Publications by authors named "Gensicke H"
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.
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 PDFIntroduction: Automated CT perfusion (aCTP) is commonly used to select patients with anterior circulation large vessel occlusion (aLVO) for endovascular treatment (EVT). The equivalence of visually assessed Non-contrast CT Alberta Stroke Program Early CT Scores (ASPECTS) and aCTP based selection in predicting favorable functional outcomes remains uncertain.
Patients And Methods: Retrospective multicenter study of adult aLVO patients from the Swiss Stroke Registry (2014-2021) treated with EVT or best medical treatment 6-24 h after stroke onset.
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.
Introduction: There is limited understanding of the pathomechanistic relationship between leptomeningeal collateral formation and ischaemic stroke aetiology. We aimed to assess the association of leptomeningeal collateral status and ischaemic stroke aetiology, using the widely recognised "Trial of Org 10172 in Acute Stroke Treatment" (TOAST) classification categorising strokes into five distinct aetiologies.
Methods: Retrospective study of consecutively admitted adult ischaemic stroke patients at a Swiss stroke centre.
Rationale: 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 PDFImportance: 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.
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.
Background: Evidence-based hemostatic treatment for intracerebral hemorrhage (ICH) associated with non-vitamin K antagonist oral anticoagulants (NOACs) is lacking. Tranexamic acid (TXA) is an antifibrinolytic drug potentially limiting hematoma expansion. We aimed to assess the efficacy and safety of TXA in NOAC-ICH.
View Article and Find Full Text PDFBackground And Objectives: IV thrombolysis (IVT) for suspected ischemic stroke in patients with intracranial neoplasms is off-label. However, data on risks of intracranial hemorrhage (ICH) are scarce.
Methods: In a multicenter registry-based analysis within the European Thrombolysis in Ischemic Stroke Patients (TRISP) collaboration, we assessed frequencies of symptomatic and fatal ICH after IVT for suspected ischemic stroke in patients with intracranial tumors by descriptive statistics and analyzed associations with clinical and imaging characteristics by binary logistic regression.
Background: Retinal artery occlusion (RAO) may lead to irreversible blindness. For acute RAO, intravenous thrombolysis (IVT) can be considered as treatment. However, due to the rarity of RAO, data about IVT safety and effectiveness is limited.
View Article and Find Full Text PDFBackground: Data on the impact of competing stroke etiologies in stroke patients with atrial fibrillation (AF) are scarce.
Methods: We used prospectively obtained data from an observational registry (Novel-Oral-Anticoagulants-in-Ischemic-Stroke-Patients-(NOACISP)-LONGTERM) of consecutive AF-stroke patients treated with oral anticoagulants. We compared the frequency of (i) the composite outcome of recurrent ischemic stroke (IS), intracerebral hemorrhage (ICH) or all-cause death as well as (ii) recurrent IS alone among AF-stroke patients with versus without competing stroke etiologies according to the TOAST classification.
Background And Purpose: This study aimed to investigate the effect of endovascular treatment (EVT, with or without intravenous thrombolysis [IVT]) versus IVT alone on outcomes in patients with acute ischemic stroke (AIS) and intracranial large vessel occlusion (LVO) attributable to cervical artery dissection (CeAD).
Methods: This multinational cohort study was conducted based on prospectively collected data from the EVA-TRISP (EndoVAscular treatment and ThRombolysis for Ischemic Stroke Patients) collaboration. Consecutive patients (2015-2019) with AIS-LVO attributable to CeAD treated with EVT and/or IVT were included.
Article Synopsis
- The study analyzed 2715 stroke patients and found that 5.9% had apical pulmonary lesions (APL) visible on computed tomography angiography (CTA).
- One-third of these patients had APL that were suspicious for malignancy, with many having no prior history of lung cancer.
- APL indicating malignancy were linked to worse in-hospital outcomes, including higher stroke severity and increased mortality risk.
Article Synopsis
- The study aimed to evaluate the safety and effectiveness of administering intravenous thrombolysis (IVT) between 4.5 to 9 hours after a stroke compared to treatment within 4.5 hours, while also examining the role of advanced neuroimaging for patient selection.
- Out of 15,827 patients, only 663 received IVT between 4.5 to 9 hours post-stroke, with no significant differences found in rates of symptomatic intracranial hemorrhage, poor functional outcomes, or mortality when compared to those treated within 4.5 hours.
- Advanced neuroimaging in patients treated between 4.5 to 9 hours was linked to a 50% reduction in mortality, suggesting that it can
Article Synopsis
- The study examines whether patients with atrial fibrillation known before ischemic stroke (KAF) have a higher recurrence risk compared to those diagnosed after stroke (AFDAS), considering factors like previous anticoagulation treatment.
- Data from 4,357 patients showed that pre-existing anticoagulation significantly influenced stroke recurrence risk, while KAF did not demonstrate an independent association with risk.
- The results suggest that KAF and AFDAS may not be as distinct in terms of stroke recurrence risk as previously thought, emphasizing the need for future research on stroke causes despite anticoagulation.
Article Synopsis
- International guidelines advise against using intravenous thrombolysis (IVT) in ischemic stroke patients who have recently taken direct oral anticoagulants (DOAC).
- A multicenter study examined the risk of symptomatic intracranial hemorrhage (sICH) in 832 patients who underwent IVT within 48 hours of DOAC use, compared to over 32,000 controls without recent DOAC intake.
- Results highlighted varied outcomes based on prior DOAC therapy, with focus on sICH incidence measured through established stroke scales, and included an analysis of DOAC levels and reversal treatments prior to IVT.
Article Synopsis
- The SPOTLIGHT trial examined the effects of recombinant activated factor VIIa (rFVIIa) versus placebo on limiting hematoma expansion in patients with acute intracerebral hemorrhage but found no significant reduction in hematoma growth.
- The study involved measuring hematoma volumes at various points through CT scans, tracking changes before and after administration of the study drug.
- Results showed that despite the timing of drug administration, the increase in total hematoma volume was similar between the rFVIIa and placebo groups, indicating that rFVIIa did not provide a beneficial impact on reducing hematoma expansion.
Background: We assessed the efficacy and safety of mechanical thrombectomy (MT) in adult stroke patients with anterior circulation large vessel occlusion presenting in the late time window not fulfilling the DEFUSE-3 (Thrombectomy for Stroke at 6 to 16 Hours With Selection by Perfusion Imaging trial) and DAWN (Thrombectomy 6 to 24 Hours After Stroke With a Mismatch Between Deficit and Infarct trial) inclusion criteria.
Methods: Cohort study of adults with anterior circulation large vessel occlusion admitted between 6 and 24 hours after last-seen-well at 5 participating Swiss stroke centers between 2014 and 2021. Mismatch was assessed by computer tomography or magnetic resonance imaging perfusion with automated software (RAPID or OLEA).
Background: Patients with stroke secondary to isolated anterior cerebral artery (ACA) occlusions have poor outcomes. Whether tandem occlusions (TO) of the extracranial internal carotid (ICA) and the ACA carry even worse outcomes that remain unknown.
Methods: Patients with TO involving ICA and ACA occlusions were identified from 14 participating centers from the EndoVascular treatment And ThRombolysis in Ischemic Stroke Patients (EVATRISP) project which is a multicenter, observational, cohort study with prospective accrual of data followed by retrospective data analysis.
Introduction: Measures of cerebral small vessel disease (cSVD), such as white matter hyperintensities (WMH) and cerebral microbleeds (CMB), are associated with an unfavorable clinical course in stroke patients on oral anticoagulation (OAC) for atrial fibrillation (AF). Here, we investigated whether similar findings can be observed for global cortical atrophy (GCA).
Methods: Registry-based prospective observational study of 320 patients treated with OAC following AF stroke.
Background: The DEFUSE-3 and DAWN trials showed that mechanical thrombectomy (MT) improves the outcome of selected patients with anterior circulation large vessel occlusions (LVO) up to 24 h after stroke onset. However, it is unknown whether only those patients fulfilling the trial inclusion criteria benefit, or whether benefit is seen in a broader range of patients presenting between 6 and 24 h.
Aims: We determined whether fulfilling the DEFUSE-3 and DAWN selection criteria affects outcomes in MT patients in clinical practice.