Publications by authors named "Engelter S"
Purpose: The Multicentre Acute ischemic stroke imaGIng and Clinical data (MAGIC) repository is a collaboration established in 2024 by seven stroke centres in Europe. MAGIC consolidates clinical and radiological data from acute ischemic stroke (AIS) patients who underwent endovascular therapy, intravenous thrombolysis, a combination of both, or conservative management.
Participants: All centres ensure accuracy and completeness of the data.
Background And Aims: Previous observational data indicate that young adults treated with intravenous thrombolysis (IVT) for acute ischemic stroke have more favorable outcomes and less complications when compared to older adults. Given the limited data on this topic, we aimed to provide more evidence on clinical outcomes and safety in such patients, using a large international thrombolysis registry.
Methods: In this prospective multicenter study, we used data from the Thrombolysis in Ischemic Stroke Patients (TRISP) registry from 1998 to 2020.
Article Synopsis
- The study aimed to determine the effectiveness and safety of starting direct oral anticoagulants (DOACs) early versus delayed in patients with acute ischaemic stroke and atrial fibrillation.
- Conducted as a multicenter, randomized controlled trial across 100 UK hospitals, 3,648 patients were initially assigned to either early initiation (within 4 days) or delayed initiation (7-14 days) of anticoagulation.
- The primary outcome measured was the incidence of complications like recurrent stroke or bleeding within 90 days, with results being analyzed by an independent committee to ensure objectivity.
Background: Acute intracranial occlusion of the internal carotid artery (ICA) can be distinguished into (a) occlusion of the terminal ICA, involving the proximal segments of the middle or anterior cerebral artery (ICA-L/-T) and (b) non-terminal intracranial occlusions of the ICA with patent circle of Willis (ICA-I). While patients with ICA-L/-T occlusion were included in all randomized controlled trials on endovascular therapy (EVT) in anterior large vessel occlusion, data on EVT in ICA-I occlusion is scarce. We thus aimed to evaluate effectiveness and safety of EVT in ICA-I occlusions in comparison to ICA-L/-T occlusions.
View Article and Find Full Text PDFBackground: Stroke often results in physical impairments. Physical activity is crucial for rehabilitation, enhancing mobility, strength, and overall health. This study examines the association between Timed Up-and-Go (TUG) test performance and changes in physical activity to improve lower extremity physical function.
View Article and Find Full Text PDFIntroduction: Extracranial internal carotid artery dissection (eICAD) is a leading cause of stroke in younger patients. In this Cochrane Review update we compared benefits and harms of eICAD-patients treated with either antiplatelets or anticoagulants.
Patients And Methods: Eligible studies were identified through Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, and EMBASE and personal search until December 2023.
Article Synopsis
- Cerebral small vessel disease (SVD) can lead to various cerebrovascular issues, but research on sex differences in SVD is limited.
- This study analyzed data from over 20,000 patients with acute ischemic stroke to examine whether the presence and severity of cerebral microbleeds (CMB) and other SVD markers differ between males and females.
- Results showed that males had more frequent CMB while females had fewer lacunes but higher severe white matter hyperintensities, indicating distinct SVD characteristics based on sex.
Article Synopsis
- Patients with a heart condition called atrial fibrillation (AF) who have strokes can still be at very high risk of having more strokes, even when taking medication to prevent them.
- Left atrial appendage occlusion (LAAO) is a special procedure aimed at helping these patients avoid future strokes.
- A study compared two groups – one that had LAAO and one that only continued their usual medication – and found that there was still a risk of strokes in both groups over a two-year period.
Article Synopsis
- The study aims to assess how common intracranial vessel occlusion is among patients with atrial fibrillation (AF) who have ischemic strokes, as well as its impact on their functional recovery after 90 days.
- It analyzed data from over 10,000 patients who underwent CT or MR angiography between 2014 and 2022, finding that over half displayed vessel occlusion, particularly in the anterior circulation.
- Results showed that those with vessel occlusion had a significantly higher rate of poor functional outcomes, indicating that this condition worsens recovery prospects regardless of anticoagulant use.
Article Synopsis
- Cervical artery dissection (CeAD) is a leading cause of ischemic strokes in young adults, and this study explored the effects of intravenous thrombolysis (IVT) on patients with CeAD and stroke symptoms.
- Analyzed data from the STOP-CAD study, it found that IVT significantly improved functional independence after 90 days in patients without increasing the risk of symptomatic intracranial hemorrhage.
- The results suggest that IVT is a beneficial treatment for eligible patients with CeAD, aligning with current medical guidelines on its use.
Article Synopsis
- The study evaluated the effectiveness and safety of endovascular thrombectomy (EVT) in acute ischemic stroke patients treated within early (<6 hours) and extended (6-24 hours) time windows after symptom onset.
- It compared outcomes like good functional recovery, intracranial hemorrhage, and mortality rates between the two groups, finding that while early treatment showed slightly better recovery rates, both time frames had similar safety outcomes.
- Overall, the findings suggest that EVT remains a viable option for patients up to 24 hours after stroke symptoms, aligning with real-world clinical practices.
Introduction: Cervical artery dissection (CeAD) is considered a non-atherosclerotic arteriopathy, but atherosclerosis of the cervical arteries may co-exist. We explored the frequency and clinical importance of co-existent atherosclerosis in patients with CeAD.
Patients And Methods: Single-center exploratory study from the Stroke Center Basel, Switzerland.
Purpose: Lower extremity physical function (LEPF) is a key component for mobility and is impacted in stroke-related disability. A reduction in LEPF can have a significant impact on an individual's Quality of Life (QoL). The aim of this study is to characterise the relationship between LEPF and QoL.
View Article and Find Full Text PDFRationale: Novel therapeutic approaches are needed in stroke recovery. Whether pharmacological therapies are beneficial for enhancing stroke recovery is unclear. Dopamine is a neurotransmitter involved in motor learning, reward, and brain plasticity.
View Article and Find Full Text PDFBackground: It is uncertain whether antiplatelets or anticoagulants are more effective in preventing early recurrent stroke in patients with cervical artery dissection. Following the publication of the observational Antithrombotic for STOP-CAD (Stroke Prevention in Cervical Artery Dissection) study, which has more than doubled available data, we performed an updated systematic review and meta-analysis comparing antiplatelets versus anticoagulation in cervical artery dissection.
Methods: The systematic review was registered in PROSPERO (CRD42023468063).
Importance: Cervical artery dissection is the most common cause of stroke in younger adults. To date, there is no conclusive evidence on which antithrombotic therapy should be used to treat patients.
Objective: To perform an individual patient data meta-analysis of randomized clinical trials comparing anticoagulants and antiplatelets in prevention of stroke after cervical artery dissection.
Background: Patients with atrial fibrillation (AF) have a high risk for recurrent clinical events after an ischemic stroke. Direct oral anticoagulants (DOAC) are prescribed for secondary prevention. Adherence to DOAC is crucial mainly because of their short elimination half-life.
View Article and Find Full Text PDFIntroduction: The Fugl-Meyer Motor Assessment (FMMA) is recommended for evaluating stroke motor recovery in clinical practice and research. However, its widespread use requires refined reliability data, particularly across different health professions. We therefore investigated the interrater reliability of the FMMA scored by a physical therapist and a physician using video recordings of stroke patients.
View Article and Find Full Text PDFArticle Synopsis
- This study looked at whether taking statins, a type of medicine, affects the chances of having a repeat stroke or bleeding in the brain for people who have certain brain issues called cerebral microbleeds (CMBs).
- They analyzed data from many hospitals and included over 16,000 patients, dividing them into those who took statins and those who didn't.
- The results showed that people who used statins had a lower risk of having another stroke but didn't show a clear difference in the risk of brain bleeding compared to those who didn't take statins.
Objective: Uncertainty remains regarding antithrombotic treatment in cervical artery dissection. This analysis aimed to explore whether certain patient profiles influence the effects of different types of antithrombotic treatment.
Methods: This was a post hoc exploratory analysis based on the per-protocol dataset from TREAT-CAD (NCT02046460), a randomized controlled trial comparing aspirin to anticoagulation in patients with cervical artery dissection.
Article Synopsis
- The study looked at how patients with bleeding in the brain (called intracerebral hemorrhage) did after taking certain blood-thinning medicines or none at all.
- It combined data from two countries (Switzerland and Norway) and checked the effects over 3 months on how well patients recovered and if they survived.
- Results showed that patients who took blood thinners had a harder time recovering and were more likely to die compared to those who didn’t take any blood thinners.
Background: Small, randomized trials of patients with cervical artery dissection showed conflicting results regarding optimal stroke prevention strategies. We aimed to compare outcomes in patients with cervical artery dissection treated with antiplatelets versus anticoagulation.
Methods: This is a multicenter observational retrospective international study (16 countries, 63 sites) that included patients with cervical artery dissection without major trauma.
Cervical artery dissection is an important cause of stroke, particularly in young adults. Data conflict on the diagnostic evaluation and treatment of patients with suspected cervical artery dissection, leading to variability in practice. We aim to provide an overview of cervical artery dissection in the setting of minor or no reported mechanical trigger with a focus on summarizing the available evidence and providing suggestions on the diagnostic evaluation, treatment approaches, and outcomes.
View Article and Find Full Text PDFArticle Synopsis
- The study looked at how well a drug called andexanet alfa works compared to other treatments for older people who had brain bleeding because of certain blood thinners.
- They analyzed data from two different studies with 243 patients, focusing on whether their brain bleeding got worse and if they had any serious complications after treatment.
- The results showed that patients treated with andexanet alfa had a lower chance of their bleeding getting worse compared to those who got other treatments.