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Altersberger VL, Sibolt G, Enz LS, Hametner C, Scheitz JF, Henon H, Bigliardi G, Strambo D, Martinez-Majander N, Stolze LJ, Heldner MR, Grisendi I, Jovanovic DR, Bejot Y, Pezzini A, Leker RR, Kägi G, Wegener S, Cereda CW, Ntaios G, De Marchis GM, Bonati LH, Psychogios M, Lyrer P, Räty S, Tiainen M, Wouters A, Caparros F, Heyse M, Erdur H, Padjen V, Zedde M, Arnold M, Nederkoorn PJ, Michel P, Zini A, Cordonnier C, Nolte CH, Ringleb PA, Curtze S, Engelter ST, Gensicke H. Intravenous Thrombolysis 4.5-9 Hours After Stroke Onset - a Cohort Study from the TRISP Collaboration. Ann Neurol 2023. [PMID: 37114466 DOI: 10.1002/ana.26669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/27/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To investigate the safety and effectiveness of intravenous thrombolysis (IVT) >4.5-9 hours after stroke onset and the relevance of advanced neuroimaging for patient selection. METHODS Prospective multicenter cohort study from the ThRombolysis in Ischemic Stroke Patients (TRISP) collaboration. Outcomes were symptomatic intracranial hemorrhage (sICH), poor 3-month functional outcome (mRS 3-6) and mortality. We compared (i) IVT >4.5-9 hours versus 0-4.5 hours after stroke onset and (ii) within the >4.5-9 hours-group baseline advanced neuroimaging (CT perfusion, MR perfusion or MR DWI/FLAIR) versus non-advanced neuroimaging. RESULTS Of 15'827 patients, 663 (4.2%) received IVT >4.5-9 hours and 15'164 (95.8%) within 4.5 hours after stroke onset. The main baseline characteristics were evenly distributed between both groups. Time of stroke onset was known in 74.9% of patients treated between >4.5-9 hours. Using propensity score weighted binary logistic regression analysis (OTT >4.5-9 hours vs. OTT 0-4.5 hours), the probability of sICH (ORadjusted 0.80[0.53-1.17]), poor functional outcome (ORadjusted 1.01[0.83-1.22]) and mortality (ORadjusted 0.80[0.61-1.04]) did not differ significantly between both groups. In patients treated between >4.5-9 hours, the use of advanced neuroimaging was associated with a 50% lower mortality compared to non-advanced imaging only (9.9% vs 19.7%; ORadjusted 0.51[0.33-0.79]). INTERPRETATION This study showed no evidence in difference of sICH, poor outcome and mortality in selected stroke patients treated with IVT between >4.5-9 hours after stroke onset compared to those treated within 4.5 hours. Advanced neuroimaging for patient selection was associated with lower mortality. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Valerian L Altersberger
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | - Gerli Sibolt
- Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Lukas S Enz
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | | | - Jan F Scheitz
- Klinik Neurologie mit Experimenteller Neurologie, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Germany
| | - Hilde Henon
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000, Lille, France
| | - Guido Bigliardi
- Stroke Unit, Department of Neuroscience, Ospedale Civile di Baggiovara, Modena University Hospital, Modena, Italy
| | - Davide Strambo
- Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Lotte J Stolze
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Ilaria Grisendi
- Neurology Unit-Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Dejana R Jovanovic
- Neurology Clinic, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Yannick Bejot
- Department of Neurology, University Hospital Dijon, France
| | - Alessandro Pezzini
- Neurology Clinic, Department of Clinical and Experimental Sciences, University of Brescia, Italy
- Department of Neurological Sciences and Vision, ASST Spedali Civili, Brescia, Italy
| | - Ronen R Leker
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Georg Kägi
- Department of Neurology, Kantonsspital St. Gallen, Switzerland
| | - Susanne Wegener
- Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland
| | - Carlo W Cereda
- Stroke Center and department of Neurology, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Georges Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Gian Marco De Marchis
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | - Leo H Bonati
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | - Marios Psychogios
- Department of Neuroradiology, University Hospital Basel and University of Basel, Switzerland
| | - Philippe Lyrer
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland
| | - Silja Räty
- Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Marjaana Tiainen
- Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Anke Wouters
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - François Caparros
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000, Lille, France
| | - Miriam Heyse
- Department of Neurology, University Hospital Heidelberg, Germany
| | - Hebun Erdur
- Klinik Neurologie mit Experimenteller Neurologie, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Germany
| | - Visnja Padjen
- Neurology Clinic, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marialuisa Zedde
- Neurology Unit-Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Patrik Michel
- Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000, Lille, France
| | - Christian H Nolte
- Klinik Neurologie mit Experimenteller Neurologie, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Germany
| | - Peter A Ringleb
- Department of Neurology, University Hospital Heidelberg, Germany
| | - Sami Curtze
- Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Stefan T Engelter
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Henrik Gensicke
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
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Marto JP, Strambo D, Ntaios G, Nguyen TN, Herzig R, Czlonkowska A, Demeestere J, Mansour OY, Salerno A, Wegener S, Baumgartner P, Cereda CW, Bianco G, Beyeler M, Arnold M, Carrera E, Machi P, Altersberger V, Bonati L, Gensicke H, Bolognese M, Peters N, Wetzel S, Magriço M, Ramos JN, Sargento-Freitas J, Machado R, Maia C, Machado E, Nunes AP, Ferreira P, Pinho e Melo T, Dias MC, Paula A, Correia MA, Castro P, Azevedo E, Albuquerque L, Alves JN, Ferreira-Pinto J, Meira T, Pereira L, Rodrigues M, Araujo AP, Rodrigues M, Rocha M, Pereira-Fonseca Â, Ribeiro L, Varela R, Malheiro S, Cappellari M, Zivelonghi C, Sajeva G, Zini A, Gentile M, Forlivesi S, Migliaccio L, Sessa M, La Gioia S, Pezzini A, Sangalli D, Zedde M, Pascarella R, Ferrarese C, Beretta S, Diamanti S, Schwarz G, Frisullo G, Marcheselli S, Seners P, Sabben C, Escalard S, Piotin M, Maïer B, Charbonnier G, Vuillier F, Legris L, Cuisenier P, Vodret FR, Marnat G, Liegey JS, Sibon I, Flottmann F, Broocks G, Gloyer NO, Bohmann FO, Schaefer JH, Nolte C, Audebert HJ, Siebert E, Sykora M, Lang W, Ferrari J, Mayer-Suess L, Knoflach M, Gizewski ER, Stolp J, Stolze LJ, Coutinho JM, Nederkoorn P, van den Wijngaard I, De Meris J, Lemmens R, De Raedt S, Vandervorst F, Rutgers MP, Guilmot A, Dusart A, Bellante F, Calleja-Castaño P, Ostos F, González-Ortega G, Martín-Jiménez P, García-Madrona S, Cruz-Culebras A, Vera R, Matute MC, Fuentes B, Alonso-de-Leciñana M, Rigual R, Díez-Tejedor E, Perez-Sanchez S, Montaner J, Díaz-Otero F, Pérez-de-la-Ossa N, Flores-Pina B, Muñoz-Narbona L, Chamorro A, Rodríguez-Vázquez A, Renú A, Ayo-Martin O, Hernández-Fernández F, Segura T, Tejada-Meza H, Sagarra-Mur D, Serrano-Ponz M, Hlaing T, See I, Simister R, Werring D, Kristoffersen ES, Nordanstig A, Jood K, Rentzos A, Šimůnek L, Krajíčková D, Krajina A, Mikulik R, Cviková M, Vinklárek J, Školoudík D, Roubec M, Hurtikova E, Hrubý R, Ostry S, Skoda O, Pernicka M, Jurak L, Eichlová Z, Jíra M, Kovar M, Panský M, Mencl P, Palouskova H, Tomek A, Janský P, Olšerová A, Sramek M, Havlicek R, Malý P, Trakal L, Fiksa J, Slovák M, Karlinski MA, Nowak M, Sienkiewicz-Jarosz H, Bochynska A, Wrona P, Homa T, Sawczynska K, Slowik A, Wlodarczyk E, Wiacek M, Tomaszewska-Lampart I, Sieczkowski B, Bartosik-Psujek H, Bilik M, Bandzarewicz A, Dorobek M, Zielinska-Turek J, Nowakowska-Kotas M, Obara K, Urbanowski P, Budrewicz S, Guziński M, Świtońska M, Rutkowska I, Sobieszak-Skura P, Labuz-Roszak BM, Debiec A, Staszewski J, Stępień A, Zwiernik J, Wasilewski G, Tiu C, Terecoasă EO, Radu RA, Negrila A, Dorobat B, Panea C, Tiu V, Petrescu S, Ozdemir A, Mahmoud M, El-Samahy H, Abdelkhalek H, Al-Hashel J, Ismail II, Salmeen A, Ghoreishi A, Sabetay SI, Gross H, Klein P, Abdalkader M, Jabbour P, El Naamani K, Tjoumakaris S, Abbas R, Mohamed GA, Chebl A, Min J, Hovingh M, Tsai JP, Khan M, Nalleballe K, Onteddu S, Masoud H, Michael M, Kaur N, Maali L, Abraham MG, Khandelwal P, Bach I, Ong M, Babici D, Khawaja AM, Hakemi M, Rajamani K, Cano-Nigenda V, Arauz A, Amaya P, Llanos N, Arango A, Vences MÁ, Barrientos Guerra JD, Caetano R, Martins RT, Scollo SD, Yalung PM, Nagendra S, Gaikwad A, Seo KD, Georgiopoulos G, Nogueira RG, Michel P. Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19: The Global COVID-19 Stroke Registry. Neurology 2023; 100:e739-e750. [PMID: 36351814 PMCID: PMC9969910 DOI: 10.1212/wnl.0000000000201537] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/23/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES COVID-19-related inflammation, endothelial dysfunction, and coagulopathy may increase the bleeding risk and lower the efficacy of revascularization treatments in patients with acute ischemic stroke (AIS). We aimed to evaluate the safety and outcomes of revascularization treatments in patients with AIS and COVID-19. METHODS This was a retrospective multicenter cohort study of consecutive patients with AIS receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021 tested for severe acute respiratory syndrome coronavirus 2 infection. With a doubly robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with intracranial bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT). RESULTS Of a total of 15,128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19; of those, 5,848 (38.7%) patients received IVT-only and 9,280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted OR 1.53; 95% CI 1.16-2.01), symptomatic subarachnoid hemorrhage (SSAH) (OR 1.80; 95% CI 1.20-2.69), SICH and/or SSAH combined (OR 1.56; 95% CI 1.23-1.99), 24-hour mortality (OR 2.47; 95% CI 1.58-3.86), and 3-month mortality (OR 1.88; 95% CI 1.52-2.33). Patients with COVID-19 also had an unfavorable shift in the distribution of the modified Rankin score at 3 months (OR 1.42; 95% CI 1.26-1.60). DISCUSSION Patients with AIS and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non-COVID-19 patients receiving treatment. Current available data do not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in patients with COVID-19 or to establish different treatment recommendations in this subgroup of patients with ischemic stroke. Our findings can be taken into consideration for treatment decisions, patient monitoring, and establishing prognosis. TRIAL REGISTRATION INFORMATION The study was registered under ClinicalTrials.gov identifier NCT04895462.
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Affiliation(s)
- João Pedro Marto
- Department of Neurology (J.P.M., M.M.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; Stroke Centre (D.S., A.S., P.M.), Neurology Service, Department of Neurological Sciences, Lausanne University Hospital, Switzerland; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology, Radiology (T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Department of Neurology (R.H., L.S., D.K.), Comprehensive Stroke Centre, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czech Republic; 2nd Department of Neurology (A.C., M.A.K., M.N.), Institute of Psychiatry and Neurology, Warsaw, Poland; Neurology Department (J.D., R.L.), Leuven University Hospital, Belgium; Alexandria University Hospitals and Affiliated Stroke Network (O.Y.M.), Egypt; Department of Neurology (S.W., P.B.), University Hospital of Zurich, Switzerland; Stroke Center (C.W.C., G.B.), Neurocenter of Southern Switzerland, EOC, Lugano; Stroke Center (M.B, M.A.), Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland; Stroke Centre (E.C.), Geneva University Hospital, Switzerland; Department of Neuroradiology (P.M.), Geneva University Hospital, Switzerland; Stroke Centre (V.A, L.B., H.G.), University Hospital Basel and University of Basel, Switzerland; Stroke Centre (M.B.), Kantonsspital Lucerne, Switzerland; Stroke Centre (N.P., S.W.), Hirslanden Hospital, Zurich, Switzerland; Department of Neuroradiology (J.N.R.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; Department of Neurology (J.S.-F., R.M., C.M.), Centro Hospitalar Universitário de Coimbra, Portugal; Department of Neuroradiology (E.M.), Centro Hospitalar Universitário de Coimbra, Portugal; Stroke Unit (A.P.N., P.F.), Hospital de São José, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; Stroke Unit (T.P.e.M., M.C.D., A.P.), Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Department of Neuroradiology (M.A.C.), Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Department of Neurology (P.C., E.A.), Centro Hospitalar Universitário São João, Porto, Portugal; Department of Neuroradiology (L.A.), Centro Hospitalar Universitário São João, Porto, Portugal; Departments of Neurology (J.N.A., J.F.-P.), and Neuroradiology (T.M.), Hospital de Braga, Portugal; Department of Neurology (L.P., M.R.), Hospital Garcia de Orta, Almada, Portugal; Department of Neuroradiology (A.P.A., M.R.), Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal; Department of Neurology (M.R.), Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal; Department of Neurology (A.P.-F, L.R.), Unidade Local de Saúde de Matosinhos, Portugal; Department of Neurology (R.V., S.M.), Centro Hospitalar Universitário do Porto, Portugal; Stroke Unit (M.C., C.Z.), Azienda Ospedaliera Universitaria Integrata, Verona, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z., M.G., S.F., L.M.), Department of Neurology and Stroke Centre, Maggiore Hospital, Bologna, Italy; Department of Neurology (M.S., S.L.G.), ASST Papa Giovanni XXIII, Bergamo, Italy; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Italy; Department of Neurology and Stroke Unit (D.S.), Azienda Socio Sanitaria Territoriale, Lecco, Italy; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria-IRCCS di Reggio Emilia, Italy; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria-IRCCS di Reggio Emilia, Italy; Department of Neurology (C.F., S.B., S.D.), San Gerardo Hospital, Department of Medicine and Surgery and Milan Centre for Neuroscience, University of Milano Bicocca, Monza, Italy; Stroke Unit (G.S.), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Neurology (G.F.), Policlinico Universitario Agostino Gemelli, Rome, Italy; Emergency Neurology and Stroke Unit (S.M.), IRCCS Humanitas Clinical and Research Center, Rozzano, Italy; Department of Neurology (C.S., S.E.), Hôpital Fondation Ade Rothschild, Paris, France; Department of Interventional Neuroradiology (M.P., B.M.), Hôpital Fondation Ade Rothschild, Paris, France; Department of Interventional Neuroradiology (G.C., F.V.), Centre Hospitalier Régional Universitaire, Hôpital Jean Minjoz, Besançon, France; Neurology (F.L., P.C, F.R.V.), Stroke Unit, Centre Hospitalier Universitaire, Grenoble Alpes, France; Department of Interventional and Diagnostic Neuroradiology (J.-S.L., I.S.), Bordeaux University Hospital, France; Department of Diagnostic and Interventional Neuroradiology (F.F, G.B., N.-O.G.), University Medical Center-Hamburg-Eppendorf, Germany; Department of Neurology (F.O.B., J.H.S.), University Hospital Frankfurt, Goethe University, Germany; Department of Neurology and Centre for Stroke Research (H.J.A.), Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Germany; Department of Neuroradiology (E.S.), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology (M.S, W.L., J.F.), St. John's Hospital, Vienna, Austria; Departments of Neurology (L.M.-S., M.K.), and Neuroradiology (E.R.G.), Medical University of Innsbruck, Austria; Department of Neurology (J.S., L.J.S., J.M.C.), Amsterdam University Medical Centers, Netherlands; Department of Neurology (I.v.d.W., J.d.M.), Haaglanden Medical Centre, Hague and Department of Radiology, Leiden University Medical Centre, Netherlands; Department of Neurology (S.D.R., F.V.), Universitair Ziekenhuis Brussel, Centre for Neurosciences, Vrije Universiteit Brussel, Belgium; Department of Neurology (M.P.R, A.G.), Stroke Unit, Europe Hospitals, Brussels, Belgium; Department of Neurology (A.D., F.B.), Centre Hospitalier Universitaire de Charleroi, Belgium; Department of Neurology and Stroke Centre (P.C.-C., F.O., P.M.-J.), Hospital Universitario de OctubreInstituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain; Department of Neurology and Stroke Centre (A.C.-C., R.V., M.C.M.), Hospital Universitario Ramón y Cajal, Ramon y Cajal Institute for Health Research (IRYCIS), Madrid, Spain; Department of Neurology and Stroke (B.F, M.A.d.L., R.R., E.D.D.), Centre Hospital La Paz Institute for Health Research-IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Spain; Department of Neurology (S.P.-S., J.M.), Hospital Universitario Virgen Macarena, Seville, Spain; Stroke Centre (F.D-.O.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; Stroke Unit (B.F.-P., J.M.-N.), Germans Trias Hospital, Barcelona, Spain; Department of Neurology (A.C, A.R.-V., A.R), Comprehensive Stroke Centre, Hospital Clinic from Barcelona, Spain; Department of Neurology (O.A.-M, F.H.-F.), Complejo Hospitalario Universitario de Albacete; Stroke Unit (H.T.-M.), Department of Neurology, and Interventional Neuroradiology Unit, Hospital Universitario Miguel Servet, Spain; Stroke Unit (D.S.-M, M.F.P.), Department of Neurology, Hospital Universitario Miguel Servet, Spain; Stroke and Geriatric Medicine (T.H.), Aintree University Hospital, United Kingdom; Comprehensive Stroke Service (I.S., R.S.), University College London Hospitals NHS Foundation Trust and Stroke Research Centre, University College London, United Kingdom.; University College London (D.W.), Queen Square Institute of Neurology, London, United Kingdom; Department of Neurology (E.S.K.), Akershus University Hospital, Lørenskog and Department of General Practice, University of Oslo, Norway; Department of Clinical Neuroscience (A.N, K.J.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology (A.N, K.J.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Department of Radiology (A.R.), Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg and Department of Interventional and Diagnostic Neuroradiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Department of Radiology (A.K.), Comprehensive Stroke Centre, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czech Republic; International Clinical Research Centre (R.M., M.C., J.V.) and Department of Neurology, St. Anne´s University Hospital and Faculty of Medicine at Masaryk University, Brno, Czech Republic; Center for Health Research (D.S., M.R, E.H.), Faculty of Medicine, University of Ostrava, Czech Republic; Department of Neurology (R.H, S.V.), České Budějovice Hospital, Czech Republic; Department of Neurology (O.S., M.P.), Jihlava Hospital, Czech Republic; Neurocenter (L.J., Z.E., M.J.), Regional Hospital Liberec, Czech Republic; Cerebrovascular Centre (M.K., M.P., P.M.), Na Homolce Hospital, Prague, Czech Republic; Department of Neurology (H.P.), Karviná Miners Hospital Inc., Czech Republic; Cerebrovascular Centre (A.T, P.J, A.O.), University Hospital in Motol, Prague, Czech Republic; Cerebrovascular Centre (M.S., R.H, P.M., L.T.), Central Military Hospital, Prague, Czech Republic; Cerebrovascular Centre (J.F., M.S.), General University Hospital, Prague, Czech Republic; 1th Department of Neurology (H.S.-J, A.B.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Neurology (P.W, T.H., K.S., A.S), University Hospital, Jagiellonian University, Cracow, Poland; Department of Neurology (M.W., L.T.-L., B.S.), Institute of Medical Sciences, Medical College of Rzeszow University, Poland; Department of Neurology and Stroke (M.B, A.B.), St. John Paul II Western Hospital, Grodzisk Mazowiecki, Poland; Department of Neurology (M.D, J.Z.), Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland; Departments of Neurology (M.N.-K., K.O., P.U.), and Radiology (M.G.), Wroclaw Medical University, Poland; Department of Neurosurgery and Neurology (M.S.), Nicolaus Copernicus University in Torun Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland; Stroke Intervention Centre (I.R., P.S.-S.), Department of Neurosurgery and Neurology, Jan Biziel University Hospital, Bydgoszcz, Poland; Department of Neurology (B.M.L.-R.), Institute of Medical Sciences, University of Opole, Poland; Clinic of Neurology (A.D., J.S., A.S.), Military Institute of Medicine, Warsaw, Poland; Department of Neurology (J.Z.), University of Warmia and Mazury, Olsztyn, Poland; Department of Radiology (C.W.), Provincial Specialist Hospital, Olsztyn, Poland; Department of Neurology (C.T., E.O.T., R.A.R., A.N.), University Emergency Hospital Bucharest, University of Medicine and Pharmacy "Carol Davila", Romania; Department of Radiology (B.D.), University Emergency Hospital Bucharest, Romania; Department of Neurology and Stroke Unit (C.P, V.T, S.P.), Elias University Emergency Hospital, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania; Department of Neurology (A.O.), Eskisehir Osmangazi University, Turkey; Ain Shams University Affiliated Saudi German Hospital (M.M., H.E.-S.), Egypt; Neuropsychiatry Department (H.A.), Tanta University, Egypt; Department of Neurology (J.A.-H.), Ibn Sina Hospital, Kuwait; Department of Neurology (I.I.I.), Jaber Al-Ahmad Hospital, Kuwait; Department of Neurology (A.G.), School of Medicine, Zanjan University of Medical Sciences, Iran; Stroke Unit (S.I.S.), Neurology Department, Hillel Yaffe Medical Center, Hadera, Israel; Department of Neurosurgery (P.J., K.E.N, S.T., R.A.), Thomas Jefferson University Hospital, PA; Departments of Radiology (G.A.M., P.G.N.), Neurology and Neurosurgery, Grady Memorial Hospital, Atlanta, GA; Department of Neurology (A.C.), Henry Ford Hospital, Detroit, MI; Comprehensive Stroke Centre and Department of Neurosciences (J.M., M.H., M.K.), Spectrum Health and Michigan State University; Department of Neurology (K.N., S.O.), University of Arkansas for Medical Sciences, Little Rock, AR; Department of Neurology (M.K.), Upstate University Hospital, NY; Department of Neurology (L.M., M.G.A.), University of Kansas Medical Centre; Endovascular Neurological Surgery and Neurology (P.K., I.B, M.O., M.B.), Rutgers, The State University of New Jersey, Newark; Department of Neurology (A.M.K.), Wayne State University, Detroit Medical Center, MI; Stroke Clinic (V.C.-N, A.A.), Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, Mexico City, Mexico; Department of Neurology (P.A.), Fundación Valle del Lili, Cali, Colombia; Centro de Investigaciones Clínicas (N.L., A.A.), Fundación Valle del Lili, Cali, Colombia; Department of Neurology (M.A.V.), Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Péru; Hospital General San Juan de Dios (J.D.B.G.), Guatemala; Department of Neurology (R.C., R.T.M.), Hospital Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil; Ramos Mejía Hospital (S.D.S.), Stroke Unit, Buenos Aires, Argentina; St. Luke's Medical Center (P.M.Y.), Global City, Philippines; Department of Neurology (S.N., A.G.), Grant Medical College and Sir JJ Hospital, Mumbai, India; Department of Neurology (K.-D.S.), National Health Insurance Service Ilsan Hospital, Goyang, Korea; School of Biomedical Engineering and Imaging Sciences (G.G.), St Thomas Hospital, King's College London, UK; Department of Clinical Therapeutics (G.G.), National and Kapodistrian University of Athens, Greece.
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Benali F, Stolze LJ, Rozeman AD, Dinkelaar W, Coutinho JM, Emmer BJ, Gons RAR, Yo LFS, van Tuijl JH, Boukrab I, van Dam-Nolen DHK, van den Wijngaard IR, Lycklama À Nijeholt GJ, de Laat KF, van Dijk LC, den Hertog HM, Flach HZ, Wermer MJH, van Walderveen MAA, Brouwers PJAM, Bulut T, Vermeer SE, Bernsen MLE, Uyttenboogaart M, Bokkers RPH, Boogaarts JD, de Leeuw FE, van der Worp HB, van der Schaaf IC, Schonewille WJ, Vos JA, Remmers MJM, Imani F, Dippel DWJ, van Zwam WH, Nederkoorn PJ, van Oostenbrugge RJ. Impact of the lockdown on acute stroke treatments during the first surge of the COVID-19 outbreak in the Netherlands. BMC Neurol 2022; 22:22. [PMID: 35016635 PMCID: PMC8749107 DOI: 10.1186/s12883-021-02539-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/20/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION We investigated the impact of the Corona Virus Disease 2019 (COVID-19) pandemic and the resulting lockdown on reperfusion treatments and door-to-treatment times during the first surge in Dutch comprehensive stroke centers. Furthermore, we studied the association between COVID-19-status and treatment times. METHODS We included all patients receiving reperfusion treatment in 17 Dutch stroke centers from May 11th, 2017, until May 11th, 2020. We collected baseline characteristics, National Institutes of Health Stroke Scale (NIHSS) at admission, onset-to-door time (ODT), door-to-needle time (DNT), door-to-groin time (DGT) and COVID-19-status at admission. Parameters during the lockdown (March 15th, 2020 until May 11th, 2020) were compared with those in the same period in 2019, and between groups stratified by COVID-19-status. We used nationwide data and extrapolated our findings to the increasing trend of EVT numbers since May 2017. RESULTS A decline of 14% was seen in reperfusion treatments during lockdown, with a decline in both IVT and EVT delivery. DGT increased by 12 min (50 to 62 min, p-value of < 0.001). Furthermore, median NIHSS-scores were higher in COVID-19 - suspected or positive patients (7 to 11, p-value of 0.004), door-to-treatment times did not differ significantly when stratified for COVID-19-status. CONCLUSIONS During the first surge of the COVID-19 pandemic, a decline in acute reperfusion treatments and a delay in DGT was seen, which indicates a target for attention. It also appeared that COVID-19-positive or -suspected patients had more severe neurologic symptoms, whereas their EVT-workflow was not affected.
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Affiliation(s)
- Faysal Benali
- Department of Neurology and Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Lotte J Stolze
- Department of Neurology and Radiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Anouk D Rozeman
- Department of Neurology and Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Wouter Dinkelaar
- Department of Neurology and Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Jonathan M Coutinho
- Department of Neurology and Radiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Bart J Emmer
- Department of Neurology and Radiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Rob A R Gons
- Department of Neurology and Radiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Lonneke F S Yo
- Department of Neurology and Radiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Julia H van Tuijl
- Department of Neurology and Radiology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands
| | - Issam Boukrab
- Department of Neurology and Radiology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands
| | - Dianne H K van Dam-Nolen
- Department of Neurology and Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ido R van den Wijngaard
- Department of Neurology and Radiology, Haaglanden Medical Center, The Hague, the Netherlands
| | | | - Karlijn F de Laat
- Department of Neurology and Radiology, Haga Hospital, The Hague, the Netherlands
| | - Lukas C van Dijk
- Department of Neurology and Radiology, Haga Hospital, The Hague, the Netherlands
| | - Heleen M den Hertog
- Department of Neurology and Radiology, Isala Hospital, Zwolle, the Netherlands
| | - H Zwenneke Flach
- Department of Neurology and Radiology, Isala Hospital, Zwolle, the Netherlands
| | - Marieke J H Wermer
- Department of Neurology and Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Paul J A M Brouwers
- Department of Neurology and Radiology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Tomas Bulut
- Department of Neurology and Radiology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Sarah E Vermeer
- Department of Neurology and Radiology, Rijnstate Hospital, Arnhem, the Netherlands
| | | | - Maarten Uyttenboogaart
- Department of Neurology and Radiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Reinoud P H Bokkers
- Department of Neurology and Radiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Jeroen D Boogaarts
- Department of Neurosurgery and Neurology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurosurgery and Neurology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery and Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Irene C van der Schaaf
- Department of Neurology and Neurosurgery and Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wouter J Schonewille
- Department of Neurology and Radiology, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Jan A Vos
- Department of Neurology and Radiology, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Michel J M Remmers
- Department of Neurology and Radiology, Amphia Hospital, Breda, the Netherlands
| | - Farshad Imani
- Department of Neurology and Radiology, Amphia Hospital, Breda, the Netherlands
| | - Diederik W J Dippel
- Department of Neurology and Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Wim H van Zwam
- Department of Neurology and Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Paul J Nederkoorn
- Department of Neurology and Radiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Robert J van Oostenbrugge
- Department of Neurology and Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
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Altersberger VL, Stolze LJ, Heldner MR, Henon H, Martinez-Majander N, Hametner C, Nordanstig A, Zini A, Nannoni S, Gonçalves B, Nolte CH, Baumgartner P, Kastrup A, Papanagiotou P, Kägi G, Leker RR, Zedde M, Padovani A, Pezzini A, Padjen V, Cereda CW, Ntaios G, Bonati LH, Rinkel LA, Fischer U, Scheitz JF, Wegener S, Turc G, Michel P, Gentile M, Rentzos A, Ringleb PA, Curtze S, Cordonnier C, Arnold M, Nederkoorn PJ, Engelter ST, Gensicke H. Maintenance of Acute Stroke Care Service During the COVID-19 Pandemic Lockdown. Stroke 2021; 52:1693-1701. [PMID: 33793320 PMCID: PMC8078117 DOI: 10.1161/strokeaha.120.032176] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose: Timely reperfusion is an important goal in treatment of eligible patients with acute ischemic stroke. However, during the coronavirus disease 2019 (COVID-19) pandemic, prehospital and in-hospital emergency procedures faced unprecedented challenges, which might have caused a decline in the number of acute reperfusion therapy applied and led to a worsening of key quality measures for this treatment during lockdown. Methods: This prospective multicenter cohort study used data from the TRISP (Thrombolysis in Ischemic Stroke Patients) registry of patients with acute ischemic stroke treated with reperfusion therapies, that is, intravenous thrombolysis or endovascular therapy. We compared prehospital and in-hospital time-based performance measures (stroke-onset-to-admission, admission-to-treatment, admission-to-image, and image-to-treatment time) during the first 6 weeks after announcement of lockdown (lockdown period) with the same period in 2019 (reference period). Secondary outcomes included stroke severity (National Institutes of Health Stroke Scale) after 24 hours and occurrence of symptomatic intracranial hemorrhage (following the ECASS [European-Australasian Acute Stroke Study]-II criteria). Results: Across 20 stroke centers, 540 patients were treated with intravenous thrombolysis/endovascular therapy during lockdown period compared with 578 patients during reference period (−7% [95% CI, 5%–9%]). Performance measures did not change significantly during the lockdown period (2020/2019 minutes median: onset-to-admission 133/145; admission-to-treatment 51/48). Same was true for admission-to-image (20/19) and image-to-treatment (31/30) time in patients with available time of first image (n=871, 77.9%). Median National Institutes of Health Stroke Scale on admission (2020/2019: 11/11) and after 24 hours (2020/2019: 6/5) and percentage of symptomatic intracranial hemorrhage (2020/2019: 6.2/5.7) did not differ significantly between both periods. Conclusions: The COVID-19 pandemic lockdown resulted in a mild decline in the number of patients with stroke treated with acute reperfusion therapies. More importantly, the solid stability of key quality performance measures between the 2020 and 2019 period may indicate resilience of acute stroke care service during the lockdown, at least in well-established European stroke centers.
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Affiliation(s)
- Valerian L Altersberger
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland (V.L.A., L.H.B., S.T.E.)
| | - Lotte J Stolze
- Department of Neurology, Amsterdam UMC, University of Amsterdam, the Netherlands (L.J.S., L.A.R., P.J.N.)
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland (M.R.H., U.F, M.A.)
| | - Hilde Henon
- University Lille, Inserm, CHU Lille, U1172- F-59000, France (H.H., C.C.)
| | | | - Christian Hametner
- Department of Neurology, University Hospital Heidelberg, Germany (C.H., P.A.R.)
| | - Annika Nordanstig
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg (A.N., A.R.).,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (A.N., A.R.)
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy (A.Z., M.G.)
| | - Stefania Nannoni
- Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland (S.N., P.M.)
| | - Bruno Gonçalves
- Department of Neurology, Sainte-Anne Hospital, Paris, France Université Paris Descartes, France (B.G., G.T.).,Niteroi D'Or Hospital, Niteroi, Brazil (B.G.)
| | - Christian H Nolte
- Klinik Neurologie mit Experimenteller Neurologie, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Germany (C.H.N., J.F.S.)
| | - Philipp Baumgartner
- Zurich Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland (P.B., S.W.)
| | - Andreas Kastrup
- Departments of Neurology and Neuroradiology, Klinikum Bremen-Mitte, Germany (A.K., P.P.)
| | | | - Georg Kägi
- Department of Neurology, Kantonsspital St. Gallen, Switzerland (G.K.)
| | - Ronen R Leker
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (R.R.L.)
| | - Marialuisa Zedde
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy (M.Z.)
| | - Alessandro Padovani
- Neurology Section, Department of Clinical and Experimental Sciences, University of Brescia; Neurology Unit, ASST Spedali Civili, Italy (A. Padovani, A. Pezzini)
| | - Alessandro Pezzini
- Neurology Section, Department of Clinical and Experimental Sciences, University of Brescia; Neurology Unit, ASST Spedali Civili, Italy (A. Padovani, A. Pezzini)
| | - Visnja Padjen
- Neurology Clinic, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia (V.P.)
| | - Carlo W Cereda
- University Lille, Inserm, CHU Lille, U1172- F-59000, France (H.H., C.C.).,Stroke Center and Department of Neurology, Neurocenter of Southern Switzerland, Lugano (C.W.C.)
| | - Georges Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece (G.N.)
| | - Leo H Bonati
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland (V.L.A., L.H.B., S.T.E.)
| | - Leon A Rinkel
- Department of Neurology, Amsterdam UMC, University of Amsterdam, the Netherlands (L.J.S., L.A.R., P.J.N.)
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland (M.R.H., U.F, M.A.)
| | - Jan F Scheitz
- Klinik Neurologie mit Experimenteller Neurologie, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Germany (C.H.N., J.F.S.)
| | - Susanne Wegener
- Zurich Department of Neurology, University Hospital Zurich and University of Zurich, Switzerland (P.B., S.W.)
| | - Guillaume Turc
- Department of Neurology, Sainte-Anne Hospital, Paris, France Université Paris Descartes, France (B.G., G.T.)
| | - Patrik Michel
- Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland (S.N., P.M.)
| | - Mauro Gentile
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy (A.Z., M.G.)
| | - Alexandros Rentzos
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg (A.N., A.R.).,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (A.N., A.R.)
| | - Peter A Ringleb
- Department of Neurology, University Hospital Heidelberg, Germany (C.H., P.A.R.).,Diagnostic and Interventional Neuroradiology, Sahlgrenska University Hospital and Department of Radiology, Institute of clinical sciences, Sahlgrenska Academy, University of Gothenburg, Sweden (A.R.)
| | - Sami Curtze
- Neurology, University of Helsinki and Helsinki University Hospital, Finland (N.M.-M., S.C.)
| | | | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland (M.R.H., U.F, M.A.)
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam UMC, University of Amsterdam, the Netherlands (L.J.S., L.A.R., P.J.N.)
| | - Stefan T Engelter
- Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Switzerland (V.L.A., L.H.B., S.T.E.).,Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Switzerland (S.T.E., H.G.)
| | - Henrik Gensicke
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Switzerland (S.T.E., H.G.)
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