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Walter J, Alhalabi OT, Schönenberger S, Ringleb P, Vollherbst DF, Möhlenbruch M, Unterberg A, Neumann JO. Prior Thrombectomy Does Not Affect the Surgical Complication Rate of Decompressive Hemicraniectomy in Patients with Malignant Ischemic Stroke. Neurocrit Care 2024; 40:698-706. [PMID: 37639204 PMCID: PMC10959817 DOI: 10.1007/s12028-023-01820-3] [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: 03/15/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Even though mechanical recanalization techniques have dramatically improved acute stroke care since the pivotal trials of decompressive hemicraniectomy for malignant courses of ischemic stroke, decompressive hemicraniectomy remains a mainstay of malignant stroke treatment. However, it is still unclear whether prior thrombectomy, which in most cases is associated with application of antiplatelets and/or anticoagulants, affects the surgical complication rate of decompressive hemicraniectomy and whether conclusions derived from prior trials of decompressive hemicraniectomy are still valid in times of modern stroke care. METHODS A total of 103 consecutive patients who received a decompressive hemicraniectomy for malignant middle cerebral artery infarction were evaluated in this retrospective cohort study. Surgical and functional outcomes of patients who had received mechanical recanalization before surgery (thrombectomy group, n = 49) and of patients who had not received mechanical recanalization (medical group, n = 54) were compared. RESULTS The baseline characteristics of the two groups did significantly differ regarding preoperative systemic thrombolysis (63.3% in the thrombectomy group vs. 18.5% in the medical group, p < 0.001), the rate of hemorrhagic transformation (44.9% vs. 24.1%, p = 0.04) and the preoperative Glasgow Coma Score (median of 7 in the thrombectomy group vs. 12 in the medical group, p = 0.04) were similar to those of prior randomized controlled trials of decompressive hemicraniectomy. There was no significant difference in the rates of surgical complications (10.2% in the thrombectomy group vs. 11.1% in the medical group), revision surgery within the first 30 days after surgery (4.1% vs. 5.6%, respectively), and functional outcome (median modified Rankin Score of 4 at 5 and 14 months in both groups) between the two groups. CONCLUSIONS A prior mechanical recanalization with possibly associated systemic thrombolysis does not affect the early surgical complication rate and the functional outcome after decompressive hemicraniectomy for malignant ischemic stroke. Patient characteristics have not changed significantly since the introduction of mechanical recanalization; therefore, the results from former large randomized controlled trials are still valid in the modern era of stroke care.
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Affiliation(s)
- Johannes Walter
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - O T Alhalabi
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - S Schönenberger
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - P Ringleb
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - D F Vollherbst
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - M Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - A Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - J-O Neumann
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
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Fisch U, von Felten S, Wiencierz A, Jansen O, Howard G, Hendrikse J, Halliday A, Fraedrich G, Eckstein HH, Calvet D, Bulbulia R, Becquemin JP, Algra A, Rothwell P, Ringleb P, Mas JL, Brown M, Brott T, Bonati L. Risk of Stroke before Revascularisation in Patients with Symptomatic Carotid Stenosis: A Pooled Analysis of Randomised Controlled Trials. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Yu WM, Abdul-Rahim AH, Cameron AC, Kõrv J, Sevcik P, Toni D, Lees KR, Wahlgren N, Ahmed N, Caso V, Roffe C, Kobayashi A, Tsivgoulis G, Toni D, Ford G, Lees K, Ringleb P. The Incidence and Associated Factors of Early Neurological Deterioration After Thrombolysis. Stroke 2020; 51:2705-2714. [DOI: 10.1161/strokeaha.119.028287] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background and purpose:
Early neurological deterioration (END) after stroke onset may predict severe outcomes. Estimated rates of END after intravenous thrombolysis among small patient samples have been reported up to 29.8%. We studied the incidence and factors associated with END among patients following intravenous thrombolysis.
Methods:
We analyzed SITS-International Stroke Thrombolysis registry patients with known outcomes enrolled in 2010 to 2017. END was defined as an increase in National Institutes of Health Stroke Scale score ≥4 or death within 24 hours from baseline National Institutes of Health Stroke Scale. We determined the incidence of END and used logistic regression models to inspect its associated factors. We adjusted for variables found significant in univariate analyses (
P
<0.05). Main outcomes were incidence of END, associated predictors of END, ordinal day-90 mRS, and day-90 mortality.
Results:
We excluded 53 539 patients and included 50 726 patients. The incidence of END was 3415/50 726 (6.7% [95% CI, 6.5%–7.0%]). Factors independently associated with END on multivariate analysis were intracerebral hemorrhage (OR, 3.23 [95% CI, 2.96–3.54],
P
<0.001), large vessel disease (LVD) with carotid stenosis (OR, 2.97 [95% CI, 2.45–3.61],
P
<0.001), other LVD (OR, 2.41 [95% CI, 2.03–2.88],
P
<0.001), and ischemic stroke versus transient ischemic attack (TIA)/stroke mimics (OR, 16.14 [95% CI, 3.99–65.3],
P
<0.001). END was associated with worse outcome on ordinal mRS: adjusted OR 2.48 (95% CI, 2.39–2.57,
P
<0.001) by day-90 compared with no END. The adjusted OR for day-90 mortality was 9.70 (95% CI, 8.36–11.26,
P
<0.001).
Conclusions:
The routinely observed rate of END reflected by real-world data is low, but END greatly increases risk of disability and mortality. Readily identifiable factors predict END and may help with understanding causal mechanisms to assist prevention of END.
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Affiliation(s)
- Wai M. Yu
- Institute of Cardiovascular and Medical Sciences (W.M.Y., A.C.C.), University of Glasgow, United Kingdom
| | - Azmil H. Abdul-Rahim
- Institute of Neuroscience and Psychology (A.H.A.-R.), University of Glasgow, United Kingdom
| | - Alan C. Cameron
- Institute of Cardiovascular and Medical Sciences (W.M.Y., A.C.C.), University of Glasgow, United Kingdom
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, Institute of Clinical Medicine, University of Tartu, Estonia (J.K.)
| | - Petr Sevcik
- Department of Neurology, Faculty of Medicine in Pilsen-Charles University (P.S.)
- Department of Neurology-University Hospital Pilsen, Plzen, Czech Republic (P.S.)
| | - Danilo Toni
- Department of Human Neurosciences, University La Sapienza, Rome, Italy (D.T.)
| | - Kennedy R. Lees
- School of Medicine, Dentistry and Nursing (K.R.L.), University of Glasgow, United Kingdom
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Ungerer MN, Ringleb P, Reuter B, Stock C, Ippen F, Hyrenbach S, Bruder I, Martus P, Gumbinger C, Schabet M, Schoser K, Daffertshofer M, Neumaier S, Sorge R, Drewitz E, Hyrenbach S. Stroke unit admission is associated with better outcome and lower mortality in patients with intracerebral hemorrhage. Eur J Neurol 2020; 27:825-832. [DOI: 10.1111/ene.14164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 02/03/2020] [Indexed: 11/29/2022]
Affiliation(s)
- M. N. Ungerer
- Department of Neurology University Hospital Heidelberg Heidelberg
| | - P. Ringleb
- Department of Neurology University Hospital Heidelberg Heidelberg
| | | | - C. Stock
- Institute of Medical Biometry and Informatics (IMBI) University of Heidelberg Heidelberg
| | - F. Ippen
- Department of Neurology University Hospital Heidelberg Heidelberg
| | - S. Hyrenbach
- Qualitätssicherung im Gesundheitswesen Baden‐Wuerttemberg (GeQiK Baden‐Wuerttemberg) Stuttgart
| | - I. Bruder
- Qualitätssicherung im Gesundheitswesen Baden‐Wuerttemberg (GeQiK Baden‐Wuerttemberg) Stuttgart
| | - P Martus
- Institute for Clinical Epidemiology and Applied Biometry University of Tuebingen Tuebingen Germany
| | - C. Gumbinger
- Department of Neurology University Hospital Heidelberg Heidelberg
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5
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Berberich A, Schneider C, Herweh C, Hielscher T, Reiff T, Bendszus M, Gumbinger C, Ringleb P. Risk factors associated with progressive lacunar strokes and benefit from dual antiplatelet therapy. Eur J Neurol 2020; 27:817-824. [PMID: 31994783 DOI: 10.1111/ene.14159] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/22/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Early neurological deterioration (END) occurs in 20%-30% of patients with lacunar stroke and challenges their clinical management. This retrospective cohort study analyzed clinical and neuroimaging risk factors predicting the occurrence of END, the functional outcome after END and potential benefit from dual antiplatelet therapy (DAPT) in patients with lacunar strokes. METHODS Factors associated with END and benefit from DAPT were retrospectively analyzed in 308 patients with lacunar stroke symptoms and detected lacunar infarction by magnetic resonance imaging. END was defined by deterioration of ≥3 total National Institutes of Health Stroke Scale (NIHSS) points, ≥2 NIHSS points for limb paresis or documented deterioration within 5 days after admission. Patients were treated with DAPT according to in-house standards. The primary efficacy end-point for functional outcome was fulfilled if NIHSS at discharge improved after END at least to the score at admission. RESULTS Male gender [odds ratio (OR) 2.08; 95% confidence interval (CI) 1.09-4.00], higher age (OR = 1.65 per 10 years; 95% CI 1.18-2.31), motor paresis (OR = 18.89, 95% CI 4.66-76.57) and infarction of the internal capsule or basal ganglia (OR = 3.58, 95% CI 1.26-10.14) were associated with an increased risk for END. A larger diameter of infarction (OR = 0.85, 95% CI 0.76-0.95), more microangiopathic lesions (OR = 0.75, 95% CI 0.57-0.99) and pontine localization (OR = 0.29, 95% CI 0.12-0.65) were factors associated with unfavorable functional outcome after END occurred. Localization in the internal capsule or basal ganglia was identified as a significant predictive factor for a benefit from DAPT after END. CONCLUSIONS Identified clinical and neuroimaging factors predicting END occurrence, functional outcome after END and potential benefit from DAPT might improve the clinical management of patients with lacunar strokes.
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Affiliation(s)
- A Berberich
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - C Schneider
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - C Herweh
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - T Hielscher
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - T Reiff
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - M Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - C Gumbinger
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - P Ringleb
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
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Román LS, Menon BK, Blasco J, Hernández-Pérez M, Dávalos A, Majoie CBLM, Campbell BCV, Guillemin F, Lingsma H, Anxionnat R, Epstein J, Saver JL, Marquering H, Wong JH, Lopes D, Reimann G, Desal H, Dippel DWJ, Coutts S, du Mesnil de Rochemont R, Yavagal D, Ferre JC, Roos YBWEM, Liebeskind DS, Lenthall R, Molina C, Al Ajlan FS, Reddy V, Dowlatshahi D, Sourour NA, Oppenheim C, Mitha AP, Davis SM, Weimar C, van Oostenbrugge RJ, Cobo E, Kleinig TJ, Donnan GA, van der Lugt A, Demchuk AM, Berkhemer OA, Boers AMM, Ford GA, Muir KW, Brown BS, Jovin T, van Zwam WH, Mitchell PJ, Hill MD, White P, Bracard S, Goyal M, Berkhemer OA, Fransen PSS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJH, van Walderveen MAA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle J, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach Z, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, Zech M, Kowarik M, Seifert C, Schwaiger B, Puri A, Hou S, Wakhloo A, Moonis M, Henniger N, Goddeau R, van den Berg R, Massari F, Minaeian A, Lozano JD, Ramzan M, Stout C, Patel A, Tunguturi A, Onteddu S, Carandang R, Howk M, Koudstaal PJ, Ribó M, Sanjuan E, Rubiera M, Pagola J, Flores A, Muchada M, Meler P, Huerga E, Gelabert S, Coscojuela P, van Zwam WH, Tomasello A, Rodriguez D, Santamarina E, Maisterra O, Boned S, Seró L, Rovira A, Molina CA, Millán M, Muñoz L, Roos YB, Pérez de la Ossa N, Gomis M, Dorado L, López-Cancio E, Palomeras E, Munuera J, García Bermejo P, Remollo S, Castaño C, García-Sort R, van der Lugt A, Cuadras P, Puyalto P, Hernández-Pérez M, Jiménez M, Martínez-Piñeiro A, Lucente G, Dávalos A, Chamorro A, Urra X, Obach V, van Oostenbrugge RJ, Cervera A, Amaro S, Llull L, Codas J, Balasa M, Navarro J, Ariño H, Aceituno A, Rudilosso S, Renu A, Majoie CB, Macho JM, San Roman L, Blasco J, López A, Macías N, Cardona P, Quesada H, Rubio F, Cano L, Lara B, Dippel DW, de Miquel MA, Aja L, Serena J, Cobo E, Albers GW, Lees KR, Arenillas J, Roberts R, Minhas P, Al-Ajlan F, Brown MM, Salluzzi M, Zimmel L, Patel S, Eesa M, Martí-Fàbregas J, Jankowitz B, Serena J, Salvat-Plana M, López-Cancio E, Bracard S, Liebig T, Ducrocq X, Anxionnat R, Baillot PA, Barbier C, Derelle AL, Lacour JC, Richard S, Samson Y, Sourour N, Baronnet-Chauvet F, Stijnen T, Clarencon F, Crozier S, Deltour S, Di Maria F, Le Bouc R, Leger A, Mutlu G, Rosso C, Szatmary Z, Yger M, Andersson T, Zavanone C, Bakchine S, Pierot L, Caucheteux N, Estrade L, Kadziolka K, Leautaud A, Renkes C, Serre I, Desal H, Mattle H, Guillon B, Boutoleau-Bretonniere C, Daumas-Duport B, De Gaalon S, Derkinderen P, Evain S, Herisson F, Laplaud DA, Lebouvier T, Lintia-Gaultier A, Wahlgren N, Pouclet-Courtemanche H, Rouaud T, Rouaud Jaffrenou V, Schunck A, Sevin-Allouet M, Toulgoat F, Wiertlewski S, Gauvrit JY, Ronziere T, Cahagne V, van der Heijden E, Ferre JC, Pinel JF, Raoult H, Mas JL, Meder JF, Al Najjar-Carpentier AA, Birchenall J, Bodiguel E, Calvet D, Domigo V, Ghannouti N, Godon-Hardy S, Guiraud V, Lamy C, Majhadi L, Morin L, Naggara O, Trystram D, Turc G, Berge J, Sibon I, Fleitour N, Menegon P, Barreau X, Rouanet F, Debruxelles S, Kazadi A, Renou P, Fleury O, Pasco-Papon A, Dubas F, Caroff J, Hooijenga I, Godard Ducceschi S, Hamon MA, Lecluse A, Marc G, Giroud M, Ricolfi F, Bejot Y, Chavent A, Gentil A, Kazemi A, Puppels C, Osseby GV, Voguet C, Mahagne MH, Sedat J, Chau Y, Suissa L, Lachaud S, Houdart E, Stapf C, Buffon Porcher F, Pellikaan W, Chabriat H, Guedin P, Herve D, Jouvent E, Mawet J, Saint-Maurice JP, Schneble HM, Turjman F, Nighoghossian N, Berhoune NN, Geerling A, Bouhour F, Cho TH, Derex L, Felix S, Gervais-Bernard H, Gory B, Manera L, Mechtouff L, Ritzenthaler T, Riva R, Lindl-Velema A, Salaris Silvio F, Tilikete C, Blanc R, Obadia M, Bartolini MB, Gueguen A, Piotin M, Pistocchi S, Redjem H, Drouineau J, van Vemde G, Neau JP, Godeneche G, Lamy M, Marsac E, Velasco S, Clavelou P, Chabert E, Bourgois N, Cornut-Chauvinc C, Ferrier A, de Ridder A, Gabrillargues J, Jean B, Marques AR, Vitello N, Detante O, Barbieux M, Boubagra K, Favre Wiki I, Garambois K, Tahon F, Greebe P, Ashok V, Voguet C, Coskun O, Guedin P, Rodesch G, Lapergue B, Bourdain F, Evrard S, Graveleau P, Decroix JP, de Bont-Stikkelbroeck J, Wang A, Sellal F, Ahle G, Carelli G, Dugay MH, Gaultier C, Lebedinsky AP, Lita L, Musacchio RM, Renglewicz-Destuynder C, de Meris J, Tournade A, Vuillemet F, Montoro FM, Mounayer C, Faugeras F, Gimenez L, Labach C, Lautrette G, Denier C, Saliou G, Janssen K, Chassin O, Dussaule C, Melki E, Ozanne A, Puccinelli F, Sachet M, Sarov M, Bonneville JF, Moulin T, Biondi A, Struijk W, De Bustos Medeiros E, Vuillier F, Courtheoux P, Viader F, Apoil-Brissard M, Bataille M, Bonnet AL, Cogez J, Kazemi A, Touze E, Licher S, Leclerc X, Leys D, Aggour M, Aguettaz P, Bodenant M, Cordonnier C, Deplanque D, Girot M, Henon H, Kalsoum E, Boodt N, Lucas C, Pruvo JP, Zuniga P, Bonafé A, Arquizan C, Costalat V, Machi P, Mourand I, Riquelme C, Bounolleau P, Ros A, Arteaga C, Faivre A, Bintner M, Tournebize P, Charlin C, Darcel F, Gauthier-Lasalarie P, Jeremenko M, Mouton S, Zerlauth JB, Venema E, Lamy C, Hervé D, Hassan H, Gaston A, Barral FG, Garnier P, Beaujeux R, Wolff V, Herbreteau D, Debiais S, Slokkers I, Murray A, Ford G, Muir KW, White P, Brown MM, Clifton A, Freeman J, Ford I, Markus H, Wardlaw J, Ganpat RJ, Lees KR, Molyneux A, Robinson T, Lewis S, Norrie J, Robertson F, Perry R, Dixit A, Cloud G, Clifton A, Mulder M, Madigan J, Roffe C, Nayak S, Lobotesis K, Smith C, Herwadkar A, Kandasamy N, Goddard T, Bamford J, Subramanian G, Saiedie N, Lenthall R, Littleton E, Lamin S, Storey K, Ghatala R, Banaras A, Aeron-Thomas J, Hazel B, Maguire H, Veraque E, Heshmatollah A, Harrison L, Keshvara R, Cunningham J, Schipperen S, Vinken S, van Boxtel T, Koets J, Boers M, Santos E, Borst J, Jansen I, Kappelhof M, Lucas M, Geuskens R, Barros RS, Dobbe R, Csizmadia M, Hill MD, Goyal M, Demchuk AM, Menon BK, Eesa M, Ryckborst KJ, Wright MR, Kamal NR, Andersen L, Randhawa PA, Stewart T, Patil S, Minhas P, Almekhlafi M, Mishra S, Clement F, Sajobi T, Shuaib A, Montanera WJ, Roy D, Silver FL, Jovin TG, Frei DF, Sapkota B, Rempel JL, Thornton J, Williams D, Tampieri D, Poppe AY, Dowlatshahi D, Wong JH, Mitha AP, Subramaniam S, Hull G, Lowerison MW, Sajobi T, Salluzzi M, Wright MR, Maxwell M, Lacusta S, Drupals E, Armitage K, Barber PA, Smith EE, Morrish WF, Coutts SB, Derdeyn C, Demaerschalk B, Yavagal D, Martin R, Brant R, Yu Y, Willinsky RA, Montanera WJ, Weill A, Kenney C, Aram H, Stewart T, Stys PK, Watson TW, Klein G, Pearson D, Couillard P, Trivedi A, Singh D, Klourfeld E, Imoukhuede O, Nikneshan D, Blayney S, Reddy R, Choi P, Horton M, Musuka T, Dubuc V, Field TS, Desai J, Adatia S, Alseraya A, Nambiar V, van Dijk R, Wong JH, Mitha AP, Morrish WF, Eesa M, Newcommon NJ, Shuaib A, Schwindt B, Butcher KS, Jeerakathil T, Buck B, Khan K, Naik SS, Emery DJ, Owen RJ, Kotylak TB, Ashforth RA, Yeo TA, McNally D, Siddiqui M, Saqqur M, Hussain D, Kalashyan H, Manosalva A, Kate M, Gioia L, Hasan S, Mohammad A, Muratoglu M, Williams D, Thornton J, Cullen A, Brennan P, O'Hare A, Looby S, Hyland D, Duff S, McCusker M, Hallinan B, Lee S, McCormack J, Moore A, O'Connor M, Donegan C, Brewer L, Martin A, Murphy S, O'Rourke K, Smyth S, Kelly P, Lynch T, Daly T, O'Brien P, O'Driscoll A, Martin M, Daly T, Collins R, Coughlan T, McCabe D, Murphy S, O'Neill D, Mulroy M, Lynch O, Walsh T, O'Donnell M, Galvin T, Harbison J, McElwaine P, Mulpeter K, McLoughlin C, Reardon M, Harkin E, Dolan E, Watts M, Cunningham N, Fallon C, Gallagher S, Cotter P, Crowe M, Doyle R, Noone I, Lapierre M, Coté VA, Lanthier S, Odier C, Durocher A, Raymond J, Weill A, Daneault N, Deschaintre Y, Jankowitz B, Baxendell L, Massaro L, Jackson-Graves C, Decesare S, Porter P, Armbruster K, Adams A, Billigan J, Oakley J, Ducruet A, Jadhav A, Giurgiutiu DV, Aghaebrahim A, Reddy V, Hammer M, Starr M, Totoraitis V, Wechsler L, Streib S, Rangaraju S, Campbell D, Rocha M, Gulati D, Silver FL, Krings T, Kalman L, Cayley A, Williams J, Stewart T, Wiegner R, Casaubon LK, Jaigobin C, del Campo JM, Elamin E, Schaafsma JD, Willinsky RA, Agid R, Farb R, ter Brugge K, Sapkoda BL, Baxter BW, Barton K, Knox A, Porter A, Sirelkhatim A, Devlin T, Dellinger C, Pitiyanuvath N, Patterson J, Nichols J, Quarfordt S, Calvert J, Hawk H, Fanale C, Frei DF, Bitner A, Novak A, Huddle D, Bellon R, Loy D, Wagner J, Chang I, Lampe E, Spencer B, Pratt R, Bartt R, Shine S, Dooley G, Nguyen T, Whaley M, McCarthy K, Teitelbaum J, Tampieri D, Poon W, Campbell N, Cortes M, Dowlatshahi D, Lum C, Shamloul R, Robert S, Stotts G, Shamy M, Steffenhagen N, Blacquiere D, Hogan M, AlHazzaa M, Basir G, Lesiuk H, Iancu D, Santos M, Choe H, Weisman DC, Jonczak K, Blue-Schaller A, Shah Q, MacKenzie L, Klein B, Kulandaivel K, Kozak O, Gzesh DJ, Harris LJ, Khoury JS, Mandzia J, Pelz D, Crann S, Fleming L, Hesser K, Beauchamp B, Amato-Marzialli B, Boulton M, Lopez-Ojeda P, Sharma M, Lownie S, Chan R, Swartz R, Howard P, Golob D, Gladstone D, Boyle K, Boulos M, Hopyan J, Yang V, Da Costa L, Holmstedt CA, Turk AS, Navarro R, Jauch E, Ozark S, Turner R, Phillips S, Shankar J, Jarrett J, Gubitz G, Maloney W, Vandorpe R, Schmidt M, Heidenreich J, Hunter G, Kelly M, Whelan R, Peeling L, Burns PA, Hunter A, Wiggam I, Kerr E, Watt M, Fulton A, Gordon P, Rennie I, Flynn P, Smyth G, O'Leary S, Gentile N, Linares G, McNelis P, Erkmen K, Katz P, Azizi A, Weaver M, Jungreis C, Faro S, Shah P, Reimer H, Kalugdan V, Saposnik G, Bharatha A, Li Y, Kostyrko P, Santos M, Marotta T, Montanera W, Sarma D, Selchen D, Spears J, Heo JH, Jeong K, Kim DJ, Kim BM, Kim YD, Song D, Lee KJ, Yoo J, Bang OY, Rho S, Lee J, Jeon P, Kim KH, Cha J, Kim SJ, Ryoo S, Lee MJ, Sohn SI, Kim CH, Ryu HG, Hong JH, Chang HW, Lee CY, Rha J, Davis SM, Donnan GA, Campbell BCV, Mitchell PJ, Churilov L, Yan B, Dowling R, Yassi N, Oxley TJ, Wu TY, Silver G, McDonald A, McCoy R, Kleinig TJ, Scroop R, Dewey HM, Simpson M, Brooks M, Coulton B, Krause M, Harrington TJ, Steinfort B, Faulder K, Priglinger M, Day S, Phan T, Chong W, Holt M, Chandra RV, Ma H, Young D, Wong K, Wijeratne T, Tu H, Mackay E, Celestino S, Bladin CF, Loh PS, Gilligan A, Ross Z, Coote S, Frost T, Parsons MW, Miteff F, Levi CR, Ang T, Spratt N, Kaauwai L, Badve M, Rice H, de Villiers L, Barber PA, McGuinness B, Hope A, Moriarty M, Bennett P, Wong A, Coulthard A, Lee A, Jannes J, Field D, Sharma G, Salinas S, Cowley E, Snow B, Kolbe J, Stark R, King J, Macdonnell R, Attia J, D'Este C, Saver JL, Goyal M, Diener HC, Levy EI, Bonafé A, Mendes Pereira V, Jahan R, Albers GW, Cognard C, Cohen DJ, 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M, Grande A, Hildebrandt D, Miller K, Scherber J, Hendrickson A, Jumaa M, Zaidi S, Hendrickson T, Snyder V, Killer-Oberpfalzer M, Mutzenbach J, Weymayr F, Broussalis E, Stadler K, Jedlitschka A, Malek A, Mueller-Kronast N, Beck P, Martin C, Summers D, Day J, Bettinger I, Holloway W, Olds K, Arkin S, Akhtar N, Boutwell C, Crandall S, Schwartzman M, Weinstein C, Brion B, Prothmann S, Kleine J, Kreiser K, Boeckh-Behrens T, Poppert H, Wunderlich S, Koch ML, Biberacher V, Huberle A, Gora-Stahlberg G, Knier B, Meindl T, Utpadel-Fischler D. Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data. Lancet Neurol 2018; 17:895-904. [DOI: 10.1016/s1474-4422(18)30242-4] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/29/2022]
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Ringleb P, Steiner T, Knaup P, Hacke W, Haux R, Brigl B. An Integrated Approach for a Knowledge-based Clinical Workstation: Architecture and Experience. Methods Inf Med 2018. [DOI: 10.1055/s-0038-1634492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Abstract:Today, the demand for medical decision support to improve the quality of patient care and to reduce costs in health services is generally recognized. Nevertheless, decision support is not yet established in daily routine within hospital information systems which often show a heterogeneous architecture but offer possibilities of interoperability. Currently, the integration of decision support functions into clinical workstations is the most promising way. Therefore, we first discuss aspects of integrating decision support into clinical workstations including clinical needs, integration of database and knowledge base, knowledge sharing and reuse and the role of standardized terminology. In addition, we draw up functional requirements to support the physician dealing with patient care, medical research and administrative tasks. As a consequence, we propose a general architecture of an integrated knowledge-based clinical workstation. Based on an example application we discuss our experiences concerning clinical applicability and relevance. We show that, although our approach promotes the integration of decision support into hospital information systems, the success of decision support depends above all on an adequate transformation of clinical needs.
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Campbell BCV, van Zwam WH, Goyal M, Menon BK, Dippel DWJ, Demchuk AM, Bracard S, White P, Dávalos A, Majoie CBLM, van der Lugt A, Ford GA, de la Ossa NP, Kelly M, Bourcier R, Donnan GA, Roos YBWEM, Bang OY, Nogueira RG, Devlin TG, van den Berg LA, Clarençon F, Burns P, Carpenter J, Berkhemer OA, Yavagal DR, Pereira VM, Ducrocq X, Dixit A, Quesada H, Epstein J, Davis SM, Jansen O, Rubiera M, Urra X, Micard E, Lingsma HF, Naggara O, Brown S, Guillemin F, Muir KW, van Oostenbrugge RJ, Saver JL, Jovin TG, Hill MD, Mitchell PJ, Berkhemer OA, Fransen PSS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJH, van Walderveen MAA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle J, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer 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Porter P, Armbruster K, Adams A, Billigan J, Oakley J, Ducruet A, Jadhav A, Giurgiutiu DV, Aghaebrahim A, Reddy V, Hammer M, Starr M, Totoraitis V, Wechsler L, Streib S, Rangaraju S, Campbell D, Rocha M, Gulati D, Silver FL, Krings T, Kalman L, Cayley A, Williams J, Stewart T, Wiegner R, Casaubon LK, Jaigobin C, del Campo JM, Elamin E, Schaafsma JD, Willinsky RA, Agid R, Farb R, ter Brugge K, Sapkoda BL, Baxter BW, Barton K, Knox A, Porter A, Sirelkhatim A, Devlin T, Dellinger C, Pitiyanuvath N, Patterson J, Nichols J, Quarfordt S, Calvert J, Hawk H, Fanale C, Frei DF, Bitner A, Novak A, Huddle D, Bellon R, Loy D, Wagner J, Chang I, Lampe E, Spencer B, Pratt R, Bartt R, Shine S, Dooley G, Nguyen T, Whaley M, McCarthy K, Teitelbaum J, Tampieri D, Poon W, Campbell N, Cortes M, Dowlatshahi D, Lum C, Shamloul R, Robert S, Stotts G, Shamy M, Steffenhagen N, Blacquiere D, Hogan M, AlHazzaa M, Basir G, Lesiuk H, Iancu D, Santos M, Choe H, Weisman DC, Jonczak K, Blue-Schaller A, Shah Q, MacKenzie L, Klein B, Kulandaivel K, Kozak O, Gzesh DJ, Harris LJ, Khoury JS, Mandzia J, Pelz D, Crann S, Fleming L, Hesser K, Beauchamp B, Amato-Marzialli B, Boulton M, Lopez- Ojeda P, Sharma M, Lownie S, Chan R, Swartz R, Howard P, Golob D, Gladstone D, Boyle K, Boulos M, Hopyan J, Yang V, Da Costa L, Holmstedt CA, Turk AS, Navarro R, Jauch E, Ozark S, Turner R, Phillips S, Shankar J, Jarrett J, Gubitz G, Maloney W, Vandorpe R, Schmidt M, Heidenreich J, Hunter G, Kelly M, Whelan R, Peeling L, Burns PA, Hunter A, Wiggam I, Kerr E, Watt M, Fulton A, Gordon P, Rennie I, Flynn P, Smyth G, O'Leary S, Gentile N, Linares G, McNelis P, Erkmen K, Katz P, Azizi A, Weaver M, Jungreis C, Faro S, Shah P, Reimer H, Kalugdan V, Saposnik G, Bharatha A, Li Y, Kostyrko P, Santos M, Marotta T, Montanera W, Sarma D, Selchen D, Spears J, Heo JH, Jeong K, Kim DJ, Kim BM, Kim YD, Song D, Lee KJ, Yoo J, Bang OY, Rho S, Lee J, Jeon P, Kim KH, Cha J, Kim SJ, Ryoo S, Lee MJ, Sohn SI, Kim CH, Ryu HG, Hong JH, Chang HW, Lee CY, Rha J, Davis SM, Donnan GA, Campbell BCV, Mitchell PJ, Churilov L, Yan B, Dowling R, Yassi N, Oxley TJ, Wu TY, Silver G, McDonald A, McCoy R, Kleinig TJ, Scroop R, Dewey HM, Simpson M, Brooks M, Coulton B, Krause M, Harrington TJ, Steinfort B, Faulder K, Priglinger M, Day S, Phan T, Chong W, Holt M, Chandra RV, Ma H, Young D, Wong K, Wijeratne T, Tu H, Mackay E, Celestino S, Bladin CF, Loh PS, Gilligan A, Ross Z, Coote S, Frost T, Parsons MW, Miteff F, Levi CR, Ang T, Spratt N, Kaauwai L, Badve M, Rice H, de Villiers L, Barber PA, McGuinness B, Hope A, Moriarty M, Bennett P, Wong A, Coulthard A, Lee A, Jannes J, Field D, Sharma G, Salinas S, Cowley E, Snow B, Kolbe J, Stark R, King J, Macdonnell R, Attia J, D'Este C, Saver JL, Goyal M, Diener HC, Levy EI, Bonafé A, Mendes Pereira V, Jahan R, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, von Kummer R, Smith W, Turjman F, Hamilton S, Chiacchierini R, Amar A, Sanossian N, Loh Y, Devlin T, Baxter B, Hawk H, Sapkota B, Quarfordt S, Sirelkhatim A, Dellinger C, Barton K, Reddy VK, Ducruet A, Jadhav A, Horev A, Giurgiutiu DV, Totoraitis V, Hammer M, Jankowitz B, Wechsler L, Rocha M, Gulati D, Campbell D, Star M, Baxendell L, Oakley J, Siddiqui A, Hopkins LN, Snyder K, Sawyer R, Hall S, Costalat V, Riquelme C, Machi P, Omer E, Arquizan C, Mourand I, Charif M, Ayrignac X, Menjot de Champfleur N, Leboucq N, Gascou G, Moynier M, du Mesnil de Rochemont R, Singer O, Berkefeld J, Foerch C, Lorenz M, Pfeilschifer W, Hattingen E, Wagner M, You SJ, Lescher S, Braun H, Dehkharghani S, Belagaje SR, Anderson A, Lima A, Obideen M, Haussen D, Dharia R, Frankel M, Patel V, Owada K, Saad A, Amerson L, Horn C, Doppelheuer S, Schindler K, Lopes DK, Chen M, Moftakhar R, Anton C, Smreczak M, Carpenter JS, Boo S, Rai A, Roberts T, Tarabishy A, Gutmann L, Brooks C, Brick J, Domico J, Reimann G, Hinrichs K, Becker M, Heiss E, Selle C, Witteler A, Al-Boutros S, Danch MJ, Ranft A, Rohde S, Burg K, Weimar C, Zegarac V, Hartmann C, Schlamann M, Göricke S, Ringlestein A, Wanke I, Mönninghoff C, Dietzold M, Budzik R, Davis T, Eubank G, Hicks WJ, Pema P, Vora N, Mejilla J, Taylor M, Clark W, Rontal A, Fields J, Peterson B, Nesbit G, Lutsep H, Bozorgchami H, Priest R, Ologuntoye O, Barnwell S, Dogan A, Herrick K, Takahasi C, Beadell N, Brown B, Jamieson S, Hussain MS, Russman A, Hui F, Wisco D, Uchino K, Khawaja Z, Katzan I, Toth G, Cheng-Ching E, Bain M, Man S, Farrag A, George P, John S, Shankar L, Drofa A, Dahlgren R, Bauer A, Itreat A, Taqui A, Cerejo R, Richmond A, Ringleb P, Bendszus M, Möhlenbruch M, Reiff T, Amiri H, Purrucker J, Herweh C, Pham M, Menn O, Ludwig I, Acosta I, Villar C, Morgan W, Sombutmai C, Hellinger F, Allen E, Bellew M, Gandhi R, Bonwit E, Aly J, Ecker RD, Seder D, Morris J, Skaletsky M, Belden J, Baker C, Connolly LS, Papanagiotou P, Roth C, Kastrup A, Politi M, Brunner F, Alexandrou M, Merdivan H, Ramsey C, Given II C, Renfrow S, Deshmukh V, Sasadeusz K, Vincent F, Thiesing JT, Putnam J, Bhatt A, Kansara A, Caceves D, Lowenkopf T, Yanase L, Zurasky J, Dancer S, Freeman B, Scheibe-Mirek T, Robison J, Rontal A, Roll J, Clark D, Rodriguez M, Fitzsimmons BFM, Zaidat O, Lynch JR, Lazzaro M, Larson T, Padmore L, Das E, Farrow-Schmidt A, Hassan A, Tekle W, Cate C, Jansen O, Cnyrim C, Wodarg F, Wiese C, Binder A, Riedel C, Rohr A, Lang N, Laufs H, Krieter S, Remonda L, Diepers M, Añon J, Nedeltchev K, Kahles T, Biethahn S, Lindner M, Chang V, Gächter C, Esperon C, Guglielmetti M, Arenillas Lara JF, Martínez Galdámez M, Calleja Sanz AI, Cortijo Garcia E, Garcia Bermejo P, Perez S, Mulero Carrillo P, Crespo Vallejo E, Ruiz Piñero M, Lopez Mesonero L, Reyes Muñoz FJ, Brekenfeld C, Buhk JH, Krützelmann A, Thomalla G, Cheng B, Beck C, Hoppe J, Goebell E, Holst B, Grzyska U, Wortmann G, Starkman S, Duckwiler G, Jahan R, Rao N, Sheth S, Ng K, Noorian A, Szeder V, Nour M, McManus M, Huang J, Tarpley J, Tateshima S, Gonzalez N, Ali L, Liebeskind D, Hinman J, Calderon-Arnulphi M, Liang C, Guzy J, Koch S, DeSousa K, Gordon-Perue G, Haussen D, Elhammady M, Peterson E, Pandey V, Dharmadhikari S, Khandelwal P, Malik A, Pafford R, Gonzalez P, Ramdas K, Andersen G, Damgaard D, Von Weitzel-Mudersbach P, Simonsen C, Ruiz de Morales Ayudarte N, Poulsen M, Sørensen L, Karabegovich S, Hjørringgaard M, Hjort N, Harbo T, Sørensen K, Deshaies E, Padalino D, Swarnkar A, Latorre JG, Elnour E, El-Zammar Z, Villwock M, Farid H, Balgude A, Cross L, Hansen K, Holtmannspötter M, Kondziella D, Hoejgaard J, Taudorf S, Soendergaard H, Wagner A, Cronquist M, Stavngaard T, Cortsen M, Krarup LH, Hyldal T, Haring HP, Guggenberger S, Hamberger M, Trenkler J, Sonnberger M, Nussbaumer K, Dominger C, Bach E, Jagadeesan BD, Taylor R, Kim J, Shea K, Tummala R, Zacharatos H, Sandhu D, Ezzeddine M, Grande A, Hildebrandt D, Miller K, Scherber J, Hendrickson A, Jumaa M, Zaidi S, Hendrickson T, Snyder V, Killer-Oberpfalzer M, Mutzenbach J, Weymayr F, Broussalis E, Stadler K, Jedlitschka A, Malek A, Mueller-Kronast N, Beck P, Martin C, Summers D, Day J, Bettinger I, Holloway W, Olds K, Arkin S, Akhtar N, Boutwell C, Crandall S, Schwartzman M, Weinstein C, Brion B, Prothmann S, Kleine J, Kreiser K, Boeckh-Behrens T, Poppert H, Wunderlich S, Koch ML, Biberacher V, Huberle A, Gora-Stahlberg G, Knier B, Meindl T, Utpadel-Fischler D, Zech M, Kowarik M, Seifert C, Schwaiger B, Puri A, Hou S. Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data. Lancet Neurol 2018; 17:47-53. [DOI: 10.1016/s1474-4422(17)30407-6] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/05/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
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Rantner B, Kollerits B, Roubin G, Ringleb P, Jansen O, Howard G. Early Endarterectomy Carries a Lower Procedural Risk Than Early Stenting in Patients With Symptomatic Stenosis of the Internal Carotid Artery. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.07.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kumar R, Batchelder A, Saratzis A, AbuRahma A, Ringleb P, Lal B, Mas J, Steinbauer M, Naylor A. Restenosis after Carotid Interventions and Its Relationship with Recurrent Ipsilateral Stroke: A Systematic Review and Meta-analysis. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Möhlenbruch M, Pfaff J, Schönenberger S, Nagel S, Bösel J, Herweh C, Ringleb P, Bendszus M, Stampfl S. Endovascular Stroke Treatment of Nonagenarians. AJNR Am J Neuroradiol 2016; 38:299-303. [PMID: 27789451 DOI: 10.3174/ajnr.a4976] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/19/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Although endovascular treatment has become a standard therapy in patients with acute stroke, the benefit for very old patients remains uncertain. The purpose of this study was the evaluation of procedural and outcome data of patients ≥90 years undergoing endovascular stroke treatment. MATERIALS AND METHODS We retrospectively analyzed prospectively collected data of patients ≥90 years in whom endovascular stroke treatment was performed between January 2011 and January 2016. Recanalization was assessed according to the TICI score. The clinical condition was evaluated on admission (NIHSS, prestroke mRS), at discharge (NIHSS), and after 3 months (mRS). RESULTS Twenty-nine patients met the inclusion criteria for this analysis. The median prestroke mRS was 2. Successful recanalization (TICI ≥ 2b) was achieved in 22 patients (75.9%). In 9 patients, an NIHSS improvement ≥ 10 points was noted between admission and discharge. After 3 months, 17.2% of the patients had an mRS of 0-2 or exhibited prestroke mRS, and 24.1% achieved mRS 0-3. Mortality rate was 44.8%. There was only 1 minor procedure-related complication (small SAH without clinical sequelae). CONCLUSIONS Despite high mortality rates and only moderate overall outcome, 17.2% of the patients achieved mRS 0-2 or prestroke mRS, and no serious procedure-related complications occurred. Therefore, very high age should not per se be an exclusion criterion for endovascular stroke treatment.
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Affiliation(s)
- M Möhlenbruch
- From the Departments of Neuroradiology (M.M., J.P., C.H., M.B., S. Stampfl)
| | - J Pfaff
- From the Departments of Neuroradiology (M.M., J.P., C.H., M.B., S. Stampfl)
| | - S Schönenberger
- Neurology (S. Schönenberger, S.N., J.B., P.R.), University Hospital Heidelberg, Heidelberg, Germany
| | - S Nagel
- Neurology (S. Schönenberger, S.N., J.B., P.R.), University Hospital Heidelberg, Heidelberg, Germany
| | - J Bösel
- Neurology (S. Schönenberger, S.N., J.B., P.R.), University Hospital Heidelberg, Heidelberg, Germany
| | - C Herweh
- From the Departments of Neuroradiology (M.M., J.P., C.H., M.B., S. Stampfl)
| | - P Ringleb
- Neurology (S. Schönenberger, S.N., J.B., P.R.), University Hospital Heidelberg, Heidelberg, Germany
| | - M Bendszus
- From the Departments of Neuroradiology (M.M., J.P., C.H., M.B., S. Stampfl)
| | - S Stampfl
- From the Departments of Neuroradiology (M.M., J.P., C.H., M.B., S. Stampfl)
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Perera KS, Vanassche T, Bosch J, Swaminathan B, Mundl H, Giruparajah M, Barboza MA, O’Donnell MJ, Gomez-Schneider M, Hankey GJ, Yoon BW, Roxas A, Lavallee P, Sargento-Freitas J, Shamalov N, Brouns R, Gagliardi RJ, Kasner SE, Pieroni A, Vermehren P, Kitagawa K, Wang Y, Muir K, Coutinho JM, Connolly SJ, Hart RG, Czeto K, Kahn M, Mattina K, Ameriso S, Pujol-Lereis V, Hawkes M, Pertierra L, Perera N, De Smedt A, Van Dyck R, Van Hooff R, Yperzeele L, Gagliardi V, Cerqueir L, Yang X, Chen W, Amarenco P, Guidoux C, Ringleb P, Bereczki D, Vastagh I, Canavan M, Toni D, Anzini A, Colosimo C, De Michele M, Di Mascio M, Durastanti L, Falcou A, Fausti S, Mancini A, Mizumo S, Uchiyama S, Kim C, Jung S, Kim Y, Kim J, Jo J, Arauz A, Quiroz-Compean A, Colin J, Nederkoorn P, Marianito V, Cunha L, Santo G, Silva F, Coelho J, Kustova M, Meshkova K, Williams G, Siegler J, Zhang C, Gallatti N, Kruszewski M. Global Survey of the Frequency of Atrial Fibrillation–Associated Stroke. Stroke 2016; 47:2197-202. [DOI: 10.1161/strokeaha.116.013378] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/27/2016] [Indexed: 12/22/2022]
Abstract
Background and Purpose—
Atrial fibrillation (AF) is increasingly recognized as the single most important cause of disabling ischemic stroke in the elderly. We undertook an international survey to characterize the frequency of AF-associated stroke, methods of AF detection, and patient features.
Methods—
Consecutive patients hospitalized for ischemic stroke in 2013 to 2014 were surveyed from 19 stroke research centers in 19 different countries. Data were analyzed by global regions and World Bank income levels.
Results—
Of 2144 patients with ischemic stroke, 590 (28%; 95% confidence interval, 25.6–29.5) had AF-associated stroke, with highest frequencies in North America (35%) and Europe (33%) and lowest in Latin America (17%). Most had a history of AF before stroke (15%) or newly detected AF on electrocardiography (10%); only 2% of patients with ischemic stroke had unsuspected AF detected by poststroke cardiac rhythm monitoring. The mean age and 30-day mortality rate of patients with AF-associated stroke (75 years; SD, 11.5 years; 10%; 95% confidence interval, 7.6–12.6, respectively) were substantially higher than those of patients without AF (64 years; SD, 15.58 years; 4%; 95% confidence interval, 3.3–5.4;
P
<0.001 for both comparisons). There was a strong positive correlation between the mean age and the frequency of AF (
r
=0.76;
P
=0.0002).
Conclusions—
This cross-sectional global sample of patients with recent ischemic stroke shows a substantial frequency of AF-associated stroke throughout the world in proportion to the mean age of the stroke population. Most AF is identified by history or electrocardiography; the yield of conventional short-duration cardiac rhythm monitoring is relatively low. Patients with AF-associated stroke were typically elderly (>75 years old) and more often women.
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Affiliation(s)
- Kanjana S. Perera
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Thomas Vanassche
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Jackie Bosch
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Balakumar Swaminathan
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Hardi Mundl
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Mohana Giruparajah
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Miguel A. Barboza
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Martin J. O’Donnell
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Maia Gomez-Schneider
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Graeme J. Hankey
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Byung-Woo Yoon
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Artemio Roxas
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Philippa Lavallee
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Joao Sargento-Freitas
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Nikolay Shamalov
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Raf Brouns
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Rubens J. Gagliardi
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Scott E. Kasner
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Alessio Pieroni
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Philipp Vermehren
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Kazuo Kitagawa
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Yongjun Wang
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Keith Muir
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Jonathan M. Coutinho
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Stuart J. Connolly
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - Robert G. Hart
- From the Population Health Research Institute, McMaster University, Hamilton Health Sciences, Ontario, Canada (K.S.P., J.B., B.S., M.G., S.J.C., R.G.H.); Department of Cardiovascular Sciences, University of Leuven, Belgium (T.V.); Bayer-Pharma AG, Wuppertal, Germany (H.M.); Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico (M.A.B.); University of Galway, Ireland (M.J.O.); Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la
| | - K. Czeto
- Population Health Research Institute (Coordinating Center), Hamilton, Ontario, Canada
| | - M. Kahn
- Population Health Research Institute (Coordinating Center), Hamilton, Ontario, Canada
| | - K.R. Mattina
- Population Health Research Institute (Coordinating Center), Hamilton, Ontario, Canada
| | - S.F. Ameriso
- Institute for Neurological Research, Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLENI), Buenos Aires, Argentina
| | - V. Pujol-Lereis
- Institute for Neurological Research, Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLENI), Buenos Aires, Argentina
| | - M. Hawkes
- Institute for Neurological Research, Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLENI), Buenos Aires, Argentina
| | - L. Pertierra
- Institute for Neurological Research, Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia (FLENI), Buenos Aires, Argentina
| | - N. Perera
- School of Medicine & Pharmacology, University of Western Australia and Sir Charles Gairdner Hospital, Perth, Australia
| | - A. De Smedt
- Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - R. Van Dyck
- Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | - L. Yperzeele
- Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | - L.G. Cerqueir
- Santa Casa de São Paulo, Medical School, Sao Paulo, Brazil
| | - X. Yang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - W. Chen
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | | | | - P.A. Ringleb
- University Hospital Heidelberg, Heidelberg, Germany
| | | | - I. Vastagh
- Semmelweis University, Budapest, Hungary
| | - M. Canavan
- Galway University Hospitals, Galway, Ireland
| | - D. Toni
- Department of Neurology and Psychiatry, ‘Sapienza’ University, Rome, Italy
| | - A. Anzini
- Department of Neurology and Psychiatry, ‘Sapienza’ University, Rome, Italy
| | - C. Colosimo
- Department of Neurology and Psychiatry, ‘Sapienza’ University, Rome, Italy
| | - M. De Michele
- Department of Neurology and Psychiatry, ‘Sapienza’ University, Rome, Italy
| | - M.T. Di Mascio
- Department of Neurology and Psychiatry, ‘Sapienza’ University, Rome, Italy
| | - L. Durastanti
- Department of Neurology and Psychiatry, ‘Sapienza’ University, Rome, Italy
| | - A. Falcou
- Department of Neurology and Psychiatry, ‘Sapienza’ University, Rome, Italy
| | - S. Fausti
- Department of Neurology and Psychiatry, ‘Sapienza’ University, Rome, Italy
| | - A. Mancini
- Department of Neurology and Psychiatry, ‘Sapienza’ University, Rome, Italy
| | - S. Mizumo
- Tokyo Women’s Medical University, Tokyo, Japan
| | - S. Uchiyama
- Tokyo Women’s Medical University, Tokyo, Japan
| | - C.K. Kim
- Seoul National University Hospital, Seoul, Korea
| | - S. Jung
- Seoul National University Hospital, Seoul, Korea
| | - Y. Kim
- Seoul National University Hospital, Seoul, Korea
| | - J.A. Kim
- Seoul National University Hospital, Seoul, Korea
| | - J.Y. Jo
- Seoul National University Hospital, Seoul, Korea
| | - A. Arauz
- Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico
| | - A. Quiroz-Compean
- Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico
| | - J. Colin
- Instituto Nacional de Neurologia y Neurocirugia, Mexico D.F., Mexico
| | | | | | - L. Cunha
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - G. Santo
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - F. Silva
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J. Coelho
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - M. Kustova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - K. Meshkova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - G. Williams
- Institute of Neuroscience and Physiology, University of Glasgow, Queen Elizabeth Hospital, Glasgow, United Kingdom
| | - J. Siegler
- Hospital of the University of Pennslyvania, Philadelphia
| | - C. Zhang
- Hospital of the University of Pennslyvania, Philadelphia
| | - N. Gallatti
- Hospital of the University of Pennslyvania, Philadelphia
| | - M. Kruszewski
- Hospital of the University of Pennslyvania, Philadelphia
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Eckstein HH, Reiff T, Ringleb P, Jansen O, Mansmann U, Hacke W. SPACE-2: A Missed Opportunity to Compare Carotid Endarterectomy, Carotid Stenting, and Best Medical Treatment in Patients with Asymptomatic Carotid Stenoses. J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2016.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Eckstein HH, Reiff T, Ringleb P, Jansen O, Mansmann U, Hacke W. SPACE-2: A Missed Opportunity to Compare Carotid Endarterectomy, Carotid Stenting, and Best Medical Treatment in Patients with Asymptomatic Carotid Stenoses. Eur J Vasc Endovasc Surg 2016; 51:761-5. [PMID: 27085660 DOI: 10.1016/j.ejvs.2016.02.005] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 02/08/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Because of recent advances in best medical treatment (BMT), it is currently unclear whether any additional surgical or endovascular interventions confer additional benefit, in terms of preventing late ipsilateral carotid territory ischemic stroke in asymptomatic patients with significant carotid stenoses. The aim was to compare the stroke-preventive effects of BMT alone, with that of BMT in combination with carotid endarterectomy (CEA) or carotid artery stenting (CAS) in patients with high grade asymptomatic extracranial carotid artery stenosis. METHODS SPACE-2 was planned as a three-armed, randomized controlled trial (BMT alone vs. CEA plus BMT vs. CAS plus BMT, ISRCTN 78592017). However, because of slow patient recruitment, the three-arm study design was amended (July 2013) to become two parallel randomized studies (BMT alone vs. CEA plus BMT, and BMT alone vs. CAS plus BMT). RESULTS The change in study design did not lead to any significant increase in patient recruitment, and trial recruitment ceased after recruiting 513 patients over a 5 year period (CEA vs. BMT (n = 203); CAS vs. BMT (n = 197), and BMT alone (n = 113)). The 30 day rate of death/stroke was 1.97% for patients undergoing CEA, and 2.54% for patients undergoing CAS. No strokes or deaths occurred in the first 30 days after randomization in patients randomized to BMT. There were several potential reasons for the low recruitment rates into SPACE-2, including the ability for referring doctors to refer their patients directly for CEA or CAS outwith the trial, an inability to convince patients (who had come "mentally prepared" that an intervention was necessary) to accept BMT, and other economic constraints. CONCLUSIONS Because of slow recruitment rates, SPACE-2 had to be stopped after randomizing only 513 patients. The German Research Foundation will provide continued funding to enable follow up of all recruited patients, and it is also planned to include these data in any future meta-analysis prepared by the Carotid Stenosis Trialists Collaboration.
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Affiliation(s)
- H-H Eckstein
- Department of Vascular and Endovascular Surgery, Technical University of Munich, Munich, Germany
| | - T Reiff
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - P Ringleb
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - O Jansen
- Department of Radiology and Neuroradiology, UKSH Campus Kiel, Kiel, Germany
| | - U Mansmann
- Institute of Medical Informatics, Biometry and Epidemiology, Ludwig Maximilian University Munich, Munich, Germany
| | - W Hacke
- Department of Neurology, University of Heidelberg, Heidelberg, Germany.
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Affiliation(s)
- P. Ringleb
- Neurologische Universitätsklinik Heidelberg
| | - G. Hamann
- Klinik für Neurologie und Neurologische Rehabilitation, Bezirkskrankenhaus Günzburg
| | - J. Röther
- Neurologische Abteilung, Asklepios Klinik Hamburg Altona
| | - O. Jansen
- Klinik für Radiologie und Neuroradiologie, Universitätsklinikum Kiel
| | - C. Groden
- Abteilung für Neuroradiologie, Universitätsklinikum Mannheim
| | - R. Veltkamp
- Department of Stroke Medicine, Imperial College London
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Fisch U, von Felten S, Roubin G, Mali W, Jansen O, Howard G, Fraederich G, Chatellier G, Becquemin J, Algra A, Ringleb P, Mas J, Brown M, Brott T, Bonati L. Low Risk of Stroke or Death among Patients with Recently Symptomatic Carotid Stenosis Awaiting Revascularization—A Pooled Analysis of Recent Randomized Trials. J Neurol Surg A Cent Eur Neurosurg 2015. [DOI: 10.1055/s-0035-1564535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Attigah N, Demirel S, Ringleb P, Hinz U, Hyhlik-Dürr A, Böckler D. Cross-flow determination by transcranial Doppler predicts clamping ischemia in patients undergoing carotid endarterectomy. J Cardiovasc Surg (Torino) 2015; 56:417-422. [PMID: 23867860] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM Aim of the paper was to assess the reliability of preoperative cross-flow determination by transcranial Doppler measurement (TCD) to detect clamping ischemia in patients undergoing carotid endarterectomy with selective shunting. METHODS Retrospective one-to-one matched-pair analysis of 72 patients undergoing carotid endarterectomy with preoperative TCD scanning. Matching criteria were gender, degree of contralateral stenosis and the type of stenosis (asymptomatic or symptomatic). RESULTS Patients in need for a secondary shunt insertion had significantly less cross-flow in preoperative TCD measurement (N.=14; 38.89%) compared to the control group (N.=32; 88.89%: P=0.0001%). The sensitivity of the cross-flow determination to predict clamping ischemia was 88.9%, the specificity 61.1%. The risk of developing a clamping ischemia in the absence of a cross-flow was 12 fold higher (OR: 12.6; 95% CI: 3.7-43.3). The existence of circulatory impairment of the MCA was associated with the presence of a collateral flow in the ACoA (OR 3.21; P=0.0531; likelihood ratio test 0.0481). Other factors like renal insufficiency, the degree of stenosis or the stump pressure showed no association with a cross-flow of the ACoA in a multivariate model. CONCLUSION TCD scanning is highly reliable to detect cross-flow prior to carotid surgery and thus helpful to identify patients at risk for clamping ischemia and need for shunting.
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Affiliation(s)
- N Attigah
- Department of Vascular and Endovascular Surgery, University of Heidelberg, Heidelberg, Germany -
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Calvet D, Mas JL, Algra A, Becquemin JP, Bonati LH, Dobson J, Fraedrich G, Jansen O, Mali WP, Ringleb PA, Chatellier G, Brown MM, Calvet D, Mas JL, Algra A, Becquemin JP, Bonati L, Dobson J, Fraedrich G, Jansen O, Mali W, Ringleb P, Chatellier G, Brown M, Algra A, Becquemin J, Chatellier G, Mas JL, Fraedrich G, Ringleb P, Jansen O, Bonati LH, Brown MM, Mali WP, Mas JL, Chatellier G, Becquemin JP, Bonneville JF, Branchereau A, Crochet D, Gaux JC, Larrue V, Leys D, Watelet J, Hacke W, Hennerici M, Allenberg J, Maurer P, Eckstein HH, Zeumer H, Jansen O, Algra A, Bamford J, Beard J, Bland M, Bradbury A, Brown M, Clifton A, Gaines P, Hacke W, Halliday A, Malik I, Mas JL, McGuire A, Sidhu P, Venables G. Carotid Stenting. Stroke 2014; 45:527-32. [DOI: 10.1161/strokeaha.113.003526] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [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)
- David Calvet
- From the Department of Neurology, Hôpital Sainte-Anne, Université Paris Descartes, INSERM UMR894, Paris, France (D.C., J.-L.M.); Department of Neurology and Julius Centre for Health Sciences and Patient Care (A.A.) and Department of Radiology (W.P.M.), University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, University Hospital Henri Mondor, Creteil, France (J.-P.B.); Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (L.H.B.)
| | - Jean-Louis Mas
- From the Department of Neurology, Hôpital Sainte-Anne, Université Paris Descartes, INSERM UMR894, Paris, France (D.C., J.-L.M.); Department of Neurology and Julius Centre for Health Sciences and Patient Care (A.A.) and Department of Radiology (W.P.M.), University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, University Hospital Henri Mondor, Creteil, France (J.-P.B.); Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (L.H.B.)
| | - Ale Algra
- From the Department of Neurology, Hôpital Sainte-Anne, Université Paris Descartes, INSERM UMR894, Paris, France (D.C., J.-L.M.); Department of Neurology and Julius Centre for Health Sciences and Patient Care (A.A.) and Department of Radiology (W.P.M.), University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, University Hospital Henri Mondor, Creteil, France (J.-P.B.); Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (L.H.B.)
| | - Jean-Pierre Becquemin
- From the Department of Neurology, Hôpital Sainte-Anne, Université Paris Descartes, INSERM UMR894, Paris, France (D.C., J.-L.M.); Department of Neurology and Julius Centre for Health Sciences and Patient Care (A.A.) and Department of Radiology (W.P.M.), University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, University Hospital Henri Mondor, Creteil, France (J.-P.B.); Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (L.H.B.)
| | - Leo H. Bonati
- From the Department of Neurology, Hôpital Sainte-Anne, Université Paris Descartes, INSERM UMR894, Paris, France (D.C., J.-L.M.); Department of Neurology and Julius Centre for Health Sciences and Patient Care (A.A.) and Department of Radiology (W.P.M.), University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, University Hospital Henri Mondor, Creteil, France (J.-P.B.); Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (L.H.B.)
| | - Joanna Dobson
- From the Department of Neurology, Hôpital Sainte-Anne, Université Paris Descartes, INSERM UMR894, Paris, France (D.C., J.-L.M.); Department of Neurology and Julius Centre for Health Sciences and Patient Care (A.A.) and Department of Radiology (W.P.M.), University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, University Hospital Henri Mondor, Creteil, France (J.-P.B.); Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (L.H.B.)
| | - Gustav Fraedrich
- From the Department of Neurology, Hôpital Sainte-Anne, Université Paris Descartes, INSERM UMR894, Paris, France (D.C., J.-L.M.); Department of Neurology and Julius Centre for Health Sciences and Patient Care (A.A.) and Department of Radiology (W.P.M.), University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, University Hospital Henri Mondor, Creteil, France (J.-P.B.); Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (L.H.B.)
| | - Olav Jansen
- From the Department of Neurology, Hôpital Sainte-Anne, Université Paris Descartes, INSERM UMR894, Paris, France (D.C., J.-L.M.); Department of Neurology and Julius Centre for Health Sciences and Patient Care (A.A.) and Department of Radiology (W.P.M.), University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, University Hospital Henri Mondor, Creteil, France (J.-P.B.); Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (L.H.B.)
| | - Willem P. Mali
- From the Department of Neurology, Hôpital Sainte-Anne, Université Paris Descartes, INSERM UMR894, Paris, France (D.C., J.-L.M.); Department of Neurology and Julius Centre for Health Sciences and Patient Care (A.A.) and Department of Radiology (W.P.M.), University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, University Hospital Henri Mondor, Creteil, France (J.-P.B.); Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (L.H.B.)
| | - Peter A. Ringleb
- From the Department of Neurology, Hôpital Sainte-Anne, Université Paris Descartes, INSERM UMR894, Paris, France (D.C., J.-L.M.); Department of Neurology and Julius Centre for Health Sciences and Patient Care (A.A.) and Department of Radiology (W.P.M.), University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, University Hospital Henri Mondor, Creteil, France (J.-P.B.); Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (L.H.B.)
| | - Gilles Chatellier
- From the Department of Neurology, Hôpital Sainte-Anne, Université Paris Descartes, INSERM UMR894, Paris, France (D.C., J.-L.M.); Department of Neurology and Julius Centre for Health Sciences and Patient Care (A.A.) and Department of Radiology (W.P.M.), University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, University Hospital Henri Mondor, Creteil, France (J.-P.B.); Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (L.H.B.)
| | - Martin M. Brown
- From the Department of Neurology, Hôpital Sainte-Anne, Université Paris Descartes, INSERM UMR894, Paris, France (D.C., J.-L.M.); Department of Neurology and Julius Centre for Health Sciences and Patient Care (A.A.) and Department of Radiology (W.P.M.), University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, University Hospital Henri Mondor, Creteil, France (J.-P.B.); Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (L.H.B.)
| | - D. Calvet
- Department of Neurology, Hôpital Sainte-Anne, Université Paris Descartes, INSERM UMR894, Paris, France
| | - J.-L. Mas
- Department of Neurology, Hôpital Sainte-Anne, Université Paris Descartes, INSERM UMR894, Paris, France
| | - A. Algra
- Department of Neurology and Julius Centre for Health Sciences and Patient Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J.-P. Becquemin
- Department of Vascular Surgery, University Hospital Henri Mondor, 94010 Creteil, France
| | - L.H. Bonati
- Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland; and Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, United Kingdom
| | - J. Dobson
- Medical Statistics Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - G. Fraedrich
- Department of Vascular Surgery, Medical University, Innsbruck, Austria
| | - O. Jansen
- Department of Neuroradiology, Schleswig-Holstein University Hospital, Kiel, Germany
| | - W.P. Mali
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - P.A. Ringleb
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - G. Chatellier
- Clinical Research Unit, Hôpital Européen Georges Pompidou, Université René Descartes, Paris, France
| | - M.M. Brown
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, United Kingdom
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Kellert L, Schrader F, Ringleb P, Steiner T, Bösel J. The impact of low hemoglobin levels and transfusion on critical care patients with severe ischemic stroke: STroke: RelevAnt Impact of HemoGlobin, Hematocrit and Transfusion (STRAIGHT)--an observational study. J Crit Care 2013; 29:236-40. [PMID: 24332995 DOI: 10.1016/j.jcrc.2013.11.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 09/19/2013] [Accepted: 11/04/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Optimal management of hemoglobin (Hb) and red blood cell transfusion (RBCT) in neurologic intensive care unit (NICU) patients has not been determined yet. Here we aimed to investigate the impact of anemia and transfusion activity in patients who had acute ischemic stroke. MATERIALS AND METHODS A retrospective analysis of clinical, laboratory, and outcome data of patients with severe acute ischemic stroke treated on our NICU between 2004 and 2011 was performed. RESULTS Of 109 patients, 97.2% developed anemia and 33% received RBCT. Significant correlations were found between NICU length of stay (NICU LOS) and lowest (nadir) Hb (correlation coefficient, -0.42, P < .001), Hb decrease (0.52, P < .001), nadir hematocrit (Hct; -0.43, P < .001), and Hct decrease (0.51, P < .001). Duration of mechanical ventilation (MV) was strongly associated with both nadir Hb (-0.41, P < .001) and decrease (0.42, P < .001) and nadir Hct (-0.43, P < .001) and decrease (0.40, P < .001). Red blood cell transfusion correlated with NICU LOS (0.33, P < .001) and with duration of MV (0.40, P < .001). None of these hematologic parameters correlated with in-hospital mortality or 90-day outcome. The linear regression model showed number of RBCT (0.29, P = .008), nadir Hb (-0.18, P = .049), Hb decrease (0.33, P < .001), nadir Hct (-0.18, P = .03), and Hct decrease (0.29, P < .001) to be independent predictors of NICU LOS. Duration of MV was also independently predicted by number of RBC transfusions (0.29, P < .001), nadir Hb (-0.20, P = .02), Hb decrease (0.25, P = .002), nadir Hct (-0.21, P = .015), and Hct decrease (0.26, P < .001). CONCLUSIONS Low and further decreasing Hb and Hct levels as well as RBCT activity are associated with prolonged NICU stay and duration of MV but not with mortality or long-term outcome. Our findings do not justify using a more aggressive transfusion practice at present.
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Affiliation(s)
- L Kellert
- Department of Neurology, University of Heidelberg, 69120 Heidelberg, Germany.
| | - F Schrader
- Department of Neurology, University of Heidelberg, 69120 Heidelberg, Germany
| | - P Ringleb
- Department of Neurology, University of Heidelberg, 69120 Heidelberg, Germany
| | - T Steiner
- Department of Neurology, University of Heidelberg, 69120 Heidelberg, Germany; Department of Neurology, Frankfurt Hoechst Hospital, Frankfurt am Main, Germany
| | - J Bösel
- Department of Neurology, University of Heidelberg, 69120 Heidelberg, Germany
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Nagel S, Kellert L, Möhlenbruch M, Bösel J, Rohde S, Ringleb P. Improved Clinical Outcome after Acute Basilar Artery Occlusion since the Introduction of Endovascular Thrombectomy Devices. Cerebrovasc Dis 2013; 36:394-400. [DOI: 10.1159/000356185] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 09/30/2013] [Indexed: 11/19/2022] Open
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21
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Gumbinger C, Reuter B, Wiethölter H, Bruder I, Rode S, Drewitz E, Habscheid W, Daffertshofer M, Diehm C, Neumaier S, Kern R, Ringleb P, Hacke W, Hennerici M. A Consecutive and Prospective Stroke Database Covers the State of Baden-Wuerttemberg with 10.8 Million Inhabitants in Germany. Neuroepidemiology 2013; 41:161-8. [DOI: 10.1159/000354356] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 07/12/2013] [Indexed: 11/19/2022] Open
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22
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23
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Ringleb P, Görtler M, Nabavi D, Arning C, Sander D, Eckstein HH, Kühnl A, Berkefeld J, Diel R, Dörfler A, Kopp I, Langhoff R, Lawall H, Storck M. S3-Leitlinie Extracranielle Carotisstenose. Gefässchirurgie 2012. [DOI: 10.1007/s00772-012-1052-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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25
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Herweh C, Attigah N, Nagel S, Demirel S, Ringleb P, Boeckler D, Bendszus M. Quantitative High-Field Diffusion Tensor Imaging of Cerebral White Matter in Asymptomatic High-Grade Internal Carotid Artery Stenosis. Eur Neurol 2012; 67:246-51. [DOI: 10.1159/000334861] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 11/04/2011] [Indexed: 11/19/2022]
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26
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Gumbinger C, Krumsdorf U, Veltkamp R, Hacke W, Ringleb P. Continuous monitoring versus HOLTER ECG for detection of atrial fibrillation in patients with stroke. Eur J Neurol 2011; 19:253-7. [DOI: 10.1111/j.1468-1331.2011.03519.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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Engelter ST, Soinne L, Ringleb P, Sarikaya H, Bordet R, Berrouschot J, Odier C, Arnold M, Ford GA, Pezzini A, Zini A, Rantanen K, Rocco A, Bonati LH, Kellert L, Strbian D, Stoll A, Meier N, Michel P, Baumgartner RW, Leys D, Tatlisumak T, Lyrer PA. IV thrombolysis and statins. Neurology 2011; 77:888-95. [DOI: 10.1212/wnl.0b013e31822c9135] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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28
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Diener HC, Aichner F, Bode C, Böhm M, Eckstein HH, Einhäupl K, Endres M, Forsting F, Gesenhues S, Grond M, Haberl R, Hacke W, Hennerici M, Lyrer P, Link A, Ringelstein B, Ringleb P, Schrader J, Weimar C. Primary and secondary prevention of cerebral ischemia. Akt Neurol 2010. [DOI: 10.1055/s-0029-1223537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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29
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Reiff T, Stingele R, Eckstein HH, Fraedrich G, Jansen O, Mudra H, Mansmann U, Hacke W, Ringleb P. Stent-Protected Angioplasty in Asymptomatic Carotid Artery Stenosis vs. Endarterectomy: SPACE2 – a Three-Arm Randomised-Controlled Clinical Trial. Int J Stroke 2009; 4:294-9. [PMID: 19689759 DOI: 10.1111/j.1747-4949.2009.00290.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Moderate to severe (≥70%) asymptomatic stenosis of the extracranial carotid artery leads to an increased rate of stroke of approximately 11% in 5 years. Patients with asymptomatic carotid stenosis, however, are also at a higher risk of nonstroke vascular events. The estimated annual risks of such events in patients with asymptomatic stenosis are 7% for a coronary ischaemic event and 4–7% for overall mortality. The superiority of carotid endarterectomy compared with medical treatment in symptomatic carotid disease is established, provided that the surgical procedure can be performed with a perioperative morbidity and mortality of <6%. The advantage of carotid endarterectomy for asymptomatic patients is less established. An alternative treatment, carotid artery stenting, has been developed. This treatment is used frequently in both symptomatic and asymptomatic patients. In the last decade, major advantages in medical primary prevention of cerebrovascular and cardiovascular disease have been accomplished. The control groups in the large trials for asymptomatic carotid artery disease (ACAS and ACST) originate from more than a decade ago and, for the most part, have not received a medical primary prevention strategy that would now be considered the standard according to current national and international guidelines. For this reason, a three-arm trial (SPACE2; http://www.space-2.de ) with a hierarchical design and a recruitment target of 3640 patients is chosen. Firstly, a superior trial of intervention (carotid artery stenting or carotid endarterectomy) vs. state-of-the-art conservative treatment is designed. In case of superiority of the interventions, a noninferiority end-point will be tested between carotid artery stenting and carotid endarterectomy. This trial is registered at Current Controlled Trials ISRCTN 78592017.
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Affiliation(s)
- T. Reiff
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - R. Stingele
- Department of Neurology, UKSH Campus Kiel, Kiel, Germany
| | - H. H. Eckstein
- Department of Vascular Surgery, University of Innsbruck, Innsbruck, Austria
| | - G. Fraedrich
- Department of Vascular Surgery, Technical University of Munich, Munich, Germany
| | - O. Jansen
- Department of Neuroradiology, UKSH Campus Kiel, Kiel, Germany
| | - H. Mudra
- Department of Cardiology, Clinic Neuperlach, Munich, Germany
| | - U. Mansmann
- Institute of Medical Informatics, Biometry, and Epidemiology, Munich, Germany
| | | | - P. Ringleb
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
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Hartmann M, Rohde S, Mührle B, Hähnel S, Ringleb P. Therapie symptomatischer atherosklerotischer intrakranieller Stenosen mit dem WINGSPAN-Stent System. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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31
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Attigah N, Külkens S, Zausig N, Hansmann J, Ringleb P, Hakimi M, Eckstein HH, Allenberg JR, Böckler D. Surgical Therapy of Extracranial Carotid Artery Aneurysms: Long-Term Results over a 24-Year Period. J Vasc Surg 2009. [DOI: 10.1016/j.jvs.2008.12.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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32
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Attigah N, Külkens S, Zausig N, Hansmann J, Ringleb P, Hakimi M, Eckstein HH, Allenberg JR, Böckler D. Surgical Therapy of Extracranial Carotid Artery Aneurysms: Long-Term Results over a 24-Year Period. Eur J Vasc Endovasc Surg 2009; 37:127-33. [DOI: 10.1016/j.ejvs.2008.10.020] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Accepted: 10/18/2008] [Indexed: 11/17/2022]
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33
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Konatschnig T, Knöll A, Hug A, Hacke W, Ringleb P. [Ten years' experience at a major stroke center]. Nervenarzt 2009; 80:166-173. [PMID: 19099282 DOI: 10.1007/s00115-008-2603-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND About 1,300 stroke patients from a primarily rural area are treated each year at the Department of Neurology of the University Hospital of Heidelberg, Germany. Demographic and treatment data of all stroke patients there were prospectively collected. In a retrospective study we report on the changes in this patient population from 1996 to 2006, with special consideration of those suitable for intravenous thrombolysis. METHODS For all stroke patients the basic data were collected--age, sex, type of stroke (transient ischemic attack, stroke, or intracerebral hemorrhage), NIH Stroke Scale, duration between symptom onset and hospital arrival, delay between arrival and first doctor's contact, patient's further whereabouts, and for patients treated by iv thrombolysis, start of treatment and dosage. RESULTS There were no changes in the total number of stroke patients and median stroke severity, according to the NIH Stroke Scale, from 1996 to 2006. The proportion of stroke patients admitted within the first 3 h after symptom onset increased from 12.1% (1996) to 21.9% (2006). Thus we managed to treat 10.1% of all our ischemic stroke patients with iv thrombolysis, which means 39% of those patients with cerebral infarction arriving within 3 h. DISCUSSION During the study period there were no significant changes in the patients' sociodemographic data. By consistent reduction of prehospital delay, the number of stroke patients that could be treated acutely by intravenous thrombolysis was increased.
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Affiliation(s)
- T Konatschnig
- Neurologische Klinik der Ruprecht Karls-Universität Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
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34
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Rizos T, Ringleb P, Huttner H, Köhrmann M, Jüttler E. Evolution of Stroke Diagnosis in the Emergency Room – A Prospective Observational Study. Cerebrovasc Dis 2009; 28:448-53. [DOI: 10.1159/000235989] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Accepted: 06/22/2009] [Indexed: 11/19/2022] Open
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35
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Hug A, Böttinger M, Ringleb P. Systemische Thrombolysetherapie des akuten Hirninfarktes: Kaum noch Platz für Zweifel. Akt Neurol 2008. [DOI: 10.1055/s-0028-1090093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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36
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Schellinger P, Ringleb P, Hacke W. Leitlinien zum Management von Patienten mit akutem Hirninfarkt oder TIA der Europäischen Schlaganfallorganisation 2008. Nervenarzt 2008; 79:1180-4, 1186-8, 1190-201. [DOI: 10.1007/s00115-008-2532-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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37
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Abstract
This article covers three major topics of acute stroke therapy: extension of the time window for thrombolysis with desmoteplase, decompressive surgery after malignant middle cerebral artery infarction, and the effect of hemostatic therapy with recombinant activated factor VII (rFVIIa) in patients with spontaneous primary intracerebral hemorrhage. Thrombolytic therapy with recombinant tissue or tissue-type plasminogen activator is still the only approved acute stroke therapy within a 3-h time window. Imaging-based patient selection seems to help extending this time window. After promising results of two phase II trials with the thrombolytic agent desmoteplase in an extended time window after acute ischemic stroke, the DIAS-II study was reconducted in Europe, North America, and Australia as a phase III trial. First results of the included 186 patients are shown. Surprisingly, patients treated with desmoteplase had no better outcome than placebo-treated patients, and there was increased mortality in the high-dose group. Among all stroke subtypes, space-occupying malignant middle cerebral artery is one with the poorest prognosis. Most patients die within a few days due to the development of massive brain edema, despite maximum intensive care. Decompressive hemicraniectomy represents a much more effective therapy for the treatment of local brain swelling. However, until recently this method was highly controversial. Here we present the results of the randomized trials published in 2007 and discuss their relevance for acute therapy. Hematoma growth occurs within 4 h in one third of patients who suffer from intracerebral hemorrhage. Prospective, placebo-controlled, multicenter trials have shown that intravenous application of rFVIIa reduces volume increase. We present preliminary results of the latest phase III trial (FAST: recombinant factor VIIa in acute hemorrhagic stroke), which tried to find whether the hemostatic effect will translate into clinical effect.
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Affiliation(s)
- T Steiner
- Neurologische Klinik, Universitätsklinikum, Heidelberg.
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38
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Hacke W, Oertel W, Wick W, Hartung HP, Ringleb P, Diener HC. Die großen klinischen Studien - Evidenzbasierte Medizin in der Deutschen Neurologie. Akt Neurol 2007. [DOI: 10.1055/s-2007-971032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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39
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Diener H, Allenberg JR, Bode C, Busse O, Forsting M, Grau A, Hennerici M, Grond M, Haberl R, Hamann G, Ringelstein E, Ringleb P. Leitlinien der Deutschen Gesellschaft für Neurologie und der Deutschen Schlaganfallgesellschaft zur Primär- und Sekundärprävention des Schlaganfalls: Aktualisierung 2007. Akt Neurol 2007. [DOI: 10.1055/s-2007-970895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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40
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Diener H, Allenberg JR, Bode C, Busse O, Forsting M, Grau A, Hennerici M, Grond M, Haberl R, Hamann G, Ringelstein E, Ringleb P. Leitlinien der Deutschen Gesellschaft für Neurologie und der Deutschen Schlaganfallgesellschaft zur Primär- und Sekundärprävention des Schlaganfalls: Aktualisierung 2007. Akt Neurol 2007. [DOI: 10.1055/s-2006-951947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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41
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Rohde S, Hähnel S, Ringleb P, Hartmann M. Stentimplantation bei symptomatischen intrakraniellen Stenosen: Einfluss des Stentdesigns auf technische und prozedurale Ergebnisse. ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-976877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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42
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Külkens S, Ringleb P, Diedler J, Hacke W, Steiner T. [Recommendations of the European Stroke Initiative for the diagnosis and treatment of spontaneous intracerebral haemorrhage]. Nervenarzt 2006; 77:970-87. [PMID: 16871377 DOI: 10.1007/s00115-006-2126-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This article summarises the recommendations for the management of managing patients with intracerebral haemorrhage published in 2006 by the European Stroke Initiative (EUSI) on behalf of the European Stroke Council (ESC), the European Neurological Society (ENS), and the European Federation of Neurological Societies (EFNS).
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Affiliation(s)
- S Külkens
- Neurologische Universitätsklinik Heidelberg für das Executive- und Writing-Komitee der EUSI, Heidelberg
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43
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Ringleb P, Hacke W. [Secondary prevention of stroke]. Hamostaseologie 2006; 26:334-42; quiz 343-4. [PMID: 17146547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
Patients suffering a transient ischaemic attack (TIA) or ischaemic stroke (IS) have a high recurrence risk. Secondary prevention aims to prevent not only further strokes but also cardiac events. Important parts of secondary prevention regimens are the modification of vascular risk factors and the inhibition of platelet function or anticoagulation if indicated. The inhibition of platelet function is effective in the reduction of secondary vascular events in patients with TIA or stroke. This is true for acetylsalicylic acid (ASA), clopidogrel, and the combination of ASA plus slow-release dipyridamole. A prediction model which allows to identify patients in whom clopidogrel or dipyridamol plus ASA is superior to ASA for the secondary prevention of stroke is presented.
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Affiliation(s)
- P Ringleb
- Neurologische Klinik der Ruprecht-Karls-Universität, Im Neuenheimer Feld 400, 69120 Heidelberg.
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44
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Hacke W, Ringleb P. Sekundärprävention des Schlaganfalls. Hamostaseologie 2006. [DOI: 10.1055/s-0037-1616979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
ZusammenfassungPatienten nach einer transitorisch-ischämischen Attacke oder einer zerebralen Ischämie sind von einem hohen Wiederholungsrisiko bedroht. Durch sekundärprophylaktische Maßnahmen sollen erneute zerebrale Ischämien, aber auch andere vaskuläre Erkrankungen (z. B. Myokardinfarkt) nach einem stattgehabten Schlaganfall verhindert werden. Wichtigste Bausteine in der Sekundärprävention der zerebralen Ischämie sind die Behandlung von Risikofaktoren, sowie die Einnahme von Thrombozytenfunktionshemmern bzw. Antikoagulation. An Thrombozytenfunktionshemmern stehen Azetylsalizylsäure (ASS), Clopidogrel und die Kombination aus retardiertem Dipyridamol und ASS zur Verfügung. Ein neues Risikomodell, das einen Anhaltspunkt für eine risikostratifizierte Differenzialtherapie liefern kann, wird vorgestellt.
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Külkens S, Hartmann M, Ringleb P. Stentgeschützte Angioplastie zur Behandlung von Restenosen nach Karotisendarteriektomie. Akt Neurol 2006. [DOI: 10.1055/s-2006-953277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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46
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Forro K, Dirlack T, Külkens S, Schellinger P, Ringleb P. Langzeitbeobachtung von Patienten mit symptomatischer intrakranieller Stenose. Akt Neurol 2006. [DOI: 10.1055/s-2006-953267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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47
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Hartmann M, Ringleb P, Bose A, Sit S. Angioplastie und Stenting intrakranieller, atherosklerotischer Stenosen mit einem selbstexpandierenden Stent (WINGSPAN™). Akt Neurol 2005. [DOI: 10.1055/s-2005-919474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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48
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Kunze A, Ringleb P, Hacke W, Hennerici M, Allenberg J, Maurer P, Zeumer H, Jansen O. Die SPACE-Studie (Stentgeschützte perkutane Angioplastie der Carotis vs. Endarterektomie). Akt Neurol 2005. [DOI: 10.1055/s-2005-919709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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49
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Thomalla G, Schwark C, Sobesky J, Bluhmki E, Fiebach J, Fiehler J, Zaro-Weber O, Kucinski T, Juettler E, Ringleb P, Schellinger P, Röther J. Das Outcome nach Thrombolyse im 6h-Zeitfenster bei Patienten mit PWI/DWI Mismatch ist unabhängig von der Zeit und besser als bei unselektierten Patienten Vergleich einer deutschen Multicenterstudie mit den Daten aus ATLANTIS, ECASS und NINDS. Akt Neurol 2005. [DOI: 10.1055/s-2005-919265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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50
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Döser S, März W, Reinecke MF, Ringleb P, Schultz A, Schwandt P, Becker HJ, Bönner G, Buerke M, Diener HC, Gohlke H, Keil U, Ringelstein EB, Steinmetz A, Gladisch R, Wehling M. Empfehlungen zur Statintherapie im Alter. Internist (Berl) 2004; 45:1053-62. [PMID: 15340698 DOI: 10.1007/s00108-004-1268-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Elderly patients are significantly less likely to receive statins than younger patients possibly because of doubts regarding compliance or concerns regarding the increased likelihood of adverse events and drug interactions. Poor compliance can be expected especially in patients suffering from dementia or depression as well as those whose stage of cardiovascular disease exhibits few symptoms. On the other hand, the clinical significance of CHD events is high in the elderly, and 80% of coronary deaths occur in patients aged over 65 years. The average statistical life expectancy of elderly and old patients is often underestimated. The HPS and PROSPER studies showed that statins reduce mortality and morbidity even in very elderly individuals with a high global cardiovascular risk and/or CAD. Patients up to the age of 79 years should be treated according to the same guidelines as younger patients. Statin therapy should only be considered for patients aged 80 years and older who are at a very high risk for cardiovascular events.
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Affiliation(s)
- S Döser
- IV. Medizinische Klinik, Fakultät für Klinische Medizin Mannheim, Ruprecht-Karls-Universität Heidelberg
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