Neurologie

BRUTUS – Biomarker Signature for Rescue Therapy in Wake-Up Stroke

Intravenous thrombolysisis (IVT) is effective and safe for the treatment of acute ischemic stroke within 4.5 hours of symptom onset. However, up to 25% of all stroke patients present to the emergency department with unknown onset of symptoms (wake-up stroke) and so, IVT is generally considered contraindicated in these patients. Imaging based trials aiming at the identification of wake-up strokes who are still eligible for IVT are currently ongoing. There are promising blood biomarker candidates which might be of additional value.
We hypothesize that our selected biomarkers or a combination of them discriminate patients with stroke symptom onset within a 4.5h time window from those between >4.5 - 24h.

International PFO-Consortium – Secondary Stroke Prevention in patients with Patent Foramen Ovale

The prevalence of patent foramen ovale (PFO) is about 25% in the general population and approximately 40% in patients with ischemic stroke of unknown cause (cryptogenic stroke, CS). Given the large number of asymptomatic patients, no primary prevention is currently recommended. In contrast, patients suffering from a PFO-related ischemic stroke are usually treated with either antiplatelets/ oral anticoagulation (AP/OAC) or percutaneous device closure (PDC). To date, there is no clear evidence that PDC is superior to medical treatment or vice versa. Three recent randomized clinical trials comparing both treatment options failed to demonstrate a significant difference in terms of secondary stroke prevention.
This multicenter registry comprising 19 hospitals in Europe and the US represents an alternative data strategy with a larger sample size and longer follow-up periods designed to overcome the difficulties observed in the latest clinical trials.
The study aims at 1) To compare the risk of recurrent stroke and TIA in CS patients aged ≤ 55 years with PFO who undergo PDC or receive AP/OAC only; 2) To assess the etiological role of PFO for stroke/TIA in patients aged > 55 years; and 3) To assess the risk of recurrent stroke/TIA in “high-risk” PFO patients.

BIOSIGNAL – Biomarker Signature of Stroke Aetiology

The identification of stroke etiology is crucial for tailored secondary stroke prevention strategies. However, despite a thorough and complete work up, up to 25% of patients are discharged with an undetermined source of stroke.
This multicenter, cohort study aims at prospectively investigating the predictive value of the most promising blood biomarkers to identify treatable stroke etiologies already on admission and risk of stroke recurrence in 3000 consecutive ischemic stroke patients enrolled by stroke centers in Europe and the US.

The type of antithrombotic treatment in cervical artery dissection (CAD) is still a matter of debate. Anticoagulants were wiedely prescribed for stroke prevention in these patients. However, observational studies suggest that the use of antiplatelets might be a safe and efficient alternative. Moreover, prior research suggested that inflammatory mechanisms are involved in CAD pathogenesis which may offer an additional treatment target.
This multicenter, randomized controlled trial aims at demonstrating the non-inferiority of acetylsalicylic acid to anticoagulant treatment in CAD-patients with regard to functional outcome and complications.

PRESS – Predicitive swallowing score validation study

Swallowing difficulties are a common sequelae of ischemic stroke occuring in up to 60% of cases and may lead to aspiration pneumonia, dehydration and malnutrition. To prevent these complications and to ensure proper nutrition, it may be necessary to establish enteral tube feeding in dysphagic patients. Guidelines recommend early tube feeding in stroke patients with impaired intake for ≥ 7 days and PEG feeding if impaired oral intake is likely to persist for ≥ 30 days. Hence, accurate and early prediction of the assumed duration of impaired swallowing is important.
Recently, the Predictive swallowing score has been developed in a derivation cohort and showed to be a good predictor of time to recovery of oral intake. The main aim of this prospective, multicenter cohort study conducted in the Swiss Stroke Centers of St. Gallen, Basel, Bern and Aarau is the validation of the new PREdictive Swallowing Score and to better guide patient selection for early enteral tube feeding/ PEG in these patients. 

Multicenter, randomized, interventional trial of secondary stroke prevention in patients with an Embolic Stroke of Unkonwn Source, comparing rivaroxaban 15mg once daily with aspirin 100mg/die.