The "Neurovascular Research Group" is scientifically involved mainly in interdisciplinary projects with the aim of optimizing clinical patient care. In addition to the recruitment and management of patients in multicenter studies, investigator-initiated trials are performed in cooperation with disciplinary neighboring departments. The detection of atrial fibrillation, the interventional acute treatment of stroke or the long-term observation of patients with extra- and intracranial stents are scientific topics that have been established in recent years. In addition, close networking with the local Neurovascular Outpatient Clinic and the Neurosonology Laboratory ensure optimal long-term patient care.
One focus of neurovascular stroke research is the interface "heart and brain", which is investigated from different angles. An investigator-initiated trial (FIND-AF) for the detection of atrial fibrillation in patients with acute stroke was successfully performed and completed (Stroke 2010). This was followed by a randomized trial that proved that intensified search for AF actually finds previously undetected AF more frequently. The results were presented at the inaugural International Stroke Conference in Los Angeles and published in the prestigious journal Lancet Neurology (Lancet Neurol 2017). Further studies on specific biomarkers (e.g., neurofilament light chains, natriuretic peptides), cardiac echo parameters, and socioeconomic aspects are currently being evaluated and analyzed. Based on this preliminary work, a grant from the German Research Foundation (DFG) was obtained. One of the largest DFG-funded studies in Germany to date (Intensive Rhythm Monitoring to Decrease Ischemic Stroke and Systemic Embolism - the Find-AF 2 Study) is now being conducted and will include 5,200 patients. This multicenter, randomized trial will prospectively investigate whether intensified search for atrial fibrillation will not only increase the burden of AF detection, but also prevent stroke recurrence.
To estimate the probability of detecting AF after a stroke, the AS5f score was developed and validated in a cohort of more than 1,500 patients (more info: German / English). This score uses purely clinical data: Patient age, stroke type (transient ischemic attack vs. stroke), and stroke severity; and from this calculates the probability of detecting AF in a 72-hour long-term ECG. It also reports the Number-Needed to Screen, which indicates how many patients need to be screened with a 72-hour long-term ECG to detect a patient with AF (Neurology 2019).
The highly endowed Boehringer-Ingelheim Science Prize was awarded in 2019 for this clinically important work.
In 2016, the recommendations for acute stroke therapy were changed to recommend local thrombectomy in addition to systemic lysis therapy as a recanalizing therapy. Within the framework of prospective registries (German Stroke Registry - Endovascular Treatment (GSR-ET)), data are collected here for quality assurance purposes so that optimized patient care can be provided. The teleneurological connection of hospitals, introduced in April 2016, also plays an important role here: our department offers neurovascular expertise in the acute care of stroke patients for other hospitals in Rheinland-Pfalz via a video consultation service (www-temes-rlp.de).
Neurofilament light chains are components of the cell skeleton of nerve cells. Since they occur exclusively in nerve cells, they have the potential to become a general marker for central nervous system involvement - similar to the way "troponin" helps cardiologists detect heart damage. In collaboration with AG Bittner and AG Zipp, the level of neurofilament light chains is determined in the blood of patients after cerebral ischemia. Our own work proves the importance of neurofilament light chains in prognosis assessment after a stroke. Further work aims to determine neurofilament light chains for diagnosis and prognosis assessment in special patient populations with neurovascular diseases in order to derive direct recommendations for clinical routine.
Prospective record of the use of Dabigatran in patients with acute stroke or TIA (PRODAST).
German Stroke Registry - Endovascular Treatment (GSR-ET)
Structured Outpatient Stroke Follow-up (SANO)
Gutenberg Stroke Study - Identification and Characterization of Markers of Etiology, Progression and Therapeutic Response in Patients with Vascular Diseases of the Central Nervous System (GSS)
Intensive Rhythm Monitoring to Decrease Ischemic Stroke and Systemic Embolism - the FIND-AF 2 Study (Find-AF2)
Prof. Dr. med. Klaus Gröschel
Dr. Timo Uphaus
Dr. Eyad Hayani