Publications by authors named "Thomas R Meinel"
Background: Selection of acute stroke patients for endovascular thrombectomy (EVT) within 6 h from symptom onset can be done using MRI or CT. However, association of either imaging modality with better clinical outcomes or shorter workflow times is still not fully understood.
Methods: We searched Medline and Ovid-Embase for studies comparing outcomes and workflow metrics between patients selected for EVT using CT or MRI from inception to November 30, 2024.
Background And Objectives: While MRI is known to be crucial for TIA workup, the benefit of perfusion-weighted imaging (PWI) is underexplored. We aimed to assess the association between focal hypoperfusion on baseline PWI MRI and the long-term incidence of subsequent acute ischemic stroke (AIS) after TIA.
Methods: Consecutive patients with TIA who underwent baseline PWI MRI as part of their emergency consultation between January 2015 and December 2019 were retrospectively identified.
Background: Intravenous thrombolysis (IVT) in patients with recent ingestion of direct oral anticoagulants (DOACs) is a frequent challenge and remains controversial. The benefit of DOAC reversal before IVT is uncertain.
Methods: Using target trial methodology, we analyzed data from 28 comprehensive stroke centers.
Background And Objectives: Diffusion-weighted imaging (DWI) lesions in patients with intracerebral hemorrhage (ICH) are associated with poor outcomes. Knowledge about the underlying pathophysiology is scarce, and it is hypothesized that they are related to either the ICH itself, adverse effects of treatment, or the activity of the underlying small vessel disease (SVD) causing the ICH. We investigated their association with time point of MRI acquisition and underlying SVD type and burden.
View Article and Find Full Text PDFBackground And Objectives: More than half of the endovascularly treated ischemic stroke patients with incomplete reperfusion (expanded Thrombolysis in Cerebral Infarction [eTICI] <3) show delayed reperfusion (DR) on 24-hour perfusion imaging, which is associated with favorable clinical outcome. The effect of intravenous thrombolysis (IVT) on the rates of DR remains unclear. This study aimed to assess the treatment effect of IVT on the occurrence of DR.
View Article and Find Full Text PDFBackground: Chronic cerebellar lesions of presumed ischemic origin are frequently found in patients with ischemic stroke and as incidental findings. However, the differentiation of embolic lesions from lesions caused by cerebral small vessel disease (SVD) is unclear. We aimed to investigate whether the location of chronic cerebellar ischemic lesions (deep versus cortical) indicates the underlying cause (embolic versus SVD).
View Article and Find Full Text PDFIntravenous 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 PDFBackground And Objectives: Covert brain infarcts (CBIs) in patients with first-ever ischemic stroke (IS) and atrial fibrillation (AF) are associated with an increased risk of stroke recurrence. We aimed to assess whether CBIs modify the treatment effect of early vs late initiation of direct oral anticoagulants (DOACs) in patients with IS and AF.
Methods: We conducted a post hoc analysis of the international, multicenter, randomized-controlled ELAN trial, which compared early (<48 hours after ischemic stroke for minor and moderate stroke, 6-7 days for major stroke) vs late (>48 hours for minor, 3-4 days for moderate, 12-14 days for major stroke) initiation of DOACs in patients with IS and AF.
Background: A third of endovascularly treated patients with stroke experience incomplete reperfusion (expanded Thrombolysis in Cerebral Infarction [eTICI] <3), and the natural evolution of this incomplete reperfusion remains unknown. We systematically reviewed the 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.
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
- 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
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
- The study investigates the timing of endovascular therapy (EVT) for severe cerebral venous sinus thrombosis (CVST), comparing early initiation (<24 hours) to late initiation (>24 hours) regarding patients' recovery outcomes.
- Results showed that early EVT significantly increased the likelihood of functional independence at 3 months (66.7% vs. 27.3%) and was associated with lower mortality rates (16.7% vs. 36.4%) at 90 days.
- The findings suggest that prompt EVT may lead to better recovery in CVST cases, but further randomized controlled trials are needed to validate these results and support the "time-is-brain" concept.
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.
Article Synopsis
- The study evaluated the safety and efficacy of using intravenous thrombolysis (IVT) with alteplase in patients on direct oral anticoagulants (DOACs) without strict guidelines on plasma levels or last intake time.
- Researchers included 98 DOAC patients from their stroke registry, comparing outcomes between those who received IVT and those who did not.
- Results showed no symptomatic intracranial hemorrhage in IVT patients, and those who received IVT had better functional outcomes, indicating a need for further randomized controlled trials.
Background: Sometimes migraine aura changes from attack to attack, raising the question of whether the change is heralding an ischemic stroke or an unusual aura. Differentiating unusual migraine aura from the onset of an acute ischemic stroke in patients with migraine with aura (MwA) can be challenging.
Objective: The aim of this cohort study was to assess clinical characteristics that help distinguish between MwA and minor stroke in patients with a previous history of MwA who presented with suspicion of stroke.
Value of intravenous alteplase before thrombectomy among patients with tandem lesions and emergent carotid artery stenting: A subgroup analysis of the SWIFT DIRECT trial.
Eur J Neurol
June 2024
Background And Purpose: The value of intravenous thrombolysis (IVT) in eligible tandem lesion patients undergoing endovascular treatment (EVT) is unknown. We investigated treatment effect heterogeneity of EVT + IVT versus EVT-only in tandem lesion patients. Additional analyses were performed for patients undergoing emergent internal carotid artery (ICA) stenting.
View Article and Find Full Text PDFIntracerebral haemorrhage in patients taking different types of oral anticoagulants: a pooled individual patient data analysis from two national stroke registries.
Stroke Vasc Neurol
December 2024
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.
Article Synopsis
- This study investigates whether the effectiveness of intravenous thrombolysis (IVT) combined with thrombectomy for treating acute ischemic stroke decreases as time from symptom onset increases.
- It involves a comprehensive analysis of data from six clinical trials, focusing on patients with anterior circulation large-vessel occlusions who arrived at treatment centers between January 2017 and July 2021.
- Results indicate a statistically significant relationship between the timing of IVT administration and treatment outcomes, suggesting that the benefit of combining IVT with thrombectomy may be time-dependent.
Thrombolysis for ischaemic stroke despite direct oral anticoagulation.
Stroke Vasc Neurol
November 2024
Intravenous thrombolysis is not recommended in anticoagulated patients receiving direct oral anticoagulants (DOACs) and a recent intake within the last 48 hours in US and European guidelines. However, three observational studies now suggest safety of thrombolysis in patients with recent intake of DOACs, and thus support previous experimental data. In this perspective, the current evidence and practical consequences are discussed.
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