurgie [Wein], Université McGill, Montréal (Qc); Fondation des maladies du cœur et de l'AVC du Canada [Lindsay, Lawrence, Simard, de Jong]; Division de neurologie [Gladstone, Casaubon], Département de médecine, Université de Toronto; Division de neurologie [Gladstone], Service de médecine, Centre régional de traitement des AVC; Programme de sciences neurologiques Hurvitz [Gladstone], Centre des sciences de la santé Sunnybrook; Institut de recherche Sunnybrook [Gladstone], Toronto (Ont.); Centre hospitalier de l'Université de Montréal (CHUM) [Poppe, Gioia], Hôpital Notre-Dame, Montréal (Qc); Département de médecine familiale [Bell, Habert], Université de Toronto; Programme de traitement des AVC de l'hôpital Toronto Western [Casaubon], Réseau universitaire de santé, Toronto (Ont.); workHORSE Consulting Ltd. [Foley], London (Ont.); Département de neurosciences cliniques [Coutts, Smith], École de médecine Cumming, Université de Calgary, Calgary (Alb.); Faculté de médecine (cardiologie) [Cox], Université Dalhousie, Halifax (N.-É.); Département de médecine [Douketis], Université McMaster, Hamilton (Ont.); Division de neurologie [Field], Département de médecine, Université de la Colombie-Britannique, Vancouver (C.-B.); Département de médecine d'urgence [Lang], École de médecine Cumming, Université de Calgary, Calgary Alb.); Division de cardiologie [Mehta], Département de médecine, Université McMaster, Hamilton (Ont.); Département de médecine familiale et communautaire [Papoushek], Faculté de pharmacie Leslie-Dan, Université de Toronto, Toronto (Ont.); École de pharmacie [Semchuk], Université de la Saskatchewan, Saskatoon (Sask.); Division de neurologie [Sharma], Département de médecine, Université McMaster, Hamilton (Ont.); Division cardiovasculaire [Udell], Service de médecine, Hôpital Women's College; Centre de cardiologie Peter-Munk [Udell], Hôpital général de Toronto, Université de Toronto, Toronto (Ont.); Divisions de physiatrie et réadaptation [Mountain] et de neurologie [Gubitz], Département de médecine, Université Dalhousie; Division de neurologie [Dowlatshahi], Faculté de médecine, Université d'Ottawa, Ottawa (Ont.)
| | - Anita Mountain
- Département de neurologie et neurochirurgie [Wein], Université McGill, Montréal (Qc); Fondation des maladies du cœur et de l'AVC du Canada [Lindsay, Lawrence, Simard, de Jong]; Division de neurologie [Gladstone, Casaubon], Département de médecine, Université de Toronto; Division de neurologie [Gladstone], Service de médecine, Centre régional de traitement des AVC; Programme de sciences neurologiques Hurvitz [Gladstone], Centre des sciences de la santé Sunnybrook; Institut de recherche Sunnybrook [Gladstone], Toronto (Ont.); Centre hospitalier de l'Université de Montréal (CHUM) [Poppe, Gioia], Hôpital Notre-Dame, Montréal (Qc); Département de médecine familiale [Bell, Habert], Université de Toronto; Programme de traitement des AVC de l'hôpital Toronto Western [Casaubon], Réseau universitaire de santé, Toronto (Ont.); workHORSE Consulting Ltd. [Foley], London (Ont.); Département de neurosciences cliniques [Coutts, Smith], École de médecine Cumming, Université de Calgary, Calgary (Alb.); Faculté de médecine (cardiologie) [Cox], Université Dalhousie, Halifax (N.-É.); Département de médecine [Douketis], Université McMaster, Hamilton (Ont.); Division de neurologie [Field], Département de médecine, Université de la Colombie-Britannique, Vancouver (C.-B.); Département de médecine d'urgence [Lang], École de médecine Cumming, Université de Calgary, Calgary Alb.); Division de cardiologie [Mehta], Département de médecine, Université McMaster, Hamilton (Ont.); Département de médecine familiale et communautaire [Papoushek], Faculté de pharmacie Leslie-Dan, Université de Toronto, Toronto (Ont.); École de pharmacie [Semchuk], Université de la Saskatchewan, Saskatoon (Sask.); Division de neurologie [Sharma], Département de médecine, Université McMaster, Hamilton (Ont.); Division cardiovasculaire [Udell], Service de médecine, Hôpital Women's College; Centre de cardiologie Peter-Munk [Udell], Hôpital général de Toronto, Université de Toronto, Toronto (Ont.); Divisions de physiatrie et réadaptation [Mountain] et de neurologie [Gubitz], Département de médecine, Université Dalhousie; Division de neurologie [Dowlatshahi], Faculté de médecine, Université d'Ottawa, Ottawa (Ont.)
| | - Gord Gubitz
- Département de neurologie et neurochirurgie [Wein], Université McGill, Montréal (Qc); Fondation des maladies du cœur et de l'AVC du Canada [Lindsay, Lawrence, Simard, de Jong]; Division de neurologie [Gladstone, Casaubon], Département de médecine, Université de Toronto; Division de neurologie [Gladstone], Service de médecine, Centre régional de traitement des AVC; Programme de sciences neurologiques Hurvitz [Gladstone], Centre des sciences de la santé Sunnybrook; Institut de recherche Sunnybrook [Gladstone], Toronto (Ont.); Centre hospitalier de l'Université de Montréal (CHUM) [Poppe, Gioia], Hôpital Notre-Dame, Montréal (Qc); Département de médecine familiale [Bell, Habert], Université de Toronto; Programme de traitement des AVC de l'hôpital Toronto Western [Casaubon], Réseau universitaire de santé, Toronto (Ont.); workHORSE Consulting Ltd. [Foley], London (Ont.); Département de neurosciences cliniques [Coutts, Smith], École de médecine Cumming, Université de Calgary, Calgary (Alb.); Faculté de médecine (cardiologie) [Cox], Université Dalhousie, Halifax (N.-É.); Département de médecine [Douketis], Université McMaster, Hamilton (Ont.); Division de neurologie [Field], Département de médecine, Université de la Colombie-Britannique, Vancouver (C.-B.); Département de médecine d'urgence [Lang], École de médecine Cumming, Université de Calgary, Calgary Alb.); Division de cardiologie [Mehta], Département de médecine, Université McMaster, Hamilton (Ont.); Département de médecine familiale et communautaire [Papoushek], Faculté de pharmacie Leslie-Dan, Université de Toronto, Toronto (Ont.); École de pharmacie [Semchuk], Université de la Saskatchewan, Saskatoon (Sask.); Division de neurologie [Sharma], Département de médecine, Université McMaster, Hamilton (Ont.); Division cardiovasculaire [Udell], Service de médecine, Hôpital Women's College; Centre de cardiologie Peter-Munk [Udell], Hôpital général de Toronto, Université de Toronto, Toronto (Ont.); Divisions de physiatrie et réadaptation [Mountain] et de neurologie [Gubitz], Département de médecine, Université Dalhousie; Division de neurologie [Dowlatshahi], Faculté de médecine, Université d'Ottawa, Ottawa (Ont.)
| | - Dar Dowlatshahi
- Département de neurologie et neurochirurgie [Wein], Université McGill, Montréal (Qc); Fondation des maladies du cœur et de l'AVC du Canada [Lindsay, Lawrence, Simard, de Jong]; Division de neurologie [Gladstone, Casaubon], Département de médecine, Université de Toronto; Division de neurologie [Gladstone], Service de médecine, Centre régional de traitement des AVC; Programme de sciences neurologiques Hurvitz [Gladstone], Centre des sciences de la santé Sunnybrook; Institut de recherche Sunnybrook [Gladstone], Toronto (Ont.); Centre hospitalier de l'Université de Montréal (CHUM) [Poppe, Gioia], Hôpital Notre-Dame, Montréal (Qc); Département de médecine familiale [Bell, Habert], Université de Toronto; Programme de traitement des AVC de l'hôpital Toronto Western [Casaubon], Réseau universitaire de santé, Toronto (Ont.); workHORSE Consulting Ltd. [Foley], London (Ont.); Département de neurosciences cliniques [Coutts, Smith], École de médecine Cumming, Université de Calgary, Calgary (Alb.); Faculté de médecine (cardiologie) [Cox], Université Dalhousie, Halifax (N.-É.); Département de médecine [Douketis], Université McMaster, Hamilton (Ont.); Division de neurologie [Field], Département de médecine, Université de la Colombie-Britannique, Vancouver (C.-B.); Département de médecine d'urgence [Lang], École de médecine Cumming, Université de Calgary, Calgary Alb.); Division de cardiologie [Mehta], Département de médecine, Université McMaster, Hamilton (Ont.); Département de médecine familiale et communautaire [Papoushek], Faculté de pharmacie Leslie-Dan, Université de Toronto, Toronto (Ont.); École de pharmacie [Semchuk], Université de la Saskatchewan, Saskatoon (Sask.); Division de neurologie [Sharma], Département de médecine, Université McMaster, Hamilton (Ont.); Division cardiovasculaire [Udell], Service de médecine, Hôpital Women's College; Centre de cardiologie Peter-Munk [Udell], Hôpital général de Toronto, Université de Toronto, Toronto (Ont.); Divisions de physiatrie et réadaptation [Mountain] et de neurologie [Gubitz], Département de médecine, Université Dalhousie; Division de neurologie [Dowlatshahi], Faculté de médecine, Université d'Ottawa, Ottawa (Ont.)
| | - Anne Simard
- Département de neurologie et neurochirurgie [Wein], Université McGill, Montréal (Qc); Fondation des maladies du cœur et de l'AVC du Canada [Lindsay, Lawrence, Simard, de Jong]; Division de neurologie [Gladstone, Casaubon], Département de médecine, Université de Toronto; Division de neurologie [Gladstone], Service de médecine, Centre régional de traitement des AVC; Programme de sciences neurologiques Hurvitz [Gladstone], Centre des sciences de la santé Sunnybrook; Institut de recherche Sunnybrook [Gladstone], Toronto (Ont.); Centre hospitalier de l'Université de Montréal (CHUM) [Poppe, Gioia], Hôpital Notre-Dame, Montréal (Qc); Département de médecine familiale [Bell, Habert], Université de Toronto; Programme de traitement des AVC de l'hôpital Toronto Western [Casaubon], Réseau universitaire de santé, Toronto (Ont.); workHORSE Consulting Ltd. [Foley], London (Ont.); Département de neurosciences cliniques [Coutts, Smith], École de médecine Cumming, Université de Calgary, Calgary (Alb.); Faculté de médecine (cardiologie) [Cox], Université Dalhousie, Halifax (N.-É.); Département de médecine [Douketis], Université McMaster, Hamilton (Ont.); Division de neurologie [Field], Département de médecine, Université de la Colombie-Britannique, Vancouver (C.-B.); Département de médecine d'urgence [Lang], École de médecine Cumming, Université de Calgary, Calgary Alb.); Division de cardiologie [Mehta], Département de médecine, Université McMaster, Hamilton (Ont.); Département de médecine familiale et communautaire [Papoushek], Faculté de pharmacie Leslie-Dan, Université de Toronto, Toronto (Ont.); École de pharmacie [Semchuk], Université de la Saskatchewan, Saskatoon (Sask.); Division de neurologie [Sharma], Département de médecine, Université McMaster, Hamilton (Ont.); Division cardiovasculaire [Udell], Service de médecine, Hôpital Women's College; Centre de cardiologie Peter-Munk [Udell], Hôpital général de Toronto, Université de Toronto, Toronto (Ont.); Divisions de physiatrie et réadaptation [Mountain] et de neurologie [Gubitz], Département de médecine, Université Dalhousie; Division de neurologie [Dowlatshahi], Faculté de médecine, Université d'Ottawa, Ottawa (Ont.)
| | - Andrea de Jong
- Département de neurologie et neurochirurgie [Wein], Université McGill, Montréal (Qc); Fondation des maladies du cœur et de l'AVC du Canada [Lindsay, Lawrence, Simard, de Jong]; Division de neurologie [Gladstone, Casaubon], Département de médecine, Université de Toronto; Division de neurologie [Gladstone], Service de médecine, Centre régional de traitement des AVC; Programme de sciences neurologiques Hurvitz [Gladstone], Centre des sciences de la santé Sunnybrook; Institut de recherche Sunnybrook [Gladstone], Toronto (Ont.); Centre hospitalier de l'Université de Montréal (CHUM) [Poppe, Gioia], Hôpital Notre-Dame, Montréal (Qc); Département de médecine familiale [Bell, Habert], Université de Toronto; Programme de traitement des AVC de l'hôpital Toronto Western [Casaubon], Réseau universitaire de santé, Toronto (Ont.); workHORSE Consulting Ltd. [Foley], London (Ont.); Département de neurosciences cliniques [Coutts, Smith], École de médecine Cumming, Université de Calgary, Calgary (Alb.); Faculté de médecine (cardiologie) [Cox], Université Dalhousie, Halifax (N.-É.); Département de médecine [Douketis], Université McMaster, Hamilton (Ont.); Division de neurologie [Field], Département de médecine, Université de la Colombie-Britannique, Vancouver (C.-B.); Département de médecine d'urgence [Lang], École de médecine Cumming, Université de Calgary, Calgary Alb.); Division de cardiologie [Mehta], Département de médecine, Université McMaster, Hamilton (Ont.); Département de médecine familiale et communautaire [Papoushek], Faculté de pharmacie Leslie-Dan, Université de Toronto, Toronto (Ont.); École de pharmacie [Semchuk], Université de la Saskatchewan, Saskatoon (Sask.); Division de neurologie [Sharma], Département de médecine, Université McMaster, Hamilton (Ont.); Division cardiovasculaire [Udell], Service de médecine, Hôpital Women's College; Centre de cardiologie Peter-Munk [Udell], Hôpital général de Toronto, Université de Toronto, Toronto (Ont.); Divisions de physiatrie et réadaptation [Mountain] et de neurologie [Gubitz], Département de médecine, Université Dalhousie; Division de neurologie [Dowlatshahi], Faculté de médecine, Université d'Ottawa, Ottawa (Ont.)
| | - Eric E Smith
- Département de neurologie et neurochirurgie [Wein], Université McGill, Montréal (Qc); Fondation des maladies du cœur et de l'AVC du Canada [Lindsay, Lawrence, Simard, de Jong]; Division de neurologie [Gladstone, Casaubon], Département de médecine, Université de Toronto; Division de neurologie [Gladstone], Service de médecine, Centre régional de traitement des AVC; Programme de sciences neurologiques Hurvitz [Gladstone], Centre des sciences de la santé Sunnybrook; Institut de recherche Sunnybrook [Gladstone], Toronto (Ont.); Centre hospitalier de l'Université de Montréal (CHUM) [Poppe, Gioia], Hôpital Notre-Dame, Montréal (Qc); Département de médecine familiale [Bell, Habert], Université de Toronto; Programme de traitement des AVC de l'hôpital Toronto Western [Casaubon], Réseau universitaire de santé, Toronto (Ont.); workHORSE Consulting Ltd. [Foley], London (Ont.); Département de neurosciences cliniques [Coutts, Smith], École de médecine Cumming, Université de Calgary, Calgary (Alb.); Faculté de médecine (cardiologie) [Cox], Université Dalhousie, Halifax (N.-É.); Département de médecine [Douketis], Université McMaster, Hamilton (Ont.); Division de neurologie [Field], Département de médecine, Université de la Colombie-Britannique, Vancouver (C.-B.); Département de médecine d'urgence [Lang], École de médecine Cumming, Université de Calgary, Calgary Alb.); Division de cardiologie [Mehta], Département de médecine, Université McMaster, Hamilton (Ont.); Département de médecine familiale et communautaire [Papoushek], Faculté de pharmacie Leslie-Dan, Université de Toronto, Toronto (Ont.); École de pharmacie [Semchuk], Université de la Saskatchewan, Saskatoon (Sask.); Division de neurologie [Sharma], Département de médecine, Université McMaster, Hamilton (Ont.); Division cardiovasculaire [Udell], Service de médecine, Hôpital Women's College; Centre de cardiologie Peter-Munk [Udell], Hôpital général de Toronto, Université de Toronto, Toronto (Ont.); Divisions de physiatrie et réadaptation [Mountain] et de neurologie [Gubitz], Département de médecine, Université Dalhousie; Division de neurologie [Dowlatshahi], Faculté de médecine, Université d'Ottawa, Ottawa (Ont.)
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Lim A, Singhal S, Lavallee P, Amarenco P, Rothwell PM, Albers G, Sharma M, Brown R, Ranta A, Maddula M, Kleinig T, Dawson J, Elkind MSV, Guarino M, Coutts SB, Clissold B, Ma H, Phan T. An International Report on the Adaptations of Rapid Transient Ischaemic Attack Pathways During the COVID-19 Pandemic. J Stroke Cerebrovasc Dis 2020; 29:105228. [PMID: 33066882 PMCID: PMC7434484 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105228] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/30/2020] [Indexed: 11/17/2022] Open
Abstract
Background This report aims to describe changes that centres providing transient ischaemic attack (TIA) pathway services have made to stay operational in response to the SARS-CoV-2 pandemic. Methods An international cross-sectional description of the adaptions of TIA pathways between 30th March and 6th May 2020. Experience was reported from 18 centres with rapid TIA pathways in seven countries (Australia, France, UK, Canada, USA, New Zealand, Italy, Canada) from three continents. Results All pathways remained active (n = 18). Sixteen (89%) had TIA clinics. Six of these clinics (38%) continued to provide in-person assessment while the majority (63%) used telehealth exclusively. Of these, three reported PPE use and three did not. Five centres with clinics (31%) had adopted a different vascular imaging strategy. Conclusion The COVID pandemic has led TIA clinics around the world to adapt and move to the use of telemedicine for outpatient clinic review and modified investigation pathways. Despite the pandemic, all have remained operational.
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Affiliation(s)
- Andy Lim
- Department of Emergency Medicine, Monash Medical Centre, Melbourne, Australia; School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Shaloo Singhal
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology, Monash Medical Centre, Melbourne, Australia
| | - Philippa Lavallee
- Department of Neurology and Stroke Centre, Bichat University Hospital, Paris, France
| | - Pierre Amarenco
- Department of Neurology and Stroke Centre, Bichat University Hospital, Paris, France
| | - Peter M Rothwell
- Nuffield Department of Clinical Neurosciences. Level 6, West Wing, John Radcliffe Hospital, Oxford, United Kingdom
| | - Gregory Albers
- Department of Neurology and Stanford Stroke Center, Stanford Medical Center, Palo Alto, CA, USA
| | - Mukul Sharma
- Division of Neurology, McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada
| | - Robert Brown
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Annemarei Ranta
- Department of Neurology, Wellington Hospital and University of Otago, Wellington
| | - Mohana Maddula
- Tauranga Hospital, Bay of Plenty District Health Board, Tauranga, New Zealand
| | - Timothy Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Maria Guarino
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Interaziendale Clinica Neurologica Metropolitana (NeuroMet), Neurologia AOU S.Orsola, Malpighi, Bologna, Italy
| | - Shelagh B Coutts
- Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Benjamin Clissold
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology, Monash Medical Centre, Melbourne, Australia
| | - Henry Ma
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology, Monash Medical Centre, Melbourne, Australia
| | - Thanh Phan
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Department of Neurology, Monash Medical Centre, Melbourne, Australia.
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Healey JS, Gladstone DJ, Swaminathan B, Eckstein J, Mundl H, Epstein AE, Haeusler KG, Mikulik R, Kasner SE, Toni D, Arauz A, Ntaios G, Hankey GJ, Perera K, Pagola J, Shuaib A, Lutsep H, Yang X, Uchiyama S, Endres M, Coutts SB, Karlinski M, Czlonkowska A, Molina CA, Santo G, Berkowitz SD, Hart RG, Connolly SJ. Recurrent Stroke With Rivaroxaban Compared With Aspirin According to Predictors of Atrial Fibrillation: Secondary Analysis of the NAVIGATE ESUS Randomized Clinical Trial. JAMA Neurol 2020; 76:764-773. [PMID: 30958508 DOI: 10.1001/jamaneurol.2019.0617] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance The NAVIGATE ESUS randomized clinical trial found that 15 mg of rivaroxaban per day does not reduce stroke compared with aspirin in patients with embolic stroke of undetermined source (ESUS); however, it substantially reduces stroke risk in patients with atrial fibrillation (AF). Objective To analyze whether rivaroxaban is associated with a reduction of recurrent stroke among patients with ESUS who have an increased risk of AF. Design, Setting, and Participants Participants were stratified by predictors of AF, including left atrial diameter, frequency of premature atrial contractions, and HAVOC score, a validated scheme using clinical features. Treatment interactions with these predictors were assessed. Participants were enrolled between December 2014 and September 2017, and analysis began March 2018. Intervention Rivaroxaban treatment vs aspirin. Main Outcomes and Measures Risk of ischemic stroke. Results Among 7112 patients with a mean (SD) age of 67 (9.8) years, the mean (SD) HAVOC score was 2.6 (1.8), the mean (SD) left atrial diameter was 3.8 (1.4) cm (n = 4022), and the median (interquartile range) daily frequency of premature atrial contractions was 48 (13-222). Detection of AF during follow-up increased for each tertile of HAVOC score: 2.3% (score, 0-2), 3.0% (score, 3), and 5.8% (score, >3); however, neither tertiles of the HAVOC score nor premature atrial contractions frequency impacted the association of rivaroxaban with recurrent ischemic stroke (P for interaction = .67 and .96, respectively). Atrial fibrillation annual incidence increased for each tertile of left atrial diameter (2.0%, 3.6%, and 5.2%) and for each tertile of premature atrial contractions frequency (1.3%, 2.9%, and 7.0%). Among the predefined subgroup of patients with a left atrial diameter of more than 4.6 cm (9% of overall population), the risk of ischemic stroke was lower among the rivaroxaban group (1.7% per year) compared with the aspirin group (6.5% per year) (hazard ratio, 0.26; 95% CI, 0.07-0.94; P for interaction = .02). Conclusions and Relevance The HAVOC score, left atrial diameter, and premature atrial contraction frequency predicted subsequent clinical AF. Rivaroxaban was associated with a reduced risk of recurrent stroke among patients with ESUS and moderate or severe left atrial enlargement; however, this needs to be independently confirmed before influencing clinical practice.
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Affiliation(s)
- Jeff S Healey
- Division of Cardiology, Hamilton Health Sciences, Population Health Research Institute, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - David J Gladstone
- Division of Neurology and Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre and Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Balakumar Swaminathan
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Jens Eckstein
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | | | - Andrew E Epstein
- Electrophysiology Section, Cardiovascular Division University of Pennsylvania, Cardiology Section, Philadelphia VA Medical Center, Philadelphia
| | | | - Robert Mikulik
- International Clinical Research Center and Neurology Department, St. Anne's University Hospital and Masaryk University, Brno, Czech Republic
| | - Scott E Kasner
- Department of Neurology, University of Pennsylvania, Philadelphia
| | - Danilo Toni
- Department of Human Neurosciences, "Sapienza" University of Rome, Rome, Italy
| | - Antonio Arauz
- Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico City, Mexico
| | - George Ntaios
- Department of Medicine, University of Thesally, Larissa, Greece
| | - Graeme J Hankey
- UWA Medical School, University of Western Australia, Sir Charles Gairdner Hospital, Perth, Australia
| | - Kanjana Perera
- McMaster University/Population Health Research Institute, Department of Medicine (Neurology), Hamilton, Ontario, Canada
| | - Jorge Pagola
- Unitat d'Ictus, Servei de Neurologia, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - Ashfaq Shuaib
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Helmi Lutsep
- Department of Neurology, OHSU, VA Portland Health Care System, Portland, Oregon
| | - Xiaomeng Yang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shinichiro Uchiyama
- International University of Health and Welfare, Sanno Hospital and Sanno Medical Center, Tokyo, Japan
| | - Matthias Endres
- Klinik für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Shelagh B Coutts
- Department of Clinical Neurosciences, Radiology, and Community Health Sciences, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Michal Karlinski
- Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Anna Czlonkowska
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.,Department of Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - Carlos A Molina
- Department of Pharmacology, Medical University of Warsaw, Warsaw, Poland.,Vall d'Hebron Stroke Unit. Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Gustavo Santo
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Scott D Berkowitz
- Bayer US LLC, Pharmaceuticals Clinical Development Thrombosis, Whippany, New Jersey
| | - Robert G Hart
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Stuart J Connolly
- Division of Cardiology, Hamilton Health Sciences, Population Health Research Institute, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Leong M, Stang JM, McGuire N, Lang E, Coutts SB, Patocka C. Regional Variation in Transient Ischemic Attack and Minor Stroke in Alberta Emergency Departments. Stroke 2020; 51:1820-1824. [DOI: 10.1161/strokeaha.119.027960] [Citation(s) in RCA: 5] [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—
Multiple studies have shown the 90-day risk of stroke following an emergency department (ED) diagnosis of transient ischemic attack (TIA) or minor stroke is significant, with the greatest risk of recurrence being within the first 24 to 48 hours following initial symptom onset. This study explored regional differences in ED disposition, neuroimaging, and subsequent 90-day stroke risk of patients diagnosed with TIA or minor stroke in Alberta.
Methods—
We used administrative databases to identify ED visits, neuroimaging, and 90-day return visits for TIA or minor stroke in Alberta from April 2011 to March 2016 among adults ≥20 years of age and stratified them based on regions of presentation (Edmonton, Calgary, or nonmajor urban).
Results—
During the 5-year study period, 22 421 patients had index ED visits for TIA or minor stroke. All 3 regions had a similar number of ED visits for TIA/minor stroke; however, on index ED visit, Calgary had a higher proportion of computed tomographic angiography imaging (48.8%;
P
<0.0001) compared with Edmonton (6.7%) and nonmajor urban region (5.7%) and higher proportion of discharged patients (83%;
P
<0.0001) compared with Edmonton (77.7%) and nonmajor urban region (73.5%). The risk of admission for stroke within 90 days of discharge after index ED visit for TIA/minor stroke in Calgary (3.4%) was lower than Edmonton (4.5%) and the nonmajor urban region (4.6%;
P
=0.002).
Conclusions—
This study demonstrates regional variation in computed tomographic angiography for neurovascular imaging of patients presenting to the ED for TIA/minor stroke and a possible association with frequency of index visit admission and 90-day readmission for the same problem.
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Affiliation(s)
- Michelle Leong
- From the Department of Emergency Medicine, Cumming School of Medicine (M.L., E.L., C.P.), University of Calgary, Alberta, Canada
| | - Jillian M. Stang
- Analytics, Data Integration, Measurement & Reporting Program, Alberta Health Services Analytics (J.M.S., N.M.)
| | - Natasha McGuire
- Analytics, Data Integration, Measurement & Reporting Program, Alberta Health Services Analytics (J.M.S., N.M.)
| | - Eddy Lang
- From the Department of Emergency Medicine, Cumming School of Medicine (M.L., E.L., C.P.), University of Calgary, Alberta, Canada
| | - Shelagh B. Coutts
- Department of Clinical Neurosciences, Radiology and Community Health Sciences (S.B.C.), University of Calgary, Alberta, Canada
| | - Catherine Patocka
- From the Department of Emergency Medicine, Cumming School of Medicine (M.L., E.L., C.P.), University of Calgary, Alberta, Canada
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Ospel JM, Singh N, Marko M, Almekhlafi M, Dowlatshahi D, Puig J, Demchuk A, Coutts SB, Hill MD, Menon BK, Goyal M. Prevalence of Ipsilateral Nonstenotic Carotid Plaques on Computed Tomography Angiography in Embolic Stroke of Undetermined Source. Stroke 2020; 51:1743-1749. [PMID: 32375585 DOI: 10.1161/strokeaha.120.029404] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [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- Embolic stroke of undetermined source (ESUS) constitutes a large proportion of acute ischemic stroke. It is crucial to identify possible stroke etiologies in this patient subgroup to individually tailor secondary stroke prevention strategies. This study aimed to assess the prevalence of carotid plaques causing <50% stenosis in ESUS patients on computed tomography angiography and the association of these plaques with ipsilateral strokes. Methods- Patients from INTERRSeCT-a multicenter prospective study of patients with acute ischemic stroke-were included in this study if their stroke etiology was not large artery atherosclerosis (>50% stenosis), and neck computed tomography angiography was obtained. Degree of stenosis (<30% versus 30%-50%), maximum plaque thickness, degree of plaque calcification (<50% versus ≥50%), plaque irregularity, ulceration, hypodensity, carotid web, and focal vessel outpouching were assessed for both carotid arteries on computed tomography angiography. Prevalence of carotid plaques with <50% stenosis (nonstenotic plaques), ipsilateral and contralateral to the stroke, in ESUS patients was determined and compared with non-ESUS patients. Features of these plaques with versus without ipsilateral stroke in ESUS patients were compared. Uni- and multivariable logistic regression was performed to determine associations between nonstenotic carotid plaque, plaque characteristics, and ipsilateral stroke in ESUS patients. Results- Four hundred forty-six patients were included in the study (median age, 73 years; 218 men), 138 of which were ESUS patients (median age, 70 years; 61 men). Nonstenotic carotid plaques (with <50% stenosis) were present in 54 of 138 (39.1%) ESUS patients. Twelve (8.7%) patients had bilateral carotid plaques. Forty (60.6%) of these plaques were ipsilateral and 26 (39.4%) contralateral to the side of the stroke (P=0.004). Nonstenotic carotid plaques were significantly associated with ipsilateral strokes (adjusted odds ratio, 1.83 [95% CI, 1.05-3.18]). Conclusions- In patients with ESUS, nonstenotic carotid plaques were significantly more common on the side of the ischemic stroke, suggesting that these plaques could be a potential stroke etiology in patients in whom the ischemic stroke is classified currently as ESUS.
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Affiliation(s)
- Johanna M Ospel
- From the Department of Clinical Neurosciences (J.M.O., M.A., A.D., S.B.C., M.D.H., B.K.M., M.G.), University of Calgary, Canada.,Department of Radiology, University Hospital of Basel, Switzerland (J.M.O.)
| | | | - Martha Marko
- From the Department of Clinical Neurosciences (J.M.O., M.A., A.D., S.B.C., M.D.H., B.K.M., M.G.), University of Calgary, Canada
| | - Mohammed Almekhlafi
- Department of Radiology (M.A., A.D., M.D.H., B.K.M., M.G.), University of Calgary, Canada
| | - Dar Dowlatshahi
- Department of Neurology, University of Ottawa, Canada (D.D.)
| | - Josep Puig
- Department of Radiology, Biomedical Research Institute Imaging Research Unit, Diagnostic Imaging Institute, Dr Josep Trueta University Hospital, Girona, Spain (J.P.)
| | - Andrew Demchuk
- From the Department of Clinical Neurosciences (J.M.O., M.A., A.D., S.B.C., M.D.H., B.K.M., M.G.), University of Calgary, Canada.,Department of Radiology (M.A., A.D., M.D.H., B.K.M., M.G.), University of Calgary, Canada
| | - Shelagh B Coutts
- From the Department of Clinical Neurosciences (J.M.O., M.A., A.D., S.B.C., M.D.H., B.K.M., M.G.), University of Calgary, Canada
| | - Michael D Hill
- From the Department of Clinical Neurosciences (J.M.O., M.A., A.D., S.B.C., M.D.H., B.K.M., M.G.), University of Calgary, Canada.,Department of Radiology (M.A., A.D., M.D.H., B.K.M., M.G.), University of Calgary, Canada
| | - Bijoy K Menon
- From the Department of Clinical Neurosciences (J.M.O., M.A., A.D., S.B.C., M.D.H., B.K.M., M.G.), University of Calgary, Canada.,Department of Radiology (M.A., A.D., M.D.H., B.K.M., M.G.), University of Calgary, Canada
| | - Mayank Goyal
- From the Department of Clinical Neurosciences (J.M.O., M.A., A.D., S.B.C., M.D.H., B.K.M., M.G.), University of Calgary, Canada.,Department of Radiology (M.A., A.D., M.D.H., B.K.M., M.G.), University of Calgary, Canada
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Goyal M, Singh N, Marko M, Hill MD, Menon BK, Demchuk A, Coutts SB, Almekhlafi MA, Ospel JM. Embolic Stroke of Undetermined Source and Symptomatic Nonstenotic Carotid Disease. Stroke 2020; 51:1321-1325. [DOI: 10.1161/strokeaha.119.028853] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mayank Goyal
- From the Department of Clinical Neurosciences (M.G., N.S., M.M., M.D.H., B.K.M., A.D., S.B.C., M.A.A., J.M.O.), University of Calgary, Canada
- Department of Radiology (M.G., M.D.H., B.K.M., A.D., M.A.A.), University of Calgary, Canada
| | - Nishita Singh
- From the Department of Clinical Neurosciences (M.G., N.S., M.M., M.D.H., B.K.M., A.D., S.B.C., M.A.A., J.M.O.), University of Calgary, Canada
| | - Martha Marko
- From the Department of Clinical Neurosciences (M.G., N.S., M.M., M.D.H., B.K.M., A.D., S.B.C., M.A.A., J.M.O.), University of Calgary, Canada
| | - Michael D. Hill
- From the Department of Clinical Neurosciences (M.G., N.S., M.M., M.D.H., B.K.M., A.D., S.B.C., M.A.A., J.M.O.), University of Calgary, Canada
- Department of Radiology (M.G., M.D.H., B.K.M., A.D., M.A.A.), University of Calgary, Canada
| | - Bijoy K. Menon
- From the Department of Clinical Neurosciences (M.G., N.S., M.M., M.D.H., B.K.M., A.D., S.B.C., M.A.A., J.M.O.), University of Calgary, Canada
- Department of Radiology (M.G., M.D.H., B.K.M., A.D., M.A.A.), University of Calgary, Canada
| | - Andrew Demchuk
- From the Department of Clinical Neurosciences (M.G., N.S., M.M., M.D.H., B.K.M., A.D., S.B.C., M.A.A., J.M.O.), University of Calgary, Canada
- Department of Radiology (M.G., M.D.H., B.K.M., A.D., M.A.A.), University of Calgary, Canada
| | - Shelagh B. Coutts
- From the Department of Clinical Neurosciences (M.G., N.S., M.M., M.D.H., B.K.M., A.D., S.B.C., M.A.A., J.M.O.), University of Calgary, Canada
| | - Mohammed A. Almekhlafi
- From the Department of Clinical Neurosciences (M.G., N.S., M.M., M.D.H., B.K.M., A.D., S.B.C., M.A.A., J.M.O.), University of Calgary, Canada
- Department of Radiology (M.G., M.D.H., B.K.M., A.D., M.A.A.), University of Calgary, Canada
| | - Johanna M. Ospel
- From the Department of Clinical Neurosciences (M.G., N.S., M.M., M.D.H., B.K.M., A.D., S.B.C., M.A.A., J.M.O.), University of Calgary, Canada
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Hill MD, Goyal M, Menon BK, Nogueira RG, McTaggart RA, Demchuk AM, Poppe AY, Buck BH, Field TS, Dowlatshahi D, van Adel BA, Swartz RH, Shah RA, Sauvageau E, Zerna C, Ospel JM, Joshi M, Almekhlafi MA, Ryckborst KJ, Lowerison MW, Heard K, Garman D, Haussen D, Cutting SM, Coutts SB, Roy D, Rempel JL, Rohr AC, Iancu D, Sahlas DJ, Yu AYX, Devlin TG, Hanel RA, Puetz V, Silver FL, Campbell BCV, Chapot R, Teitelbaum J, Mandzia JL, Kleinig TJ, Turkel-Parrella D, Heck D, Kelly ME, Bharatha A, Bang OY, Jadhav A, Gupta R, Frei DF, Tarpley JW, McDougall CG, Holmin S, Rha JH, Puri AS, Camden MC, Thomalla G, Choe H, Phillips SJ, Schindler JL, Thornton J, Nagel S, Heo JH, Sohn SI, Psychogios MN, Budzik RF, Starkman S, Martin CO, Burns PA, Murphy S, Lopez GA, English J, Tymianski M. Efficacy and safety of nerinetide for the treatment of acute ischaemic stroke (ESCAPE-NA1): a multicentre, double-blind, randomised controlled trial. Lancet 2020; 395:878-887. [PMID: 32087818 DOI: 10.1016/s0140-6736(20)30258-0] [Citation(s) in RCA: 347] [Impact Index Per Article: 86.8] [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] [Received: 01/14/2020] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Nerinetide, an eicosapeptide that interferes with post-synaptic density protein 95, is a neuroprotectant that is effective in preclinical stroke models of ischaemia-reperfusion. In this trial, we assessed the efficacy and safety of nerinetide in human ischaemia-reperfusion that occurs with rapid endovascular thrombectomy in patients who had an acute ischaemic stroke. METHODS For this multicentre, double-blind, randomised, placebo-controlled study done in 48 acute care hospitals in eight countries, we enrolled patients with acute ischaemic stroke due to large vessel occlusion within a 12 h treatment window. Eligible patients were aged 18 years or older with a disabling ischaemic stroke at the time of randomisation, had been functioning independently in the community before the stroke, had an Alberta Stroke Program Early CT Score (ASPECTS) greater than 4, and vascular imaging showing moderate-to-good collateral filling, as determined by multiphase CT angiography. Patients were randomly assigned (1:1) to receive intravenous nerinetide in a single dose of 2·6 mg/kg, up to a maximum dose of 270 mg, on the basis of estimated or actual weight (if known) or saline placebo by use of a real-time, dynamic, internet-based, stratified randomised minimisation procedure. Patients were stratified by intravenous alteplase treatment and declared endovascular device choice. All trial personnel and patients were masked to sequence and treatment allocation. All patients underwent endovascular thrombectomy and received alteplase in usual care when indicated. The primary outcome was a favourable functional outcome 90 days after randomisation, defined as a modified Rankin Scale (mRS) score of 0-2. Secondary outcomes were measures of neurological disability, functional independence in activities of daily living, excellent functional outcome (mRS 0-1), and mortality. The analysis was done in the intention-to-treat population and adjusted for age, sex, baseline National Institutes of Health Stroke Scale score, ASPECTS, occlusion location, site, alteplase use, and declared first device. The safety population included all patients who received any amount of study drug. This trial is registered with ClinicalTrials.gov, NCT02930018. FINDINGS Between March 1, 2017, and Aug 12, 2019, 1105 patients were randomly assigned to receive nerinetide (n=549) or placebo (n=556). 337 (61·4%) of 549 patients with nerinetide and 329 (59·2%) of 556 with placebo achieved an mRS score of 0-2 at 90 days (adjusted risk ratio 1·04, 95% CI 0·96-1·14; p=0·35). Secondary outcomes were similar between groups. We observed evidence of treatment effect modification resulting in inhibition of treatment effect in patients receiving alteplase. Serious adverse events occurred equally between groups. INTERPRETATION Nerinetide did not improve the proportion of patients achieving good clinical outcomes after endovascular thrombectomy compared with patients receiving placebo. FUNDING Canadian Institutes for Health Research, Alberta Innovates, and NoNO.
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Affiliation(s)
- Michael D Hill
- Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.
| | - Mayank Goyal
- Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Bijoy K Menon
- Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Raul G Nogueira
- Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - Ryan A McTaggart
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Andrew M Demchuk
- Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Alexandre Y Poppe
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Brian H Buck
- University of Alberta Hospital, Edmonton, AB, Canada
| | | | | | | | - Richard H Swartz
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto ON, Canada
| | | | - Eric Sauvageau
- Lyerly Neurosurgery, Baptist Hospital, Jacksonville, FL, USA
| | - Charlotte Zerna
- Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Johanna M Ospel
- Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Manish Joshi
- Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | | | - Karla J Ryckborst
- Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Mark W Lowerison
- Clinical Research Unit, University of Calgary, Calgary, AB, Canada
| | | | | | - Diogo Haussen
- Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - Shawna M Cutting
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Shelagh B Coutts
- Foothills Medical Centre, University of Calgary, Calgary, AB, Canada
| | - Daniel Roy
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | | | - Axel Cr Rohr
- University of British Columbia, Vancouver, BC, Canada
| | - Daniela Iancu
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | | | - Amy Y X Yu
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto ON, Canada
| | | | - Ricardo A Hanel
- Lyerly Neurosurgery, Baptist Hospital, Jacksonville, FL, USA
| | - Volker Puetz
- University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden Neurovascular Center, Dresden, Germany
| | - Frank L Silver
- University Health Network, University of Toronto, Toronto, ON, Canada
| | - Bruce C V Campbell
- The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - René Chapot
- Department of Neuroradiology and Endovascular Therapy, Alfred Krupp Krankenhaus Hospital, Essen, Germany
| | - Jeanne Teitelbaum
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | | | | | | | - Donald Heck
- Forsyth Medical Center, Winston-Salem, NC, USA
| | - Michael E Kelly
- Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
| | - Aditya Bharatha
- St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Oh Young Bang
- Samsung Medical Center, Departments of Neurology and Radiology, Sungkyunkwan University, Seoul, South Korea
| | - Ashutosh Jadhav
- University of Pittsburgh Medical Centre, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rishi Gupta
- Wellstar Health Systems, Kennestone Hospital, Marietta, GA, USA
| | - Donald F Frei
- Swedish Medical Center, Colorado Neurological Institute, Denver, CO, USA
| | - Jason W Tarpley
- Providence Little Company of Mary Medical Center, Providence Saint John's Health Center and The Pacific Neuroscience Institute, Torrance, CA, USA
| | | | - Staffan Holmin
- Department of Clinical Neuroscience, Karolinska Institutet and Departments of Neuroradiology and Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Joung-Ho Rha
- Inha University Hospital Neurology, Incheon, South Korea
| | - Ajit S Puri
- University of Massachusetts Medical Center, University of Massachusetts, Worcester, MA, USA
| | - Marie-Christine Camden
- Enfant-Jésus Hospital, Centre Hospitalier Universitaire de Québec, Laval University, Québec City, QC, Canada
| | - Götz Thomalla
- Department of Neurology and Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hana Choe
- Neurosciences Institute, Abington Jefferson Hospital, Philadelphia, PA, USA
| | - Stephen J Phillips
- Queen Elizabeth II Health Science Centre, Dalhousie University, Halifax, NS, Canada
| | | | | | - Simon Nagel
- University Hospital Heidelberg, Heidelberg, Germany
| | - Ji Hoe Heo
- Yonsei University College of Medicine, Seoul, South Korea
| | - Sung-Il Sohn
- Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea
| | | | - Ronald F Budzik
- Ohio Health, Riverside Methodist Hospital, Columbus, OH, USA
| | - Sidney Starkman
- UCLA Comprehensive Stroke Center, University of California, Los Angeles, Los Angeles, CA, USA
| | | | | | - Seán Murphy
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - George A Lopez
- Rush University Medical Center, Rush University, Chicago, IL, USA
| | - Joey English
- California Pacific Medical Center, Sutter Health, San Francisco, CA, USA
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48
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Kelly PJ, Camps-Renom P, Giannotti N, Martí-Fàbregas J, McNulty JP, Baron JC, Barry M, Coutts SB, Cronin S, Delgado-Mederos R, Dolan E, Fernández-León A, Foley S, Harbison J, Horgan G, Kavanagh E, Marnane M, McCabe J, McDonnell C, Sharma VK, Williams DJ, O’Connell M, Murphy S. A Risk Score Including Carotid Plaque Inflammation and Stenosis Severity Improves Identification of Recurrent Stroke. Stroke 2020; 51:838-845. [DOI: 10.1161/strokeaha.119.027268] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background and Purpose—
In randomized trials of symptomatic carotid endarterectomy, only modest benefit occurred in patients with moderate stenosis and important subgroups experienced no benefit. Carotid plaque
18
F-fluorodeoxyglucose uptake on positron emission tomography, reflecting inflammation, independently predicts recurrent stroke. We investigated if a risk score combining stenosis and plaque
18
F-fluorodeoxyglucose would improve the identification of early recurrent stroke.
Methods—
We derived the score in a prospective cohort study of recent (<30 days) non-severe (modified Rankin Scale score ≤3) stroke/transient ischemic attack. We derived the SCAIL (symptomatic carotid atheroma inflammation lumen-stenosis) score (range, 0–5) including
18
F-fluorodeoxyglucose standardized uptake values (SUV
max
<2 g/mL, 0 points; SUV
max
2–2.99 g/mL, 1 point; SUV
max
3–3.99 g/mL, 2 points; SUV
max
≥4 g/mL, 3 points) and stenosis (<50%, 0 points; 50%–69%, 1 point; ≥70%, 2 points). We validated the score in an independent pooled cohort of 2 studies. In the pooled cohorts, we investigated the SCAIL score to discriminate recurrent stroke after the index stroke/transient ischemic attack, after positron emission tomography-imaging, and in mild or moderate stenosis.
Results—
In the derivation cohort (109 patients), recurrent stroke risk increased with increasing SCAIL score (
P
=0.002, C statistic 0.71 [95% CI, 0.56–0.86]). The adjusted (age, sex, smoking, hypertension, diabetes mellitus, antiplatelets, and statins) hazard ratio per 1-point SCAIL increase was 2.4 (95% CI, 1.2–4.5,
P
=0.01). Findings were confirmed in the validation cohort (87 patients, adjusted hazard ratio, 2.9 [95% CI, 1.9–5],
P
<0.001; C statistic 0.77 [95% CI, 0.67–0.87]). The SCAIL score independently predicted recurrent stroke after positron emission tomography-imaging (adjusted hazard ratio, 4.52 [95% CI, 1.58–12.93],
P
=0.005). Compared with stenosis severity (C statistic, 0.63 [95% CI, 0.46–0.80]), prediction of post-positron emission tomography stroke recurrence was improved with the SCAIL score (C statistic, 0.82 [95% CI, 0.66–0.97],
P
=0.04). Findings were confirmed in mild or moderate stenosis (adjusted hazard ratio, 2.74 [95% CI, 1.39–5.39],
P
=0.004).
Conclusions—
The SCAIL score improved the identification of early recurrent stroke. Randomized trials are needed to test if a combined stenosis-inflammation strategy improves selection for carotid revascularization where benefit is currently uncertain.
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Affiliation(s)
- Peter J. Kelly
- From the UCD Neurovascular Clinical Science Unit, Stroke Service/Department of Neurology, Mater University Hospital, Dublin, Ireland (P.J.K., N.G., G.H., M.M., J.M., S.M.)
- HRB Stroke Clinical Trials Network, Ireland (P.J.K., S.C., E.D., J.H., G.H., M.M., J.M., D.J.W., S.M.)
| | - Pol Camps-Renom
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona (Department of Medicine), Spain (P.C.-R., J.M.-F., R.D.-M.)
| | - Nicola Giannotti
- From the UCD Neurovascular Clinical Science Unit, Stroke Service/Department of Neurology, Mater University Hospital, Dublin, Ireland (P.J.K., N.G., G.H., M.M., J.M., S.M.)
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin (N.G., J.P.M., S.F.), Mater University Hospital, University College Dublin, Ireland
| | - Joan Martí-Fàbregas
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona (Department of Medicine), Spain (P.C.-R., J.M.-F., R.D.-M.)
| | - Jonathan P. McNulty
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin (N.G., J.P.M., S.F.), Mater University Hospital, University College Dublin, Ireland
| | - Jean-Claude Baron
- Department of Neurology, Université de Paris, Hopital Sainte-Anne, Inserm U1266, Paris, France (J.-C.B.)
| | - Mary Barry
- Department of Vascular Surgery, St Vincent’s University Hospital (M.B.), Mater University Hospital, University College Dublin, Ireland
| | - Shelagh B. Coutts
- Hotchkiss Brain Institute, Departments of Clinical Neurosciences, Radiology and Community Health Sciences, University of Calgary, Canada (S.B.C.)
| | - Simon Cronin
- HRB Stroke Clinical Trials Network, Ireland (P.J.K., S.C., E.D., J.H., G.H., M.M., J.M., D.J.W., S.M.)
- Department of Neurology and Clinical Neuroscience, Cork University Hospital/University College Cork, Ireland (S.C.)
| | - Raquel Delgado-Mederos
- Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona (Department of Medicine), Spain (P.C.-R., J.M.-F., R.D.-M.)
| | - Eamon Dolan
- HRB Stroke Clinical Trials Network, Ireland (P.J.K., S.C., E.D., J.H., G.H., M.M., J.M., D.J.W., S.M.)
- Connolly Hospital Dublin/Royal College of Surgeons Ireland (E.D.)
| | - Alejandro Fernández-León
- Department of Nuclear Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (A.F.-L.)
| | - Shane Foley
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin (N.G., J.P.M., S.F.), Mater University Hospital, University College Dublin, Ireland
| | - Joseph Harbison
- HRB Stroke Clinical Trials Network, Ireland (P.J.K., S.C., E.D., J.H., G.H., M.M., J.M., D.J.W., S.M.)
- Stroke Service, Department of Geriatric Medicine, St James’ Hospital/Trinity College Dublin (J.H.)
| | - Gillian Horgan
- From the UCD Neurovascular Clinical Science Unit, Stroke Service/Department of Neurology, Mater University Hospital, Dublin, Ireland (P.J.K., N.G., G.H., M.M., J.M., S.M.)
- HRB Stroke Clinical Trials Network, Ireland (P.J.K., S.C., E.D., J.H., G.H., M.M., J.M., D.J.W., S.M.)
| | - Eoin Kavanagh
- Department of Radiology (E.K., M.O.), Mater University Hospital, University College Dublin, Ireland
| | - Michael Marnane
- From the UCD Neurovascular Clinical Science Unit, Stroke Service/Department of Neurology, Mater University Hospital, Dublin, Ireland (P.J.K., N.G., G.H., M.M., J.M., S.M.)
- HRB Stroke Clinical Trials Network, Ireland (P.J.K., S.C., E.D., J.H., G.H., M.M., J.M., D.J.W., S.M.)
| | - John McCabe
- From the UCD Neurovascular Clinical Science Unit, Stroke Service/Department of Neurology, Mater University Hospital, Dublin, Ireland (P.J.K., N.G., G.H., M.M., J.M., S.M.)
- HRB Stroke Clinical Trials Network, Ireland (P.J.K., S.C., E.D., J.H., G.H., M.M., J.M., D.J.W., S.M.)
| | - Ciaran McDonnell
- Department of Vascular Surgery (C.M.), Mater University Hospital, University College Dublin, Ireland
| | - Vijay K. Sharma
- Division of Neurology, National University Health System/Yong Loo Lin School of Medicine, National University of Singapore (V.K.S.)
| | - David J. Williams
- HRB Stroke Clinical Trials Network, Ireland (P.J.K., S.C., E.D., J.H., G.H., M.M., J.M., D.J.W., S.M.)
- Royal College of Surgeons in Ireland/Beaumont Hospital, Dublin (D.J.W.)
| | - Martin O’Connell
- Department of Radiology (E.K., M.O.), Mater University Hospital, University College Dublin, Ireland
| | - Sean Murphy
- From the UCD Neurovascular Clinical Science Unit, Stroke Service/Department of Neurology, Mater University Hospital, Dublin, Ireland (P.J.K., N.G., G.H., M.M., J.M., S.M.)
- HRB Stroke Clinical Trials Network, Ireland (P.J.K., S.C., E.D., J.H., G.H., M.M., J.M., D.J.W., S.M.)
- Royal College of Surgeons in Ireland, Dublin (S.M.)
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49
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Butcher KS, Ng K, Sheridan P, Field TS, Coutts SB, Siddiqui M, Gioia LC, Buck B, Hill MD, Miller J, Klahr AC, Sivakumar L, Benavente OR, Hart RG, Sharma M. Dabigatran Treatment of Acute Noncardioembolic Ischemic Stroke. Stroke 2020; 51:1190-1198. [PMID: 32098609 DOI: 10.1161/strokeaha.119.027569] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 11/16/2022]
Abstract
Background and Purpose- Patients with transient ischemic attack (TIA) and minor ischemic stroke are at risk for early recurrent cerebral ischemia. Anticoagulants are associated with reduced recurrence but also increased hemorrhagic transformation (HT). The safety of the novel oral anticoagulant dabigatran in acute stroke has not been evaluated. Methods- DATAS II (Dabigatran Treatment of Acute Stroke II) was a phase II prospective, randomized open label, blinded end point trial. Patients with noncardioembolic stroke/transient ischemic attack (National Institutes of Health Stroke Scale score, ≤9; infarct volume, ≤25 mL) were randomized to dabigatran or aspirin. Magnetic resonance imaging was performed before randomization and repeated at day 30. Imaging end points were ascertained centrally by readers blinded to treatment. The primary end point was symptomatic HT within 37 days of randomization. Results- A total of 305 patients, mean age 66.59±13.21 years, were randomized to dabigatran or aspirin a mean of 42.00±17.31 hours after symptom onset. The qualifying event was a transient ischemic attack in 21%, and ischemic stroke in 79% of patients. Median National Institutes of Health Stroke Scale (interquartile range) was 1 (0-2), and mean infarct volume 3.2±6.5 mL. No symptomatic HT occurred. Asymptomatic petechial HT developed in 11/142 (7.8%) of dabigatran-assigned patients and 5/142 (3.5%) of aspirin-assigned patients (relative risk, 2.301 [95% CI, 0.778-6.802]). Baseline infarct volume predicted incident HT (odds ratio, 1.07 [95% CI, 1.03-1.12]; P=0.0026). Incident covert infarcts on day 30 imaging occurred in 9/142 (6.3%) of dabigatran-assigned and 14/142 (9.8%) of aspirin-assigned patients (relative risk, 0.62 [95% CI, 0.26, 1.48]). Conclusions- Dabigatran was associated with a risk of HT similar to aspirin in acute minor noncardioembolic ischemic stroke/transient ischemic attack. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT02295826.
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Affiliation(s)
- Ken S Butcher
- From the Division of Neurology, University of Alberta, Edmonton, Canada (K.S.B., A.C.K., B.B., L.S., M.S.).,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia (K.S.B.)
| | - Kelvin Ng
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada (M.S., K.N., J.M., T.S.F., J.M., R.G.H)
| | | | - Thalia S Field
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada (M.S., K.N., J.M., T.S.F., J.M., R.G.H).,University of British Columbia, Vancouver, Canada (T.S.F., O.R.B.)
| | - Shelagh B Coutts
- Department of Clinical Neuroscience, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, AB, Canada (S.B.C., M.D.H.)
| | - Muzzafar Siddiqui
- From the Division of Neurology, University of Alberta, Edmonton, Canada (K.S.B., A.C.K., B.B., L.S., M.S.)
| | | | - Brian Buck
- From the Division of Neurology, University of Alberta, Edmonton, Canada (K.S.B., A.C.K., B.B., L.S., M.S.)
| | - Michael D Hill
- Department of Clinical Neuroscience, Radiology, and Community Health Sciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, AB, Canada (S.B.C., M.D.H.)
| | - Jodi Miller
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada (M.S., K.N., J.M., T.S.F., J.M., R.G.H)
| | - Ana C Klahr
- From the Division of Neurology, University of Alberta, Edmonton, Canada (K.S.B., A.C.K., B.B., L.S., M.S.)
| | - Leka Sivakumar
- From the Division of Neurology, University of Alberta, Edmonton, Canada (K.S.B., A.C.K., B.B., L.S., M.S.)
| | | | - Robert G Hart
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada (M.S., K.N., J.M., T.S.F., J.M., R.G.H)
| | - Mike Sharma
- From the Division of Neurology, University of Alberta, Edmonton, Canada (K.S.B., A.C.K., B.B., L.S., M.S.).,Population Health Research Institute, McMaster University, Hamilton, ON, Canada (M.S., K.N., J.M., T.S.F., J.M., R.G.H)
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50
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Cucchiara B, Elm J, Easton JD, Coutts SB, Willey JZ, Biros MH, Ross MA, Johnston SC. Disability After Minor Stroke and Transient Ischemic Attack in the POINT Trial. Stroke 2020; 51:792-799. [PMID: 32078486 DOI: 10.1161/strokeaha.119.027465] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 11/16/2022]
Abstract
Background and Purpose- While combination aspirin and clopidogrel reduces recurrent stroke compared with aspirin alone in patients with transient ischemic attack (TIA) or minor stroke, the effect on disability is uncertain. Methods- The POINT trial (Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke) randomized patients with TIA or minor stroke (National Institutes of Health Stroke Scale score ≤3) within 12 hours of onset to dual antiplatelet therapy (DAPT) with aspirin plus clopidogrel versus aspirin alone. The primary outcome measure was a composite of stroke, myocardial infarction, or vascular death. We performed a post hoc exploratory analysis to examine the effect of treatment on overall disability (defined as modified Rankin Scale score >1) at 90 days, as well as disability ascribed by the local investigator to index or recurrent stroke. We also evaluated predictors of disability. Results- At 90 days, 188 of 1964 (9.6%) of patients enrolled with TIA and 471 of 2586 (18.2%) of those enrolled with stroke were disabled. Overall disability was similar between patients assigned DAPT versus aspirin alone (14.7% versus 14.3%; odds ratio, 0.97 [95% CI, 0.82-1.14]; P=0.69). However, there were numerically fewer patients with disability in conjunction with a primary outcome event in the DAPT arm (3.0% versus 4.0%; odds ratio, 0.73 [95% CI, 0.53-1.01]; P=0.06) and significantly fewer patients in the DAPT arm with disability attributed by the investigators to either the index event or recurrent stroke (5.9% versus 7.4%; odds ratio, 0.78 [95% CI, 0.62-0.99]; P=0.04). Notably, disability attributed to the index event accounted for the majority of this difference (4.5% versus 6.0%; odds ratio, 0.74 [95% CI, 0.57-0.96]; P=0.02). In multivariate analysis, age, subsequent ischemic stroke, serious adverse events, and major bleeding were significantly associated with disability in TIA; for those with stroke, female sex, hypertension, or diabetes mellitus, National Institutes of Health Stroke Scale score, recurrent ischemic stroke, subsequent myocardial infarction, and serious adverse events were associated with disability. Conclusions- In addition to reducing recurrent stroke in patients with acute minor stroke and TIA, DAPT might reduce stroke-related disability. Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT00991029.
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Affiliation(s)
- Brett Cucchiara
- From the Department of Neurology, University of Pennsylvania, Philadelphia (B.C.)
| | - Jordan Elm
- Data Coordination Unit, Department of Public Health Sciences, Medical University of South Carolina, Charleston (J.E.)
| | - J Donald Easton
- Department of Neurology, University of California, San Francisco (J.D.E.)
| | - Shelagh B Coutts
- Department of Clinical Neurosciences, Radiology and Community Health Sciences, University of Calgary, Hotchkiss Brain Institute, AB, Canada (S.B.C.)
| | - Joshua Z Willey
- Department of Neurology, Columbia University, New York, NY (J.Z.W.)
| | - Michelle H Biros
- Emergency Medicine, University of Minnesota, Minneapolis (M.H.B.)
| | - Michael A Ross
- Department of Neurology, Emory University, Atlanta, GA (M.A.R.)
| | - S Claiborne Johnston
- Emergency Medicine Dean's Office, Dell Medical School, University of Texas-Austin (S.C.J.)
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