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Weller JM, Dorn F, Meissner JN, Stösser S, Beckonert NM, Nordsiek J, Kindler C, Riegler C, Keil F, Petzold GC, Bode FJ, Reich A, Nikoubashman O, Röther J, Eckert B, Braun M, Hamann GF, Siebert E, Nolte CH, Bohner G, Eckert RM, Borggrefe J, Schellinger P, Berrouschot J, Bormann A, Kraemer C, Leischner H, Petersen M, Stögbauer F, Boeck-Behrens T, Wunderlich S, Ludolph A, Henn KH, Gerloff C, Fiehler J, Thomalla G, Alegiani A, Schäfer JH, Tiedt S, Kellert L, Trumm C, Ernemann U, Poli S, Liman J, Ernst M, Gröschel K, Uphaus T. Antithrombotic treatment and outcome after endovascular treatment and acute carotid artery stenting in stroke patients with atrial fibrillation. Neurol Res Pract 2022; 4:42. [PMID: 36089621 PMCID: PMC9465921 DOI: 10.1186/s42466-022-00207-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Oral anticoagulation (OAC) is the mainstay of secondary prevention in ischemic stroke patients with atrial fibrillation (AF). However, in AF patients with large vessel occlusion stroke treated by endovascular therapy (ET) and acute carotid artery stenting (CAS), the optimal antithrombotic medication remains unclear.
Methods This is a subgroup analysis of the German Stroke Registry—Endovascular Treatment (GSR-ET), a prospective multicenter cohort of patients with large vessel occlusion stroke undergoing ET. Patients with AF and CAS during ET were included. We analyzed baseline and periprocedural characteristics, antithrombotic strategies and functional outcome at 90 days. Results Among 6635 patients in the registry, a total of 82 patients (1.2%, age 77.9 ± 8.0 years, 39% female) with AF and extracranial CAS during ET were included. Antithrombotic medication at admission, during ET, postprocedural and at discharge was highly variable and overall mortality in hospital (21%) and at 90 days (39%) was high. Among discharged patients (n = 65), most frequent antithrombotic regimes were dual antiplatelet therapy (DAPT, 37%), single APT + OAC (25%) and DAPT + OAC (20%). Comparing DAPT to single or dual APT + OAC, clinical characteristics at discharge were similar (median NIHSS 7.5 [interquartile range, 3–10.5] vs 7 [4–11], p = 0.73, mRS 4 [IQR 3–4] vs. 4 [IQR 3–5], p = 0.79), but 90-day mortality was higher without OAC (32 vs 4%, p = 0.02). Conclusions In AF patients who underwent ET and CAS, 90-day mortality was higher in patients not receiving OAC. Registration: https://www.clinicaltrials.gov; Unique identifier: NCT03356392. Supplementary Information The online version contains supplementary material available at 10.1186/s42466-022-00207-7.
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Schmidbauer ML, Rizas KD, Tiedt S, Dimitriadis K. Low rate of intracerebral hemorrhage after cardiac catheterization in patients with acute ischemic stroke in a large case series. Clin Neurol Neurosurg 2020; 198:106159. [PMID: 32829200 DOI: 10.1016/j.clineuro.2020.106159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Myocardial infarction complicating acute ischemic stroke (IS) is associated with high mortality, but evidence guiding the acute management is scarce. In particular, data on the risk of intracerebral hemorrhage (ICH) due to early cardiac catheterization including the peri-procedural application of antithrombotic drugs in patients with acute ischemic stroke are limited. Here, we aimed to evaluate the incidence and patient characteristics of ICH after cardiac catheterization in acute stroke patients to help to govern the risk of intracranial bleeding versus the benefits of myocardial reperfusion via cardiac catheterization. METHODS We screened a consecutive cohort of n = 126 patients with acute ischemic stroke (IS) who underwent cardiac catheterization during the same hospital stay at a large German neurovascular center (LMU Munich). Eventually, we identified n = 42 patients with cardiac catheterization after acute stroke. N = 22/42 patients did not receive neuroimaging post cardiac catheterization and were discharged without any new neurological deficits, n = 20/42 had neuroimaging after cardiac catheterization and were included for final analysis. RESULTS Cardiac catheterization was performed within a median of 3,6 days after ischemic stroke (No-ICH 7,3 days (IQR, 3,8-16,2) vs. ICH 1,1 days (IQR, 0,8-74,6), p = 0,40), One patient showed new neurological deficits after cardiac procedures (n = 1/42, 2,4 %). New or progressive ICH was ultimately found in 15 % (3/20) of cases. They were classified as HT1, PH1 and PH2 according to ECASS II criteria, respectively. With regards to the coronary catheterization, 85 % of all patients undergoing catheterization ultimately received percutaneous cardiac intervention. ICH was not significantly associated with any of the independent variables. Intrahospital death due to either ischemic stroke, ICH or cardiovascular events did not occur. CONCLUSION The incidence of ICH in ischemic stroke followed by early cardiac catheterization and application of antithrombotic drugs was comparable to studies reporting on the incidence of ICH in ischemic stroke patients without catheterization. This study's results strengthen the hypothesis that in presence of both, acute myocardial infarction and acute ischemic stroke, the general risk for ICH is not prohibitive of cardiac catheterization.
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Affiliation(s)
- M L Schmidbauer
- Department of Neurology, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Marchioninistr. 15, 81377, Munich, Germany.
| | - K D Rizas
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site: Munich Heart Alliance, Munich, Germany
| | - S Tiedt
- Institute for Stroke and Dementia Research (ISD), LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - K Dimitriadis
- Institute for Stroke and Dementia Research (ISD), LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
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Kolkenbeck-Ruh A, Woodiwiss AJ, Monareng T, Sadiq E, Mabena P, Robinson C, Motau TH, Stevens B, Manyatsi N, Tiedt S, Dembskey R, Abdool-Carrim T, Veller M, Cassimjee I, Modi G, Hale M, Norton GR. Complementary Impact of Carotid Intima-Media Thickness With Plaque in Associations With Noncardiac Arterial Vascular Events. Angiology 2019; 71:122-130. [PMID: 31303025 DOI: 10.1177/0003319719862681] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The ability of carotid intima-media thickness (IMT) to predict risk beyond plaque is controversial. In 952 participants (critical limb ischemia [CLI] or stroke, n = 473; community, n = 479), we assessed whether relationships with events for IMT complement the impact of plaque in young patients depending on the extent of thrombotic versus atherosclerotic disease. The extent of atherosclerotic versus thrombotic occlusion was determined in 54 patients with CLI requiring amputations. Thrombotic occlusion in CLI was associated with younger age (P < .0001) and less plaque (P = .02). Independent relations between plaque and CLI were noted in older (>50 years; P < .005 to <.0001) but not younger (P > .38) participants, while independent relations between plaque and stroke (P < .005 to <.0001) and between IMT and CLI (P < .0001) were noted in younger participants. Although in performance (area under the receiver operating curve) for event detection, IMT thresholds failed to add to plaque alone in older patients (0.680 ± 0.020 vs 0.664 ± 0.017, P = .27), IMT improved performance for combined stroke and CLI detection when added to plaque in younger patients (0.719 ± 0.023 vs 0.631 ± 0.026, P < .0001). Because in younger participants the high prevalence of thrombotic occlusion in CLI is associated with less plaque, IMT adds information in associations with arterial vascular events.
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Affiliation(s)
- Andrea Kolkenbeck-Ruh
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Angela J Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Talib Monareng
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Eitzaz Sadiq
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Philanathi Mabena
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Chanel Robinson
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tshegofatso H Motau
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Belinda Stevens
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nomvuyo Manyatsi
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Scott Tiedt
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Reinhard Dembskey
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Talib Abdool-Carrim
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Martin Veller
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ismail Cassimjee
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Girish Modi
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Martin Hale
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gavin R Norton
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Ebinger S, Ozdemir E, Tiedt S, Ziegenhain C, Castro-Alves C, Enard W, Jeremias I. Characterization of a novel dormant, drug resistant, stem cell subpopulation in acute lymphoblastic leukemia. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61729-x] [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: 11/28/2022]
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Kunisch R, Guder P, Schinke K, Nörenberg D, Ruf VC, Alig S, Bauer HJ, Kirchner SK, Kruger S, Noerenberg D, Singer K, Tiedt S, Weckbach L, Wypior G, Angstwurm M. [Reforming the Surgical Section of the Practical Year at Ludwig-Maximilians-University Munich]. Zentralbl Chir 2015; 141:310-4. [PMID: 26554334 DOI: 10.1055/s-0034-1396254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- R Kunisch
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Deutschland
| | - P Guder
- Medizinische Fakultät, Klinikum der Universität München, Deutschland
| | - K Schinke
- Medizinische Fakultät, Klinikum der Universität München, Deutschland
| | - D Nörenberg
- Institut für Radiologie, CCM, Charité - Campus Mitte, Berlin, Deutschland
| | - V C Ruf
- Medizinische Fakultät, Klinikum der Universität München, Deutschland
| | - S Alig
- Medizinische Klinik III, Klinikum der Universität München, Deutschland
| | - H J Bauer
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Deutschland
| | - S-K Kirchner
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, Deutschland
| | - S Kruger
- Medizinische Fakultät, Klinikum der Universität München, Deutschland
| | - D Noerenberg
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité - Campus Virchow-Klinikum, Berlin, Deutschland
| | - K Singer
- Medizinische Fakultät, Klinikum der Universität München, Deutschland
| | - S Tiedt
- Institut für Schlaganfall- und Demenzforschung, Klinikum der Universität München, Deutschland
| | - L Weckbach
- Medizinische Klinik I, Klinikum der Universität München, Deutschland
| | - G Wypior
- Medizinische Klinik V, Klinikum der Universität München, Deutschland
| | - M Angstwurm
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Deutschland
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