Project 13

Stroke: risk factors and etiology, prognosis and treatment

Stroke is a heterogeneous disease; it comprises ischemic stroke, intracerebral hemorrhage and subarachnoid hemorrhage. Stroke is a high-ranking cause of death and the most common cause of acquired disability in The Netherlands and Western Europe.  Causes of disability include motor dysfunction and disturbances of language, memory and cognition.
Etiologic studies within this project include genetics, hemostasis (von Willebrand factor, fibrinogen), glucose metabolism, cardioembolic disorders, and carotid plaque morphology (PARISK). New translational research will be aimed at microvascular obstruction after thrombectomy in acute ischemic stroke.
Intervention studies included a series of multicenter RCT's of the effect of prevention of high body temperature and fever (PAIS). Also, we conducted a large national multicenter study of the effect of intra-arterial treatment for acute ischemic stroke (MR CLEAN), which was extended into a national registry of thrombectomy interventions, and includes a database with thrombus material and neuro-imaging.

In 2017 we started the CONTRAST consortium, a national COllaboration for New Treatments of Acute Stroke, funded by Dutch Heart Foundation, Brain Foundation Netherlands, Health Holland and several private parties (unrestricted funding). The overarching aim of CONTRAST is to improve outcome of patients with stroke by merging translational research and pragmatic randomized clinical trials, with a firm view of the future of Dutch Stroke Research beyond the coming five years. Consortium leaders are D Dippel (Erasmus MC) and CB Majoie (AMC). The consortium's projects include a multicenter clinical trial of prehospital glyceryl trinitrate treatment for acute stroke, 3 trials of modifications of endovascular treatment for acute ischemic stroke, and multicenter neurosurgical pilot study of endoscopy guided microsurgery for acute intracerebral hematoma treatment. The consortium further includes a clinical databank, biobank, imaging databank to facilitate prognostic studies and links with the translational science work package, see www.contrast-consortium.nl .

Furthermore, we evaluated early cognitive linguistic treatment of aphasia in a series of multicenter RCTs (RATS), and the role of endocrine dysfunction in SAH.
Data for genetic, prognostic and etiologic studies are derived from the Erasmus Stroke Study, an ongoing hospital based registry, and from the Rotterdam study, a large population based cohort study.

Principal Investigators DWJ Dippel, PJ Koudstaal
Co-InvestigatorsHMM van Beusekom, CM van Duijn, BJ Emmer, A van Es, MH den Hertog, MA Ikram, MK Ikram, PM Janssen, F van Kooten, H. Lingsma, M de Maat,  HF Lingsma, A van der Lugt,  MPM de Maat, G Ribbers, B Roozenbeek,  M Smits, EW Steyerberg,
EJG Sijbrands, MW Vernooij, EG Visch-Brink.
PhD candidatesD Beumer, V Chalos, C Compagne, PSS Fransen, RA van de Graaf, L Khajeh, E Osei, E Venema, E Wiegers, H Hund, P Homburg, N Samuels, S Dijkland, M van Gils