Prof. Dr. med. Marios-Nikos Psychogios

Hintergrund: Die zellfreie DNA (cfDNA) ist ein pro-inflammatorischer und pro-thrombotischer Mediator im akuten ischämischem Hirnschlag. CfDNA wird von sterbenden Gehirnzellen freigesetzt und ist auch wichtiger ein Bestandteil von „neutrophil extracellular traps“ (NETs) und damit in die Immunothrombose involviert. Die genaue Herkunft von cfDNA und ihre Bedeutung für die Ätiologie und Therapie des Hirnschlags sind jedoch unklar.

Ziel: Die CANTO-Studie untersucht cfDNA im akuten Stadium des Hirnschlags durch kombinierte Blut- und Thrombusanalysen. Ziel ist es, cfDNA in verschiedenen Schlaganfallätiologien sowie in Bezug auf sekundäre Embolien und die Reperfusionswahrscheinlichkeit zu analysieren.

Methodik: In einer prospektiven Kohortenstudie werden Patienten mit akutem ischämischem Hirnschlag untersucht, die einer mechanischen Thrombektomie unterzogen werden. Blutproben werden vor dem Eingriff entnommen, Thromben schockgefroren und mittels Nanopore-Sequenzierung analysiert. Ein 90-Tage-Follow-up wird durchgeführt.

Bedeutung: CANTO wird neue Erkenntnisse zur Rolle von cfDNA im Hirnschlag liefern und damit potentiell neue diagnostische und therapeutische Ansätze ermöglichen.

The frequency of thrombectomy (i.e. endovascular therapy for acute ischemic stroke) is rising, but complications of thrombectomy are poorly explored. Vessel perforation with consecutive intracranial hemorrhage is a severe complication of thrombectomy. The risk factors of vessel perforation are largely unknown. There is also almost no data to guide endovascular hemostatic therapy or to decide whether thrombectomy should be continued after the event of vessel perforation.

PREVENT is a multicenter, prospective and retrospective registry with the aim to

(1) Identify risk factors of vessel perforations

(2) Explore the pathophysiology of vessel perforations

(3) Develop a classification system

(4) Compare different hemostatic treatment strategies

(5) Compare continuation of thrombectomy after vessel perforation and abortion of thrombectomy

(6) Develop a novel, safety-optimized thrombectomy technique

Anticipated study cohort: 500 patients with vessel perforation during thrombectomy and 500 matched patients without perforation during thrombectomy. 

The ICARUS study is a SNSF funded randomized study investigating, whether the permanent insertion of a stent in a cerebral artery improves the long-term quality of life in patients with an acute stroke due to a large vessel occlusion refractory to conventional therapy. It will allow a conclusion to be drawn as to whether this therapeutic strategy is beneficial or not.

The DISTAL study is a SNSF funded randomized study investigating, whether endovascular therapy in addition to best medical therapy improves the long-term quality of life in patients with an acute stroke due to a medium distal vessel occlusion. It will allow a conclusion to be drawn as to whether this therapeutic strategy is beneficial or not.

Stroke is one of the leading causes of mortality and disability worldwide. Optimization of intra-hospital pathways is as of today one of the most promising research topics in stroke treatment. A potential solution to shorten the time needed for current workflows, and therefore reperfusion, is to do both imaging and subsequent endovascular therapy (EVT) in the angiography suite using non-contrast syngo DynaCT Sine Spin (FDCT) for the exclusion of intracranial hemorrhage and flat detector CT angiography (FDCTA) or digital subtraction angiography for diagnosis of LVO. It is still a matter of debate if FDCT can reliably differentiate between ischemic and hemorrhagic stroke.

This study aims to investigate if non-contrast syngo DynaCT Sine Spin imaging is non-inferior to non-contrast MDCT imaging regarding its sensitivity and specificity for the detection of intracranial hemorrhages.