Imperial College London

ProfessorRolandVeltkamp

Faculty of MedicineDepartment of Brain Sciences

Professor of Neurology and Chair of Stroke Medicine
 
 
 
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r.veltkamp

 
 
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3 East6East WingCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
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164 results found

Connolly SJ, Sharma M, Cohen AT, Demchuk AM, Członkowska A, Lindgren AG, Molina CA, Bereczki D, Toni D, Seiffge DJ, Tanne D, Sandset EC, Tsivgoulis G, Christensen H, Beyer-Westendorf J, Coutinho JM, Crowther M, Verhamme P, Amarenco P, Roine RO, Mikulik R, Lemmens R, Veltkamp R, Middeldorp S, Robinson TG, Milling TJ, Tedim-Cruz V, Lang W, Himmelmann A, Ladenvall P, Knutsson M, Ekholm E, Law A, Taylor A, Karyakina T, Xu L, Tsiplova K, Poli S, Kallmünzer B, Gumbinger C, Shoamanesh A, ANNEXA-I Investigatorset al., 2024, Andexanet for Factor Xa Inhibitor-Associated Acute Intracerebral Hemorrhage., N Engl J Med, Vol: 390, Pages: 1745-1755

BACKGROUND: Patients with acute intracerebral hemorrhage who are receiving factor Xa inhibitors have a risk of hematoma expansion. The effect of andexanet alfa, an agent that reverses the effects of factor Xa inhibitors, on hematoma volume expansion has not been well studied. METHODS: We randomly assigned, in a 1:1 ratio, patients who had taken factor Xa inhibitors within 15 hours before having an acute intracerebral hemorrhage to receive andexanet or usual care. The primary end point was hemostatic efficacy, defined by expansion of the hematoma volume by 35% or less at 12 hours after baseline, an increase in the score on the National Institutes of Health Stroke Scale of less than 7 points (scores range from 0 to 42, with higher scores indicating worse neurologic deficit) at 12 hours, and no receipt of rescue therapy between 3 hours and 12 hours. Safety end points were thrombotic events and death. RESULTS: A total of 263 patients were assigned to receive andexanet, and 267 to receive usual care. Efficacy was assessed in an interim analysis that included 452 patients, and safety was analyzed in all 530 enrolled patients. Atrial fibrillation was the most common indication for factor Xa inhibitors. Of the patients receiving usual care, 85.5% received prothrombin complex concentrate. Hemostatic efficacy was achieved in 150 of 224 patients (67.0%) receiving andexanet and in 121 of 228 (53.1%) receiving usual care (adjusted difference, 13.4 percentage points; 95% confidence interval [CI], 4.6 to 22.2; P = 0.003). The median reduction from baseline to the 1-to-2-hour nadir in anti-factor Xa activity was 94.5% with andexanet and 26.9% with usual care (P<0.001). Thrombotic events occurred in 27 of 263 patients (10.3%) receiving andexanet and in 15 of 267 (5.6%) receiving usual care (difference, 4.6 percentage points; 95% CI, 0.1 to 9.2; P = 0.048); ischemic stroke occurred in 17 patients (6.5%) and 4 patients (1.5%), respectively. There were no

Journal article

Tütüncü S, Olma MC, Kunze C, Dietzel J, Schurig J, Rosenkranz M, Stingele R, Maschke M, Heuschmann PU, Kirchhof P, Laufs U, Nabavi DG, Röther J, Thomalla G, Veltkamp R, Endres M, Haeusler KG, MonDAFIS Investigatorset al., 2024, Heart failure, recurrent vascular events and death in patients with ischemic stroke-results of the MonDAFIS study., Intern Emerg Med

Heart failure (HF) is associated with poor outcome after stroke, but data from large prospective trials are sparse.We assessed the impact of HF on clinical endpoints in patients hospitalized with acute ischemic stroke or transient ischemic attack (TIA) enrolled in the prospective, multicenter Systematic Monitoring for Detection of Atrial Fibrillation in Patients with Acute Ischemic Stroke (MonDAFIS) trial. HF was defined as left ventricular ejection fraction (LVEF) < 55% or a history of HF on admission. The composite of recurrent stroke, major bleeding, myocardial infarction, and all-cause death, and its components during the subsequent 24 months were assessed. We used estimated hazard ratios in confounder-adjusted models. Overall, 410/2562 (16.0%) stroke patients fulfilled the HF criteria (i.e. 381 [14.9%] with LVEF < 55% and 29 [1.9%] based on medical history). Patients with HF had more often diabetes, coronary and peripheral arterial disease and presented with more severe strokes on admission. HF at baseline correlated with myocardial infarction (HR 2.21; 95% CI 1.02-4.79), and all-cause death (HR 1.67; 95% CI 1.12-2.50), but not with major bleed (HR 1.93; 95% CI 0.73-5.06) or recurrent stroke/TIA (HR 1.08; 95% CI 0.75-1.57). The data were adjusted for age, stroke severity, cardiovascular risk factors, and randomization. Patients with ischemic stroke or TIA and comorbid HF have a higher risk of myocardial infarction and death compared with non-HF patients whereas the risk of recurrent stroke or major hemorrhage was similar. Trial registration number Clinicaltrials.gov NCT02204267.

Journal article

Prats-Sanchez L, Camps-Renom P, Nash PS, Wilson D, Ambler G, Best JG, Guasch-Jiménez M, Ramos-Pachón A, Martinez-Domeño A, Lambea-Gil Á, Díaz GE, Guisado-Alonso D, Du H, Al-Shahi Salman R, Jäger HR, Lip GY, Ay H, Jung S, Bornstein NM, Gattringer T, Eppinger S, van Dam-Nolen DH, Koga M, Toyoda K, Fluri F, Phan TG, Srikanth VK, Heo JH, Bae H-J, Kelly PJ, Imaizumi T, Staals J, Köhler S, Yakushiji Y, Orken DN, Smith EE, Wardlaw JM, Chappell FM, Makin SD, Mas J-L, Calvet D, Bordet R, Chen CP, Veltkamp R, Kandiah N, Simister RJ, De Leeuw F-E, Engelter ST, Peters N, Soo YO, Zietz A, Hendrikse J, Mess WH, Werring DJ, Marti-Fabregas J, Microbleeds International Collaborative Network MICONet al., 2024, Statin Therapy for Secondary Prevention in Ischemic Stroke Patients With Cerebral Microbleeds., Neurology, Vol: 102

BACKGROUND AND OBJECTIVES: The association between statin use and the risk of intracranial hemorrhage (ICrH) following ischemic stroke (IS) or transient ischemic attack (TIA) in patients with cerebral microbleeds (CMBs) remains uncertain. This study investigated the risk of recurrent IS and ICrH in patients receiving statins based on the presence of CMBs. METHODS: We conducted a pooled analysis of individual patient data from the Microbleeds International Collaborative Network, comprising 32 hospital-based prospective studies fulfilling the following criteria: adult patients with IS or TIA, availability of appropriate baseline MRI for CMB quantification and distribution, registration of statin use after the index stroke, and collection of stroke event data during a follow-up period of ≥3 months. The primary endpoint was the occurrence of recurrent symptomatic stroke (IS or ICrH), while secondary endpoints included IS alone or ICrH alone. We calculated incidence rates and performed Cox regression analyses adjusting for age, sex, hypertension, atrial fibrillation, previous stroke, and use of antiplatelet or anticoagulant drugs to explore the association between statin use and stroke events during follow-up in patients with CMBs. RESULTS: In total, 16,373 patients were included (mean age 70.5 ± 12.8 years; 42.5% female). Among them, 10,812 received statins at discharge, and 4,668 had 1 or more CMBs. The median follow-up duration was 1.34 years (interquartile range: 0.32-2.44). In patients with CMBs, statin users were compared with nonusers. Compared with nonusers, statin therapy was associated with a reduced risk of any stroke (incidence rate [IR] 53 vs 79 per 1,000 patient-years, adjusted hazard ratio [aHR] 0.68 [95% CI 0.56-0.84]), a reduced risk of IS (IR 39 vs 65 per 1,000 patient-years, aHR 0.65 [95% CI 0.51-0.82]), and no association with the risk of ICrH (IR 11 vs 16 per 1,000 patient-years, aHR 0.73 [95% CI 0.46-1.15]). The results in aHR remained con

Journal article

Strunk D, Bauer P, Keyvani K, Diehl RR, Veltkamp R, Berlit P, Meuth SG, Timmermann L, Schwitalla JC, Kraemer Met al., 2024, Moyamoya disease in Southeast Asians: genetic and autopsy data, new cases, systematic review, and meta-analysis of all patients from the literature., J Neurol

BACKGROUND: Moyamoya disease (MMD) is a rare disorder causing ischemic and hemorrhagic juvenile stroke. It is associated with the founder susceptibility variant p.R4810K in the RNF213 gene in East Asia. Our aim was to enhance understanding of MMD in so far poorly characterized Southeast Asians and exploring differences with Caucasian Europeans. METHODS: By retrospective analysis of medical records and systematic database search on PubMed for all published cases, we identified Southeast Asian patients with MMD. We extracted and pooled proportions using fixed-effects models. Our own cohort was tested for the East Asian RNF213 founder variant p.R4810K. One of our Southeast Asian patients underwent post-mortem histopathological examination. RESULTS: The study cohort comprised 32 Southeast Asians. Mean age at onset in the entire cohort was 32.5 ± 20.3 years (n = 24), 43.4 ± 8.7 years in patients admitted to our center (n = 11), and 23.4 ± 22.4 years in patients from the international literature (n = 13). Female-to-male ratio was 1.6:1. MMD predominantly affected bilateral anterior intracranial vessels. Cerebral ischemia outnumbered transient ischemic attacks (TIAs) and intracranial hemorrhage. TIAs, arterial hypertension and obesity were significantly less frequent in Southeast Asian patients compared to Caucasian Europeans. p.R4810K was absent in all examined Southeast Asians despite of typical histopathological signs of MMD in one autopsy case. CONCLUSION: Clinical and histopathological manifestations of MMD in Southeast Asians are similar to those in Caucasian Europeans. The genotype of MMD in Southeast Asians differs from that of most East Asian patients.

Journal article

Wafa HA, Marshall I, Wolfe CDA, Xie W, Johnson CO, Veltkamp R, Wang Y, PRESTIGE-AF consortiumet al., 2024, Burden of intracerebral haemorrhage in Europe: forecasting incidence and mortality between 2019 and 2050., Lancet Reg Health Eur, Vol: 38

BACKGROUND: Anticipating the burden of intracerebral haemorrhage is crucial for proactive management and building resilience against future health challenges. Prior forecasts are based on population demography and to a lesser extent epidemiological trends. This study aims to utilise selected modifiable risk factors and socio-demographic indicators to forecast the incidence and mortality of intracerebral haemorrhage in Europe between 2019 and 2050. METHODS: Three intracerebral haemorrhage risk factors identified in the Global Burden of Diseases, Injuries, and Risk Factors study (GBD 2019)-high systolic blood pressure, high fasting plasma glucose, and high body mass index-were utilised to predict the risk-attributable fractions between 2019 and 2050. Disease burden not attributable to these risk factors was then forecasted using time series models (autoregressive integrated moving average [ARIMA]), incorporating the Socio-demographic Index (SDI) as an external predictor. The optimal parameters of ARIMA models were selected for each age-sex-country group based on the Akaike Information Criterion (AIC). Different health scenarios were constructed by extending the past 85th and 15th percentiles of annualised rates of change in risk factors and SDI across all location-years, stratified by age and sex groups. A decomposition analysis was performed to assess the relative contributions of population size, age composition, and intracerebral haemorrhage risk on the projected changes. FINDINGS: Compared with observed figures in 2019, our analysis predicts an increase in the burden of intracerebral haemorrhage in Europe in 2050, with a marginal rise of 0.6% (95% uncertainty interval [UI], -7.4% to 9.6%) in incident cases and an 8.9% (-2.8% to 23.6%) increase in mortality, reaching 141.2 (120.6-166.5) thousand and 144.2 (122.9-172.2) thousand respectively. These projections may fluctuate depending on trajectories of the risk factors and SDI; worsened trends could result

Journal article

Al-Shahi Salman R, Stephen J, Tierney JF, Lewis SC, Newby DE, Parry-Jones AR, White PM, Connolly SJ, Benavente OR, Dowlatshahi D, Cordonnier C, Viscoli CM, Sheth KN, Kamel H, Veltkamp R, Larsen KT, Hofmeijer J, Kerkhoff H, Schreuder FHBM, Shoamanesh A, Klijn CJM, van der Worp HB, Collaboration of Controlled Randomised Trials of Long-Term Oral Antithrombotic Agents After Spontaneous Intracranial Haemorrhage COCROACHet al., 2023, Effects of oral anticoagulation in people with atrial fibrillation after spontaneous intracranial haemorrhage (COCROACH): prospective, individual participant data meta-analysis of randomised trials., Lancet Neurol, Vol: 22, Pages: 1140-1149

BACKGROUND: The safety and efficacy of oral anticoagulation for prevention of major adverse cardiovascular events in people with atrial fibrillation and spontaneous intracranial haemorrhage are uncertain. We planned to estimate the effects of starting versus avoiding oral anticoagulation in people with spontaneous intracranial haemorrhage and atrial fibrillation. METHODS: In this prospective meta-analysis, we searched bibliographic databases and trial registries using the strategies of a Cochrane systematic review (CD012144) on June 23, 2023. We included clinical trials if they were registered, randomised, and included participants with spontaneous intracranial haemorrhage and atrial fibrillation who were assigned to either start long-term use of any oral anticoagulant agent or avoid oral anticoagulation (ie, placebo, open control, another antithrombotic agent, or another intervention for the prevention of major adverse cardiovascular events). We assessed eligible trials using the Cochrane Risk of Bias tool. We sought data for individual participants who had not opted out of data sharing from chief investigators of completed trials, pending completion of ongoing trials in 2028. The primary outcome was any stroke or cardiovascular death. We used individual participant data to construct a Cox regression model of the time to the first occurrence of outcome events during follow-up in the intention-to-treat dataset supplied by each trial, followed by meta-analysis using a fixed-effect inverse-variance model to generate a pooled estimate of the hazard ratio (HR) with 95% CI. This study is registered with PROSPERO, CRD42021246133. FINDINGS: We identified four eligible trials; three were restricted to participants with atrial fibrillation and intracranial haemorrhage (SoSTART [NCT03153150], with 203 participants) or intracerebral haemorrhage (APACHE-AF [NCT02565693], with 101 participants, and NASPAF-ICH [NCT02998905], with 30 participants), and one included a subgroup of p

Journal article

Ingwersen T, Olma MC, Schlemm E, Mayer C, Cheng B, Tuetuencue S, Kirchhof P, Veltkamp R, Roether J, Laufs U, Nabavi DG, Ntaios G, Endres M, Haeusler KG, Thomalla Get al., 2023, Independent external validation of a stroke recurrence score in patients with embolic stroke of undetermined source, NEUROLOGICAL RESEARCH AND PRACTICE, Vol: 5

Journal article

Schwarzbach CJ, Echer FA, Ruecker V, Hofmann A-L, Keller M, Audebert HJ, von Bandemer S, Engelter ST, Geis D, Groeschel K, Haeusler KG, Hamann GF, Meisel A, Sander D, Schutzmeier M, Veltkamp R, Heuschmann PU, SANO SGet al., 2023, The structured ambulatory post-stroke care program for outpatient aftercare in patients with ischaemic stroke in Germany (SANO): an open-label, cluster-randomised controlled trial, LANCET NEUROLOGY, Vol: 22, Pages: 787-799, ISSN: 1474-4422

Journal article

Strunk D, Diehl RR, Veltkamp R, Meuth SG, Kraemer Met al., 2023, Progression of initially unilateral Moyamoya angiopathy in Caucasian Europeans, JOURNAL OF NEUROLOGY, Vol: 270, Pages: 4415-4422, ISSN: 0340-5354

Journal article

Poli S, Mbroh J, Baron J-C, Singhal AB, Strbian D, Molina C, Lemmens R, Turc G, Mikulik R, Michel P, Tatlisumak T, Audebert HJ, Dichgans M, Veltkamp R, Huesing J, Graessner H, Fiehler J, Montaner J, Adeyemi AK, Althaus K, Arenillas JF, Bender B, Benedikt F, Broocks G, Burghaus I, Cardona P, Deb-Chatterji M, Cvikova M, Defreyne L, De Herdt V, Detante O, Ernemann U, Flottmann F, Guillamon LG, Glauch M, Gomez-Exposito A, Gory B, Grand SS, Harsany M, Hauser TK, Heck O, Hemelsoet D, Hennersdorf F, Hoppe J, Kalmbach P, Kellert L, Kohrmann M, Kowarik M, Lara-Rodriguez B, Legris L, Lindig T, Luntz S, Lusk J, Mac Grory B, Manger A, Martinez-Majander N, Mengel A, Meyne J, Muller S, Mundiyanapurath S, Naggara O, Nedeltchev K, Nguyen TN, Nilsson MA, Obadia M, Poli K, Purrucker JC, Raty S, Richard S, Richter H, Schilte C, Schlemm E, Stohr L, Stolte B, Sykora M, Thomalla G, Tomppo L, van Horn N, Zeller J, Ziemann U, Zuern CS, Hartig F, Tuennerhoff Jet al., 2023, Penumbral Rescue by normobaric O?=?O administration in patients with ischemic stroke and target mismatch proFile (PROOF): Study protocol of a phase IIb trial, INTERNATIONAL JOURNAL OF STROKE, ISSN: 1747-4930

Journal article

Soo Y, Zietz A, Yiu B, Mok VCT, Polymeris AA, Seiffge D, Ambler G, Wilson D, Leung TWH, Tsang SF, Chu W, Abrigo J, Cheng C, Lee K-J, Lim J-S, Shiozawa M, Koga M, Chabriat H, Hennerici M, Wong YK, Mak H, Collet R, Inamura S, Yoshifuji K, Arsava EM, Horstmann S, Purrucker J, Lam BYK, Wong A, Kim YD, Song T-J, Lemmens R, Eppinger S, Gattringer T, Uysal E, Demirelli DS, Bornstein NM, Ben Assayag E, Hallevi H, Molad J, Nishihara M, Tanaka J, Coutts SB, Kappelle LJ, Salman RA-S, Jager R, Lip GYH, Goeldlin MB, Panos LD, Mas J-L, Legrand L, Karayiannis C, Thanh P, Bellut M, Chappell F, Makin S, Hayden D, Williams D, van Dam-Nolen DHK, Nederkoorn PJ, Barbato C, Browning S, Wiegertjes K, Tuladhar AM, Mendyk A-M, Kohler S, van Oostenburgge R, Zhou Y, Xu C, Hilal S, Gyanwali B, Chen C, Lou M, Staals J, Bordet R, Kandiah N, de Leeuw F-E, Simister R, Hendrikse J, Wardlaw J, Kelly P, Fluri F, Srikanth V, Calvet D, Jung S, Kwa VIH, Smith EE, Hara H, Yakushiji Y, Orken DN, Fazekas F, Thijs V, Heo J-H, Veltkamp R, Ay H, Imaizumi T, Lau KK, Jouvent E, Toyoda K, Yoshimura S, Bae H-J, Marti-Fabregas J, Prats-Sanchez L, Lyrer P, Best J, Werring D, Engelter ST, Peters Net al., 2023, Impact of Cerebral Microbleeds in Stroke Patients with Atrial Fibrillation, ANNALS OF NEUROLOGY, Vol: 94, Pages: 61-74, ISSN: 0364-5134

Journal article

Olma MC, Tuetuencue S, Grittner U, Kunze C, Jawad-Ul-Qamar M, Kirchhof P, Roether J, Thomalla G, Veltkamp R, Laufs U, Nabavi DG, Heuschmann PU, Endres M, Haeusler KGet al., 2023, Extent of routine diagnostic cardiac work-up at certified German stroke units participating in the prospective MonDAFIS study, NEUROLOGICAL RESEARCH AND PRACTICE, Vol: 5

Journal article

D'Anna L, Searle G, Harvey K, Matthews PM, Veltkamp Ret al., 2023, Time course of neuroinflammation after human stroke - a pilot study using co-registered PET and MRI, BMC NEUROLOGY, Vol: 23

Journal article

Strunk D, Becker J, Veltkamp R, Meuth SGG, Bauer P, Boettcher T, Rolfs A, Schwitalla JC, Kraemer Met al., 2023, How relevant are cerebral white matter lesions in the D313Y variant of the α-galactosidase A gene? Neurological, cardiological, laboratory, and MRI data of 21 patients within a follow-up of 3 years, NEUROLOGICAL SCIENCES, Vol: 44, Pages: 1375-1381, ISSN: 1590-1874

Journal article

Meinel TR, Wilson D, Gensicke H, Scheitz JF, Ringleb P, Goganau I, Kaesmacher J, Bae H-J, Kim DY, Kermer P, Suzuki K, Kimura K, Macha K, Koga M, Wada S, Altersberger V, Salerno A, Palanikumar L, Zini A, Forlivesi S, Kellert L, Wischmann J, Kristoffersen E, Beharry J, Barber PA, Hong JB, Cereda C, Schlemm E, Yakushiji Y, Poli S, Leker R, Romoli M, Zedde M, Curtze S, Ikenberg B, Uphaus T, Giannandrea D, Portela PC, Veltkamp R, Ranta A, Arnold M, Fischer U, Cha J-K, Wu TY, Purrucker JC, Seiffge DJet al., 2023, Intravenous Thrombolysis in Patients With Ischemic Stroke and Recent Ingestion of Direct Oral Anticoagulants, JAMA NEUROLOGY, Vol: 80, Pages: 233-243, ISSN: 2168-6149

Journal article

Olma MC, Tutuncu S, Fiessler C, Kunze C, Kraemer M, Steindorf-Sabath L, Jawad-Ul-Qamar M, Kirchhof P, Laufs U, Schurig J, Kraft P, Roether J, Guenther A, Thomalla G, Dimitrijeski B, Nabavi DG, Veltkamp R, Heuschmann PU, Haeusler KG, Endres Met al., 2023, In-Hospital ECG Findings, Changes in Medical Management, and Cardiovascular Outcomes in Patients With Acute Stroke or Transient Ischemic Attack, JOURNAL OF THE AMERICAN HEART ASSOCIATION, Vol: 12

Journal article

Becker J, Berlit P, Kastrup O, Schuster S, Strunk D, Veltkamp R, Kraemer Met al., 2022, A contrast medium uptake of the vessel wall is not specific for cerebral vasculitis, NERVENARZT, Vol: 93, Pages: 1271-1273, ISSN: 0028-2804

Journal article

Pompsch M, Veltkamp R, Diehl RR, Kraemer Met al., 2022, Microembolic signals and antiplatelet therapy in Moyamoya angiopathy, JOURNAL OF NEUROLOGY, Vol: 269, Pages: 6605-6612, ISSN: 0340-5354

Journal article

Weber R, Winezki E, Katsanos AH, Cueillette M, Hajjar K, Yamac E, Veltkamp R, Chapot Ret al., 2022, Sex differences in etiology and short-term outcome in young ischemic stroke patients receiving mechanical thrombectomy, Neurological Research and Practice, Vol: 4, ISSN: 2524-3489

BACKGROUND: Although there are well known sex differences in older patients with ischemic stroke receiving acute reperfusion treatments, there is paucity of data in younger patients. METHODS: We investigated sex-related differences in clinical presentation, stroke etiology and short-term outcomes in consecutive young patients with acute ischemic stroke (AIS) below the age of 50 years receiving mechanical thrombectomy (MT) between January 2011 and May 2021 in a tertiary stroke center. RESULTS: We identified a total of 202 young ischemic stroke patients with MT, with 51% being female. Young female AIS patients were significantly younger (39 ± 8 vs. 43 ± 7 years, p < 0.001), and presented with a trend for more severe stroke on admission (median NIHSS 12 vs. 9, p = 0.065), compared to males, respectively. Young female AIS patients had higher rates of embolic strokes of determined or undetermined sources in the anterior circulation, while young male AIS patients suffered more often strokes of arterio-arterial embolism. Complete reperfusion (TICI score 3) was achieved significantly less often in young female AIS patients (69% vs. 83%, p = 0.006), and in-hospital mortality was 2-times higher (5% vs. 2%, p = 0.271) compared to males. CONCLUSIONS: Young female AIS patients receiving MT have higher rates of severe embolic strokes and less often complete reperfusion due to different occlusion sites and stroke etiology compared to males.

Journal article

Focke JK, Veltkamp R, Bauer P, Kraemer Met al., 2022, Novel heterozygous COL4A2 variant c.2572A &gt; G, p.(I858V) mimicking Sneddon's and Divry van Bogaert Syndrome, JOURNAL OF NEUROLOGY, Vol: 269, Pages: 5153-5156, ISSN: 0340-5354

Journal article

Pimentel BC, Ingwersen T, Haeusler KG, Schlemm E, Forkert ND, Rajashekar D, Mouches P, Koenigsberg A, Kirchhof P, Kunze C, Tuetuencue S, Olma MC, Kraemer M, Michalski D, Kraft A, Rizos T, Helberg T, Ehrlich S, Nabavi DG, Roether J, Laufs U, Veltkamp R, Heuschmann PU, Cheng B, Endres M, Thomalla Get al., 2022, Association of stroke lesion shape with newly detected atrial fibrillation - Results from the MonDAFIS study, European Stroke Journal, Vol: 7, Pages: 230-237, ISSN: 2396-9873

Paroxysmal Atrial fibrillation (AF) is often clinically silent and may be missed by the usual diagnostic workup after ischemic stroke. We aimed to determine whether shape characteristics of ischemic stroke lesions can be used to predict AF in stroke patients without known AF at baseline. Lesion shape quantification on brain MRI was performed in selected patients from the intervention arm of the Impact of standardized MONitoring for Detection of Atrial Fibrillation in Ischemic Stroke (MonDAFIS) study, which included patients with ischemic stroke or TIA without prior AF. Multiple morphologic parameters were calculated based on lesion segmentation in acute brain MRI data. Multivariate logistic models were used to test the association of lesion morphology, clinical parameters, and AF. A stepwise elimination regression was conducted to identify the most important variables. A total of 755 patients were included. Patients with AF detected within 2 years after stroke (n = 86) had a larger overall oriented bounding box (OBB) volume (p = 0.003) and a higher number of brain lesion components (p = 0.008) than patients without AF. In the multivariate model, OBB volume (OR 1.72, 95%CI 1.29–2.35, p < 0.001), age (OR 2.13, 95%CI 1.52–3.06, p < 0.001), and female sex (OR 2.45, 95%CI 1.41–4.31, p = 0.002) were independently associated with detected AF. Ischemic lesions in patients with detected AF after stroke presented with a more dispersed infarct pattern and a higher number of lesion components. Together with clinical characteristics, these lesion shape characteristics may help in guiding prolonged cardiac monitoring after stroke.

Journal article

Tutuncu S, Olma MC, Kunze C, Kraemer M, Dietzel J, Schurig J, Filser P, Pfeilschifter W, Hamann GF, Buettner T, Heuschmann PU, Kirchhof P, Laufs U, Nabavi DG, Roether J, Thomalla G, Veltkamp R, Eckardt K-U, Haeusler KG, Endres Met al., 2022, Levels and dynamics of estimated glomerular filtration rate and recurrent vascular events and death in patients with minor stroke or transient ischemic attack, EUROPEAN JOURNAL OF NEUROLOGY, Vol: 29, Pages: 2716-2724, ISSN: 1351-5101

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Nielsen PB, Melgaard L, Overvad TF, Jensen M, Larsen TB, Lip GYHet al., 2022, Risk of cerebrovascular events in intracerebral hemorrhage survivors with atrial fibrillation: a nationwide cohort study, Stroke, Vol: 53, Pages: 2559-2568, ISSN: 0039-2499

Background:In patients with intracerebral hemorrhage (ICH) and prevalent atrial fibrillation (AF), the optimal stroke prevention strategy is unclear. We sought to estimate the risk of cerebrovascular events among ICH survivors with AF.Methods:We used the Danish Stroke Registry to identify patients with incident ICH and prevalent AF between 2003 and 2018. Key inclusion/exclusion criteria of the PRESTIGE-AF (Prevention of Stroke in Intracerebral hemorrhage Survivors With Atrial Fibrillation) trial were applied. Cumulative incidence of recurrent ICH, cerebrovascular ischemic event, and all-cause death were investigated after one year.Results:A total of 1885 patients (median age 80.0 years; 47.6% females) were included in the study. We observed 191 cerebrovascular events and 650 all-cause deaths, and more cerebrovascular ischemic events (N=63) than recurrent ICH events (N=40). Risks of recurrent ICH, cerebrovascular ischemic event, and all-cause death were 1.5%, 3.2%, and 30.3%, respectively, among patients not exposed to OAC during follow-up. The cumulative incidences were 2.8% for recurrent ICH, 3.2% for cerebrovascular ischemic events, and 22.0% for all-cause death among patients initiating/resuming OAC during follow-up.Conclusions:We observed a high risk of cerebrovascular ischemic events and a very high risk of all-cause death at one year after the incident ICH. The results of ongoing clinical trials are warranted to determine optimal stroke prevention treatment among ICH survivors with concomitant AF.

Journal article

Best JG, Arram L, Ahmed N, Balogun M, Bennett K, Bordea E, Campos MG, Caverly E, Chau M, Cohen H, Dehbi H-M, Dore CJ, Engelter ST, Fenner R, Freemantle N, Hunter R, James M, Lip GYH, Murray ML, Norrving B, Sprigg N, Veltkamp R, Zaczyk I, Werring DJet al., 2022, Optimal timing of anticoagulation after acute ischemic stroke with atrial fibrillation (OPTIMAS): Protocol for a randomized controlled trial, INTERNATIONAL JOURNAL OF STROKE, Vol: 17, Pages: 583-589, ISSN: 1747-4930

Journal article

Kraemer M, Strunk D, Becker J, Veltkamp R, Berlit Pet al., 2022, Recovery of intracranial stenoses in varicella zoster virus vasculitis after long-term treatment with valacyclovir and prednisolone, Neurological Research and Practice, Vol: 4, ISSN: 2524-3489

BACKGROUND AND PURPOSE: Optimal treatment of intracranial stenoses in varicella zoster virus (VZV)-associated vasculitis is unknown. This study aims to evaluate the merits and potential pitfalls of a specific therapeutic strategy, initially proposed by Don Gilden in 2015. METHODS: We describe three patients with intracranial stenoses caused by VZV vasculitis successfully treated by a long-term combination of valacyclovir and prednisolone. RESULTS: All three patients were young men suffering from stroke. Only one reported a first contact to VZV in adulthood. All three presented stenoses in the intracranial part of the internal carotid artery or the proximal segments of the middle cerebral artery as well as an elevated cell count and positive VZV antibody index in cerebrospinal fluid. They received a combination therapy regimen with prednisone and valacyclovir about a minimum of one year. Intracranial stenoses improved markedly in one and almost resolved completely in the other two patients. Side effects of corticosteroid treatment occurred in two patients. CONCLUSIONS: Long-term combination treatment with prednisone and valacyclovir proved to be effective in three young men suffering from intracranial stenosis due to VZV vasculitis.

Journal article

D'Anna L, Filippidis F, Harvey K, Korompoki E, Veltkamp Ret al., 2022, Ischemic Stroke in orally anticoagulated patients with atrial fibrillation, Acta Neurologica Scandinavica, Vol: 145, Pages: 288-296, ISSN: 0001-6314

BackgroundIschemic strokes in orally anticoagulated patients pose challenges for acute management and secondary prevention but the characteristics of these strokes are poorly understood. We examined the clinical and imaging features, the presumed underlying etiology and the subsequent antithrombotic management.MethodsWe analyzed a consecutive series of patients enrolled into the EIDASAF study, a single center, observational study of ischemic stroke patients with a diagnosis atrial fibrillation (AF) prior to the index event who had been admitted to the Hyperacute Stroke Unit of Imperial College London between 2010 and 2017. We compared patients with oral anticoagulation therapy prior admission (OACprior) with those without anticoagulation (OACnaive). Brain imaging was analyzed centrally.Results763 patients were included in the analysis. 481 (63%) were OACnaive while 282 (37%) were OACprior. Patients with OACprior were younger, more often had a previous history of stroke or transient ischemic attack (TIA), and more often suffered from hypertension and diabetes. In OACnaive, patients, large and deep middle cerebral artery infarcts occurred more often than in OACprior patients. The groups differed significantly in the distribution of competing etiologies underlying their stroke. At discharge, OACprior more frequently were (re)-anticoagulated compared to OACnaive patients. Within the OACprior group, patients with recurrent strokes did not differ from those with a first stroke regarding clinical characteristics and pattern of cerebral infarction but they were less frequently anticoagulated.ConclusionsIschemic strokes on OAC represent a significant proportion of AF-related strokes. There is an unmet need to better understand the causes underlying these strokes and to optimize the medical management.

Journal article

Strunk D, Veltkamp R, Meuth SG, Chapot R, Kraemer Met al., 2022, Intra-arterial application of nimodipine in reversible cerebral vasoconstriction syndrome: a neuroradiological method to help differentiate from primary central nervous system vasculitis, Neurological Research and Practice, Vol: 4, ISSN: 2524-3489

BACKGROUND: Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by a prolonged, but self-limiting segmental cerebral vasoconstriction. Neurological outcomes vary, but can be severe. The clinical hallmark of RCVS is thunderclap headache, which might come along with further neurological symptoms. Distinguishing RCVS from other entities, such as primary angiitis of the central nervous system (PACNS), is of utmost importance for appropriate therapy. The angiographic response to intra-arterial nimodipine application has been suggested as an additional diagnostic criterion for RCVS but confirmatory studies are limited. We aimed to evaluate the angiographic nimodipine test. METHODS: We reviewed retrospectively the clinical and imaging data of 13 RCVS patients, who were admitted to a single German neurological department between January 2013 and December 2020. RESULTS: Out of 13 patients diagnosed with RCVS, 4 patients underwent an angiographic nimodipine test. In all 4 patients cerebral vasoconstriction completely resolved during nimodipine application. Among the four patients with a positive test, there was one individual, in whom a response was detected after a delay of 60 min. In all patients, we found a complete resolution of cerebral vasoconstriction within 12 weeks. CONCLUSION: Our findings support the usefulness of the application of nimodipine in diagnosing RCVS. Prolonged angiographic observation of the vascular response after nimodipine injection is important.

Journal article

Van Mieghem NM, Unverdorben M, Hengstenberg C, Moellmann H, Mehran R, Lopez-Otero D, Nombela-Franco L, Moreno R, Nordbeck P, Thiele H, Lang I, Zamorano JL, Shawl F, Yamamoto M, Watanabe Y, Hayashida K, Hambrecht R, Meincke F, Vranckx P, Jin J, Boersma E, Rodes-Cabau J, Ohlmann P, Capranzano P, Kim H-S, Pilgrim T, Anderson R, Baber U, Duggal A, Laeis P, Lanz H, Chen C, Valgimigli M, Veltkamp R, Saito S, Dangas GDet al., 2021, Edoxaban versus Vitamin K Antagonist for Atrial Fibrillation after TAVR, NEW ENGLAND JOURNAL OF MEDICINE, Vol: 385, Pages: 2150-2160, ISSN: 0028-4793

Journal article

Laible M, Horstmann S, Ringleb PA, Veltkamp R, Jenetzky E, Rizos Tet al., 2021, Does Chronic Kidney Disease Have an Impact on the Use of Oral Anticoagulants after Stroke? An Observational Follow-Up Study, EUROPEAN NEUROLOGY, Vol: 84, Pages: 354-360, ISSN: 0014-3022

Journal article

D'Anna L, Filippidis FT, Harvey K, Marinescu M, Bentley P, Korompoki E, Veltkamp Ret al., 2021, Extent of white matter lesion is associated with early hemorrhagic transformation in acute ischemic stroke related to atrial fibrillation, Brain and Behavior, Vol: 11, Pages: 1-8, ISSN: 2162-3279

BackgroundHemorrhagic transformation (HT) after stroke, related to atrial fibrillation (AF), is a frequent complication, and it can be associated with a delay in the (re-)initiation of oral anticoagulation therapy. We investigated the effect of the presence and severity of white matter disease (WMD) on early HT after stroke related to AF.MethodsA consecutive series of patients with recent (<4 weeks) ischemic stroke and AF, treated at the Hyper Acute Stroke Unit of the Imperial College London between 2010 and 2017, were enrolled. Patients with brain MRI performed 24–72 h from stroke onset and not yet started on anticoagulant treatment were included. WMD was graded using the Fazekas score.ResultsAmong the 441 patients eligible for the analysis, 91 (20.6%) had any HT. Patients with and without HT showed similar clinical characteristics. Patients with HT had a larger diffusion-weighted imaging (DWI) infarct volume compared to patients without HT (p < .001) and significant difference in the distribution of the Fazekas score (p = .001). On multivariable analysis, HT was independently associated with increasing DWI infarct volume (odd ratio (OR), 1.03; 95% confidence interval (CI), 1.01–1.05; p < .001), higher Fazekas scores (OR, 1.94; 95% CI, 1.47–2.57; p < .001) and history of previous intracranial hemorrhage (OR, 4.80; 95% CI, 1.11–20.80; p = .036).ConclusionsPresence and severity of WMD is associated with increased risk of development of early HT in patients with stroke and AF. Further evidence is needed to provide reliable radiological predictors of the risk of HT in cardioembolic stroke.

Journal article

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