Publications by authors named "Seiffge D"
Background: Whether bridging thrombolysis with tenecteplase is beneficial compared with thrombectomy alone in patients who had a stroke with large-vessel occlusion remains unclear.
Methods: This is a causal inference study of observational data from the trials SWIFT DIRECT and EXTEND-IA TNK Parts 1 and 2 applying target trial emulation. We compared patients receiving thrombectomy alone to patients receiving tenecteplase 0.
Background: Either dual antiplatelet therapy or oral anticoagulation in combination with aspirin represent recommended treatment regimens following left atrial appendage closure (LAAC). As the majority of patients receiving LAAC have high bleeding risk, less aggressive antithrombotic treatments are needed, such as single antiplatelet therapy.
Objectives: To compare both ischemic and bleeding outcomes in patients receiving single (SAPT) or dual antiplatelet therapy (DAPT) after successful LAAC.
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.
Intravenous thrombolysis and mechanical thrombectomy reduce morbidity and improve functional outcome in ischemic stroke. However, acute recanalization therapies may increase the risk of symptomatic intracranial hemorrhage due to its effects on the brain tissue. An increasing proportion of patients with ischemic stroke are using direct oral anticoagulants (DOACs).
View Article and Find Full Text PDFImaging can help to diagnose CNS vasculitis. Yet so far, no imaging studies of CNS vasculitis at 7T are available. We share our experience of vessel wall imaging (VWI) at 7T in patients with suspected vasculitis.
View Article and Find Full Text PDFBackground: A third of endovascularly treated stroke patients experience incomplete reperfusion (expanded Thrombolysis in Cerebral Infarction, eTICI<3) and the natural evolution of this incomplete reperfusion remains unknown. We systematically reviewed literature and performed a meta-analysis on the natural evolution of incomplete reperfusion after endovascular therapy.
Methods: A systematic review of MEDLINE, Embase and PubMed up until March 1, 2024 using a predefined strategy.
Intracerebral haemorrhage (ICH) is a devastating condition associated with high mortality and substantial residual disability among survivors. Effective treatments for the acute stages of ICH are limited. However, promising findings from randomized trials of therapeutic strategies, including acute care bundles that target anticoagulation therapies, blood pressure control and other physiological parameters, and trials of minimally invasive neurosurgical procedures have led to renewed optimism that patient outcomes can be improved.
View Article and Find Full Text PDFArticle Synopsis
- A significant portion of spontaneous intracerebral hemorrhages (ICH) arise from macrovascular causes, necessitating a swift diagnosis, often through invasive procedures like digital subtraction angiography (DSA), which aren't suitable for all patients.
- This study aimed to develop a new risk stratification score, the MACRO score, incorporating MRI findings to improve the identification of macrovascular causes of ICH.
- The MACRO score successfully incorporates various patient factors and MRI markers, demonstrating better predictive capabilities than current CT-based scores, validating its effectiveness in a diverse patient population.
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.
Background: Distal occlusions associated with incomplete reperfusion (expanded Thrombolysis in Cerebral Infarction,
Methods: Retrospective registry analysis of patients undergoing endovascular therapy between July 2020 and December 2022, with available immediate post-interventional FPDCT and 24 hours follow-up perfusion imaging.
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
- A study evaluated the safety and efficacy of IV thrombolysis (IVT) for acute ischemic stroke (AIS) in patients who received dabigatran reversal with idarucizumab, as limited data exist on this topic.
- Thirteen cohorts and one case series involving 553 patients were analyzed, revealing low rates of symptomatic intracranial hemorrhage (4%), any intracranial hemorrhage (10%), and 3-month mortality (18%).
- Functional outcomes were promising, with 56% achieving excellent outcomes and 70% good outcomes at 3 months, with no significant differences observed between patients treated with idarucizumab and those without.
Article Synopsis
- Administering IV thrombolysis for acute ischemic stroke in patients recently on direct oral anticoagulants (DOACs) is risky due to fears of intracranial hemorrhage, prompting guidelines to recommend waiting 48 hours post-ingestion unless safe via coagulation tests.
- New observational studies suggest that IV thrombolysis may be safe for certain patients on DOACs, showing no significant increase in bleeding risk compared to those not on anticoagulants, though reversal agents like idarucizumab could help mitigate risks.
- The variability in treatment guidelines worldwide reflects differing healthcare systems and underscores the need for tailored approaches, particularly in countries like India, while emphasizing the need for further research via randomized trials to solidify protocols for
Introduction: The risk of ischemic stroke and intracerebral hemorrhage (ICH) with intensive lipid control by statins among patients with atrial fibrillation (AF) who require direct oral anticoagulants (DOAC) is unclear. We aimed to determine the risks of ischemic stroke and ICH in AF patients treated with DOAC and statins.
Patients And Methods: In a population-based retrospective cohort study, we identified AF patients concurrently on DOAC and statins from 2015 to 2021 in Hong Kong.
Background: Perfusion abnormalities in the infarct and salvaged penumbra have been proposed as a potential reason for poor clinical outcome (modified Rankin Scale score >2) despite complete angiographic reperfusion (Thrombolysis in Cerebral Infarction [TICI3]). In this study, we aimed to identify different microvascular perfusion patterns and their association with clinical outcomes among TICI3 patients.
Methods: University Hospital Bern's stroke registry of all patients between February 2015 and December 2021.
Article Synopsis
- Early diagnosis of occult cancer in acute ischemic stroke (AIS) patients might lead to quicker treatment and better outcomes, prompting this study to compare mortality rates based on when cancers were diagnosed.
- The research analyzed data from AIS patients treated between 2015 and 2020, finding that out of 3894 patients, 1.5% were diagnosed with new cancer within a year, with a nearly even split between those diagnosed during hospitalization and after discharge.
- Results indicated no significant difference in long-term mortality between the two groups, suggesting that the timing of cancer diagnosis does not impact survival rates, highlighting the need for larger studies to verify these findings.
Factors impacting D-dimer levels in patients with acute ischemic cerebrovascular events.
J Stroke Cerebrovasc Dis
August 2024
Article Synopsis
- The study aimed to understand how time from symptom onset affects D-dimer levels in patients with acute ischemic stroke (AIS) and transient ischemic attack (TIA), as this knowledge may help identify other thrombotic conditions.
- A total of 2467 AIS patients and 708 TIA patients were analyzed, finding that D-dimer levels were higher in AIS patients compared to TIA patients, with distinct fluctuations in D-dimer levels over time in AIS patients.
- The research concluded that while D-dimer levels in AIS patients change significantly after symptoms begin, TIA patients do not show these time-dependent variations, indicating the need for further studies to better utilize D-dimer as a biomarker in acute stroke cases.
Article Synopsis
- The PROCEED model was developed to predict persistent perfusion deficit (PPD) in patients after thrombectomy who have incomplete blood flow restoration, and this study aimed to validate its effectiveness using data from multiple centers.
- Researchers used data from two clinical trials and a cohort from the Medical University of Graz to assess how well the model can predict PPD, analyzing metrics like discrimination and calibration accuracy.
- Results showed the model performed well, accurately identifying PPD in 38% of 371 patients, and offering the potential to reduce unnecessary medical interventions while maintaining the identification of patients with PPD.
Article Synopsis
- Cancer patients have a higher risk of acute ischemic stroke (AIS) and may have a cardiac right-to-left shunt (RLS), but the relationship between RLS and cancer in AIS is unclear.
- In a study of 2,236 AIS patients, only 4.6% had active cancer, and RLS was found less frequently in these patients compared to those without cancer.
- The findings suggest that arterial causes could be more significant than paradoxical embolism in cancer-related strokes, indicating a need for further research on treatment options like patent foramen ovale (PFO) closure for these patients.
Intracerebral hemorrhage (ICH) is a devastating disease, causing high rates of death, disability, and suffering across the world. For decades, its treatment has been shrouded by the lack of reliable evidence, and consequently, the presumption that an effective treatment is unlikely to be found. Neutral results arising from several major randomized controlled trials had established a negative spirit within and outside the stroke community.
View Article and Find Full Text PDFBackground: Pericardial effusion (PE) is the most common serious left atrial appendage closure (LAAC) complication, but its mechanisms, time course, and prognostic impact are poorly understood.
Objectives: This study sought to assess the frequency, timing, predictors and clinical impact of PE after LAAC.
Methods: Data on consecutive patients undergoing percutaneous LAAC between 2009 and 2022 were prospectively collected including the 1-year follow-up.