[FG] Tränka Christopher

Our research in clinical neurology and neurorehabilitation focuses on two main areas:

(1) Cervical artery dissection (CeAD) is the leading cause of stroke in the young. Despite its importance, and despite two recent randomized controlled trials (RCTs) and a large observational study, it remains unclear whether CeAD patients should receive antiplatelet agents or anticoagulation for stroke prevention, and data on modern options such as direct oral anticoagulants are lacking. With this in mind, we designed the TREAT-CAD 2 RCT. This successor to our prior TREAT-CAD trial is an international, multicentre strategy trial comparing antiplatelet with anticoagulation treatment strategies, and will be the largest treatment RCT in CeAD patients to date.

Beyond acute treatment, a second strand of our CeAD research addresses long-term outcomes. Most patients experience a good physical and functional recovery, with low rates of delayed strokes and recurrent dissections beyond three months. Yet limited evidence suggests these outcomes look far less favourable once psychological sequelae and long-term quality of life are considered: mental health problems after CeAD are a major, under-recognized, and poorly understood burden. We are therefore building a prospective CeAD cohort with up to ten years of follow-up, focused on the neuropsychological consequences and social impact of the disease, the evolution of vascular risk factors, and the genetic determinants underlying these outcomes — particularly the neuropsychological ones.

(2) Recovery after stroke. While acute stroke treatment has advanced dramatically, our ability to actively enhance recovery afterwards remains limited and under-explored. Building on the successful completion of ESTREL — our multicentre randomised trial of levodopa versus placebo to promote motor recovery — our aim is to transform ESTREL into a lasting research platform. By linking genetics, biomarkers, and imaging to deeply phenotyped patients and high-quality outcome data, this platform will allow us to pursue more fundamental questions: what actually drives recovery, why some patients regain function while others do not, and how the determinants of motor recovery can be identified early enough to act upon. Ultimately, we aim to identify new treatment targets and test them in future RCTs designed to enhance stroke recovery, including pharmacologically.