Publications by authors named "Katan M"
Background: Secondary stroke prevention in patients with atrial fibrillation (AF) is one of the fastest growing areas in the field of cerebrovascular diseases. This Scientific statement from the World Stroke Organization Brain & Heart Task Force provides a critical analysis of the strength of current evidence this topic, highlights areas of current controversy, identifies knowledge gaps, and proposes priorities for future research.
Methods: We select topics with the highest clinical relevance and perform a systematic search to answer specific practical questions.
Background And Objectives: Despite effective secondary prevention, including oral anticoagulant (OAC) therapy, the risk of recurrent stroke (RS) in patients with atrial fibrillation (AF) remains substantial with an annualized risk of 3.2%-6.5% per year.
View Article and Find Full Text PDFBackground: The rising prevalence of acute ischemic stroke (AIS) in young adults, particularly with undetermined pathogenesis, is a growing concern. This study assessed risk factors, treatments, and outcomes between young AIS patients with undetermined and determined pathogeneses.
Methods And Results: This was a retrospective cohort study including AIS patients aged 18 to 55 years in Switzerland, treated between 2014 and 2022.
Background: Inflammation promotes atherogenesis. Randomized controlled trials of anti-inflammatory therapies for prevention after stroke have not yet demonstrated clear benefit. IL-6 (interleukin-6) and hsCRP (high-sensitivity C-reactive protein) are independently associated with major adverse cardiovascular events poststroke and may guide patient selection in future randomized controlled trials.
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- The European Stroke Organisation recommends using tenecteplase (TNK) as an alternative to alteplase (TPA) for treating acute ischemic stroke within 4.5 hours, based on previous studies establishing its noninferiority.
- An updated systematic review and meta-analysis assessed the efficacy and safety of TNK compared to TPA, using data from 11 randomized controlled trials involving nearly 7,600 patients.
- Results showed that TNK was linked to better chances of achieving excellent functional outcomes and reduced disability at 3 months, while maintaining similar safety profiles for symptomatic intracranial hemorrhage when compared to TPA.
Introduction: 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
- GLP-1 receptor agonists (liraglutide, semaglutide, tirzepatide) may lower cardiovascular risk in overweight/obese individuals without diabetes.
- A systematic review of 16 trials involving over 28,000 participants showed these medications reduced major adverse cardiovascular events and all-cause mortality compared to placebo.
- While they significantly lowered the risk of myocardial infarction, the relationship with stroke is less clear due to limited data.
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.
Characterisation of molecular mechanisms for PLCγ2 disease-linked variants.
Adv Biol Regul
December 2024
The phospholipase C enzyme PLCγ2 is best characterised in the context of immune cell regulation. Furthermore, many mutations discovered in PLCγ2 have been linked to the development of complex immune disorders as well as resistance to ibrutinib treatment in chronic lymphocytic leukaemia. Importantly, it has also been found that a rare variant of PLCγ2 (P522R) has a protective role in Alzheimer's disease (AD).
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- * Data from 459 patients with vessel perforation showed a 90-day mortality rate of 51.9%, with only 16.3% achieving a favorable recovery (mRS 0-2).
- * The findings indicate that large vessel perforation leads to worse outcomes, while thrombolysis doesn’t worsen prognoses; quick management of bleeding is crucial for survival.
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.
This topical review assesses the growing role of cardiac biomarkers beyond cardiovascular health and focuses on their importance in stroke and dementia. The first part describes blood-based cardiac biomarkers in patients with stroke and highlights applications in the setting of early diagnosis, poststroke complications, outcome prediction as well as secondary prevention. Among other applications, natriuretic peptides can be helpful in differentiating stroke subtypes.
View Article and Find Full Text PDFBackground And Objectives: Prolonged cardiac monitoring (PCM) increases atrial fibrillation (AF) detection after ischemic stroke, but access is limited, and it is burdensome for patients. Our objective was to assess whether midregional proatrial natriuretic peptide (MR-proANP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) could classify people who are unlikely to have AF after ischemic stroke and allow better targeting of PCM.
Methods: We analyzed people from the Biomarker Signature of Stroke Aetiology (BIOSIGNAL) study with ischemic stroke, no known AF, and ≥3 days cardiac monitoring.
Background And Objectives: The published data about mechanical thrombectomy (MT) in cancer patients is sparse. We present our institutional experience in this clinical scenario, and a meta-analysis.
Methods: The baseline data, procedural data, clinical and radiological outcomes of MT were analyzed and compared among three groups of stroke patients: controls, patients with active malignancy (AM), and patients with history of malignancy (HOM).
Embolic strokes of undetermined source (ESUS) represent 9%-25% of all ischemic strokes. Based on the suspicion that a large proportion of cardioembolic sources remain undetected among embolic stroke of undetermined source patients, it has been hypothesized that a universal approach of anticoagulation would be better than aspirin for preventing recurrent strokes. However, 4 randomized controlled trials (RCTs), with different degrees of patient selection, failed to confirm this hypothesis.
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- The study investigates whether the size of a brain infarct influences the effectiveness and safety of initiating direct oral anticoagulants (DOACs) soon after an ischemic stroke in patients with atrial fibrillation.
- This was a post hoc analysis of the ELAN trial, involving nearly 2,000 participants from over 100 sites worldwide, comparing early DOAC initiation within 48 hours versus late initiation according to the severity of the stroke.
- The main outcome measured was serious complications (like recurrent strokes or bleeding) within 30 days, with findings suggesting minimal difference in outcomes between early and late DOAC initiation for minor strokes specifically.
Background: Whether hemorrhagic transformation (HT) modifies the treatment effect of early compared with late initiation of direct oral anticoagulation in people with ischemic stroke and atrial fibrillation is unknown.
Methods: This is a post hoc analysis of the ELAN trial (Early Versus Late Initiation of Direct Oral Anticoagulants in Post-Ischaemic Stroke Patients With Atrial Fibrillation). The primary outcome was a composite of recurrent ischemic stroke, symptomatic intracranial hemorrhage, major extracranial bleeding, systemic embolism, or vascular death within 30 days.
Implications for driving based on the risk of seizures after ischaemic stroke.
J Neurol Neurosurg Psychiatry
August 2024
Article Synopsis
- After having a stroke, some people might have seizures, which can affect their ability to drive safely.
- Researchers studied over 4,400 stroke survivors to figure out their risk of having a seizure in the next year using the SeLECT model.
- The results showed that people without seizures right after their stroke have a lower risk, while those with seizures have a much higher risk, and tools like apps can help decide if they can drive safely.
Introduction: There is a longstanding clinical uncertainty regarding the optimal timing of initiating oral anticoagulants (OAC) for non-valvular atrial fibrillation following acute ischemic stroke. Current international recommendations are based on expert opinions, while significant diversity among clinicians is noted in everyday practice.
Methods: We conducted an updated systematic review and meta-analysis including all available randomized-controlled clinical trials (RCTs) and observational cohort studies that investigated early versus later OAC-initiation for atrial fibrillation after acute ischemic stroke.
Background: Lipoprotein (a) [Lp(a)] serum levels are highly genetically determined and promote atherogenesis. High Lp(a) levels are associated with increased cardiovascular morbidity. Serum Lp(a) levels have recently been associated with large artery atherosclerosis (LAA) stroke.
View Article and Find Full Text PDFA Self-Calibrated Single Wavelength Biosensor for Measuring Oxygen Saturation.
Biosensors (Basel)
March 2024
Traditional methods for measuring blood oxygen use multiple wavelengths, which produce an intrinsic error due to ratiometric measurements. These methods assume that the absorption changes with the wavelength, but in fact the scattering changes as well and cannot be neglected. We found that if one measures in a specific angle around a cylindrical tissue, called the iso-pathlength (IPL) point, the reemitted light intensity is unaffected by the tissue's scattering.
View Article and Find Full Text PDFIntroduction: The impact of leptomeningeal collateralization on the efficacy of mechanical thrombectomy (MT) in patients with anterior circulation large vessel occlusion (aLVO) presenting in the 6-24 h time window remains poorly elucidated.
Patients And Methods: Retrospective multicenter study of aLVO patients presenting between 6 and 24 h after stroke onset who received MT plus Best Medical Treatment (BMT) or BMT alone. Leptomeningeal collateralization was assessed using single-phase computed tomography angiography (grade 0: no filling; grade 1: filling ⩽50%; grade 2: filling >50% but <100%; grade 3: filling 100% of the occluded territory).
Introduction: Mounting evidence suggests that glucagon-like-peptide-1 receptor-agonists (GLP-1 RAs) attenuate cardiovascular-risk in type-2 diabetes (T2DM). Tirzepatide is the first-in-class, dual glucose-dependent-insulinotropic-polypeptide GIP/GLP-1 RA approved for T2DM.
Patients And Methods: A systematic review and meta-analysis of randomized-controlled clinical trials (RCTs) was performed to estimate: (i) the incidence of major adverse cardiovascular events (MACE); and (ii) incidence of stroke, fatal, and nonfatal stroke in T2DM-patients treated with GLP-1 or GIP/GLP-1 RAs (vs placebo).
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: Impaired cerebrovascular reactivity (CVR) has been correlated with recurrent ischemic stroke. However, for clinical purposes, most CVR techniques are rather complex, time-consuming, and lack validation for quantitative measurements. The recent adaptation of a standardized hypercapnic stimulus in combination with a blood-oxygenation-level-dependent (BOLD) magnetic resonance imaging signal as a surrogate for cerebral blood flow offers a potential universally comparable CVR assessment.
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