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Predicting outcome after stroke: take a look at the other side

English title Predicting outcome after stroke: take a look at the other side
Applicant Wegener Susanne
Number 170683
Funding scheme SNSF Professorships
Research institution Neurologische Klinik Universitätsspital Zürich
Institution of higher education University of Zurich - ZH
Main discipline Clinical Cardiovascular Research
Start/End 01.09.2017 - 31.08.2021
Approved amount 1'509'881.00
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Keywords (3)

neuroimaging; stroke; outcome prediction

Lay Summary (German)

Lead
Die Behandlung des Schlaganfalles in der Akutphase ist schwierig, da sie mit Komplikationen verbunden sein kann, Therapie-Entscheidungen aber in kurzer Zeit getroffen werden müssen. Bisherige Prädiktoren für Therapieerfolg konzentrieren sich auf die Schlaganfall-Läsion selbst (Größe, Schwere des Gewebeschadens). In dem Projekt soll untersucht werden, wieweit die Gegenseite des Gehirns über Regulation der Hirndurchblutung und Kollateralversorgung zum Schutz des betroffenen Gebietes beiträgt. Hieraus sollen neue Prädiktoren für Therapie-Erfolg entwickelt werden.
Lay summary

Inhalt und Ziele des Forschungsprojektes

Trotz weiterentwickelter Behandlungsmöglichkeiten stellt Schlaganfall weiterhin ein immenses Problem für die Betroffenen und ihre Familien dar. Zudem ist die Akutbehandlung (Thrombolyse) mit Risiken verbunden. Bildgebung des Gehirns ist ein zentraler Bestandteil der Schlaganfalldiagnostik und wird zur Entscheidung für oder gegen eine Therapie genutzt. Hierbei beurteilt der Kliniker Grösse und Schwere der Läsion zusammen mit anderen Faktoren wie Alter und Begleiterkrankungen, um eine optimale Entscheidung für den Patienten zu treffen. Dies ist aber mit den bestehenden Methoden nur ungenügend möglich. In dem aktuellen Projekt sollen neue, bessere Bildgebungsprädiktoren entwickelt werden. Aus experimentellen Schlaganfallstudien und Pilotdaten von Patienten wissen wir, dass die Gegenseite des Hirnes eine wichtige Rolle zur Unterstützung des betroffenen Gewebes spielt. In einem klinischen Projektteil sollen Bildgebungsdaten, speziell Bilder der Hirndurchblutung aus der Routinediagnostik mit neuen Methoden untersucht werden, um den Beitrag der Gegenseite zu charakterisieren. Hierbei kommen auch automatisierte Methoden («deep learning») zur Anwendung. In einem experimentellen Teil werden Mechanismen der Blutflussregulation auf der Gegenseite analysiert. Dazu wird in einem Schlaganfallmodell die Reaktion der Blutgefässe auf der Gegenseite durch optische Verfahren in vivo beurteilt.

Wissenschaftlicher und gesellschaftlicher Kontext des Forschungsprojektes

In dem translationalen Projekt werden sich klinischer und experimenteller Forschungsteil ergänzen, um Mechanismen von Blutflussregulation bei Schlaganfall zu erforschen, und neue Bildgebungsprädiktoren zu entwickeln, die direkt in der Klinik angewandt werden können. Das Ziel ist, Therapieentscheidungen bei Schlagfall zu verbessern.

Direct link to Lay Summary Last update: 04.07.2017

Responsible applicant and co-applicants

Employees

Publications

Publication
Predictors for affected stroke territory and outcome of acute stroke treatments are different for posterior versus anterior circulation stroke
Handelsmann H., Herzog L., Kulcsar Z., Luft A. R., Wegener S. (2021), Predictors for affected stroke territory and outcome of acute stroke treatments are different for posterior versus anterior circulation stroke, in Scientific Reports, 11(1), 10544-10544.
Quantitative susceptibility mapping in ischemic stroke patients after successful recanalization
Probst Jasmin, Rohner Marco, Zahn Malin, Piccirelli Marco, Pangalu Athina, Luft Andreas, Deistung Andreas, Klohs Jan, Wegener Susanne (2021), Quantitative susceptibility mapping in ischemic stroke patients after successful recanalization, in Scientific Reports, 11(1), 16038-16038.
Circle of Willis variants and their association with outcome in patients with middle cerebral artery‐M1‐occlusion stroke
Westphal Laura P., Lohaus Niklas, Winklhofer Sebastian, Manzolini Christian, Held Ulrike, Steigmiller Klaus, Hamann Janne M., El Amki Mohamad, Dobrocky Tomas, Panos Leonidas D., Kaesmacher Johannes, Fischer Urs, Heldner Mirjam R., Luft Andreas R., Gralla Jan, Arnold Marcel, Wiest Roland, Wegener Susanne (2021), Circle of Willis variants and their association with outcome in patients with middle cerebral artery‐M1‐occlusion stroke, in European Journal of Neurology, ene.15013-ene.15013.
Agreement of novel hemodynamic imaging parameters for the acute and chronic stages of ischemic stroke: a matched-pair cohort study
Sebök Martina, van Niftrik Christiaan Hendrik Bas, Wegener Susanne, Luft Andreas, Regli Luca, Fierstra Jorn (2021), Agreement of novel hemodynamic imaging parameters for the acute and chronic stages of ischemic stroke: a matched-pair cohort study, in Neurosurgical Focus, 51(1), E12-E12.
Investigating the Association of Wallerian Degeneration and Diaschisis After Ischemic Stroke With BOLD Cerebrovascular Reactivity
van Niftrik C. H. B., Sebök M., Muscas G., Wegener S., Luft A. R., Stippich C., Regli L., Fierstra J. (2021), Investigating the Association of Wallerian Degeneration and Diaschisis After Ischemic Stroke With BOLD Cerebrovascular Reactivity, in Frontiers in Physiology, 12, eCollectio.
Mapping Cerebrovascular Reactivity Impairment in Patients With Symptomatic Unilateral Carotid Artery Disease
Sebök Martina, van Niftrik Christiaan Hendrik Bas, Winklhofer Sebastian, Wegener Susanne, Esposito Giuseppe, Stippich Christoph, Luft Andreas, Regli Luca, Fierstra Jorn (2021), Mapping Cerebrovascular Reactivity Impairment in Patients With Symptomatic Unilateral Carotid Artery Disease, in Journal of the American Heart Association, 10(12), e020792-e020792.
Leptomeningeal collateral activation indicates severely impaired cerebrovascular reserve capacity in patients with symptomatic unilateral carotid artery occlusion
Sebök Martina, Niftrik Christiaan Hendrik Bas van, Lohaus Niklas, Esposito Giuseppe, Amki Mohamad El, Winklhofer Sebastian, Wegener Susanne, Regli Luca, Fierstra Jorn (2021), Leptomeningeal collateral activation indicates severely impaired cerebrovascular reserve capacity in patients with symptomatic unilateral carotid artery occlusion, in Journal of Cerebral Blood Flow & Metabolism, 0271678X21-0271678X21.
Crossed Cerebellar Diaschisis in Patients With Symptomatic Unilateral Anterior Circulation Stroke Is Associated With Hemodynamic Impairment in the Ipsilateral MCA Territory
Sebök Martina, Niftrik Christiaan Hendrik Bas, Piccirelli Marco, Muscas Giovanni, Pangalu Athina, Wegener Susanne, Stippich Christoph, Regli Luca, Fierstra Jorn (2021), Crossed Cerebellar Diaschisis in Patients With Symptomatic Unilateral Anterior Circulation Stroke Is Associated With Hemodynamic Impairment in the Ipsilateral MCA Territory, in Journal of Magnetic Resonance Imaging, 53(4), 1190-1197.
Machine‐learning‐based outcome prediction in stroke patients with middle cerebral artery‐M1 occlusions and early thrombectomy
Hamann Janne, Herzog Lisa, Wehrli Carina, Dobrocky Tomas, Bink Andrea, Piccirelli Marco, Panos Leonidas, Kaesmacher Johannes, Fischer Urs, Stippich Christoph, Luft Andreas R., Gralla Jan, Arnold Marcel, Wiest Roland, Sick Beate, Wegener Susanne (2021), Machine‐learning‐based outcome prediction in stroke patients with middle cerebral artery‐M1 occlusions and early thrombectomy, in European Journal of Neurology, 28(4), 1234-1243.
Use of levamisole-adulterated cocaine is associated with increased load of white matter lesions
Conrad Florian, Hirsiger Sarah, Winklhofer Sebastian, Baumgartner Markus R., Stämpfli Philipp, Seifritz Erich, Wegener Susanne, Quednow Boris B. (2021), Use of levamisole-adulterated cocaine is associated with increased load of white matter lesions, in Journal of Psychiatry & Neuroscience, 46(2), E281-E291.
Crossed Cerebellar Diaschisis Indicates Hemodynamic Compromise in Ischemic Stroke Patients
von Bieberstein Lita, van Niftrik Christiaan Hendrik Bas, Sebök Martina, El Amki Mohamad, Piccirelli Marco, Stippich Christoph, Regli Luca, Luft Andreas R., Fierstra Jorn, Wegener Susanne (2021), Crossed Cerebellar Diaschisis Indicates Hemodynamic Compromise in Ischemic Stroke Patients, in Translational Stroke Research, 12(1), 39-48.
Reperfusion failure despite recanalization in stroke: New translational evidence
Amki Mohamad El, Wegener Susanne (2021), Reperfusion failure despite recanalization in stroke: New translational evidence, in Clinical and Translational Neuroscience, 5(1), 2514183X21-2514183X21.
Embolization of tumor cells is rare in patients with systemic cancer and cerebral large vessel occlusion
Wolpert F., Kulcsár Z., Hänsel M., Rushing E., Seystahl K., Schweizer J., Roth P., Luft A.R., Wegener S., Weller M. (2020), Embolization of tumor cells is rare in patients with systemic cancer and cerebral large vessel occlusion, in European Journal of Neurology, 27(10), 2041-2046.
Integrating uncertainty in deep neural networks for MRI based stroke analysis
Herzog Lisa, Murina Elvis, Dürr Oliver, Wegener Susanne, Sick Beate (2020), Integrating uncertainty in deep neural networks for MRI based stroke analysis, in Medical Image Analysis, 65, 101790-101790.
Neutrophils Obstructing Brain Capillaries Are a Major Cause of No-Reflow in Ischemic Stroke
El Amki Mohamad, Glück Chaim, Binder Nadine, Middleham William, Wyss Matthias T., Weiss Tobias, Meister Hanna, Luft Andreas, Weller Michael, Weber Bruno, Wegener Susanne (2020), Neutrophils Obstructing Brain Capillaries Are a Major Cause of No-Reflow in Ischemic Stroke, in Cell Reports, 33(2), 108260-108260.
Association of prestroke metformin use, stroke severity, and thrombolysis outcome
Westphal Laura P., Widmer Roni, Held Ulrike, Steigmiller Klaus, Hametner Christian, Ringleb Peter, Curtze Sami, Martinez-Majander Nicolas, Tiainen Marjaana, Nolte Christian H., Scheitz Jan F., Erdur Hebun, Polymeris Alexandros A., Traenka Christopher, Eskandari Ashraf, Michel Patrik, Heldner Mirjam R., Arnold Marcel, Zini Andrea, Vandelli Laura, Coutinho Jonathan M., Groot Adrien E., Padjen Visnja, Jovanovic Dejana R., et al. (2020), Association of prestroke metformin use, stroke severity, and thrombolysis outcome, in Neurology, 95(4), e362-e373.
Intravenous thrombolysis for suspected ischemic stroke with seizure at onset
Polymeris Alexandros A., Curtze Sami, Erdur Hebun, Hametner Christian, Heldner Mirjam R., Groot Adrien E., Zini Andrea, Béjot Yannick, Dietrich Annina, Martinez‐Majander Nicolas, von Rennenberg Regina, Gumbinger Christoph, Schaedelin Sabine, De Marchis Gian Marco, Thilemann Sebastian, Traenka Christopher, Lyrer Philippe A., Bonati Leo H., Wegener Susanne, Ringleb Peter A., Tatlisumak Turgut, Nolte Christian H., Scheitz Jan F., Arnold Marcel, et al. (2019), Intravenous thrombolysis for suspected ischemic stroke with seizure at onset, in Annals of Neurology, ana.25582-ana.25582.
Sensorimotor stroke alters hippocampo-thalamic network activity
Baumgartner Philipp, El Amki Mohamad, Bracko Oliver, Luft Andreas R., Wegener Susanne (2018), Sensorimotor stroke alters hippocampo-thalamic network activity, in Scientific Reports, 8(1), 15770-15770.
Cohort profile: Thrombolysis in Ischemic Stroke Patients (TRISP): a multicentre research collaboration.
(2018), Cohort profile: Thrombolysis in Ischemic Stroke Patients (TRISP): a multicentre research collaboration., in BMJ Open, e023265-e023265.
Ischemic stroke across sexes: What is the status quo?
Liberale Luca, Carbone Federico, Montecucco Fabrizio, Gebhard Cathérine, Lüscher Thomas F., Wegener Susanne, Camici Giovanni G. (2018), Ischemic stroke across sexes: What is the status quo?, in Frontiers in Neuroendocrinology, 50, 3-17.
Impact of Smoking on Clinical Outcome and Recanalization After Intravenous Thrombolysis for StrokeMulticenter Cohort Study
Kurmann Rebekka, Engelter Stefan T., Michel Patrik, Luft Andreas R., Wegener Susanne, Branscheidt Meret, Eskioglou Elissavet, Sirimarco Gaia, Lyrer Philippe A., Gensicke Henrik, Horvath Thomas, Fischer Urs, Arnold Marcel, Sarikaya Hakan (2018), Impact of Smoking on Clinical Outcome and Recanalization After Intravenous Thrombolysis for StrokeMulticenter Cohort Study, in Stroke, 49(5), 1170-1175.
Getting the First Grant
Wegener Susanne, Katan Mira (2017), Getting the First Grant, in Stroke, 49(1), e7-e9.
Improving Cerebral Blood Flow after Arterial Recanalization: A Novel Therapeutic Strategy in Stroke
El AmkiMohamad, WegenerSusanne (2017), Improving Cerebral Blood Flow after Arterial Recanalization: A Novel Therapeutic Strategy in Stroke, in International Journal of Molecular Sciences, 18(12), 2669-2669.
Contraceptive drugs mitigate experimental stroke-induced brain injury
El AmkiMohamad, BinderNAdine, Steffen Riccardo, SchneiderHannah, LuftAndreas, WellerMichael, ImthurnBruno, Merki-FeldGabriele, WegenerSusanne, Contraceptive drugs mitigate experimental stroke-induced brain injury, in Cardiovascular Research.

Datasets

Stroke Data set (Herzog et al. "Integrating uncertainty in deep neural networks for MRI based stroke analysis" 2020)

Author Herzog, Lisa
Persistent Identifier (PID) https://www.zora.uzh.ch/search/?q=10.1016%2Fj.media.2020.101790&size=n_10_n
Repository Github


Stroke outcome prediction

Author Herzog, Lisa
Persistent Identifier (PID) https://github.com/liherz/stroke_outcome_prediction_ML
Repository Github


Collaboration

Group / person Country
Types of collaboration
Prof. Prof. Sick/ Institute of Epidemiology, Biostatistics and Prevention Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
- Exchange of personnel
Prof. Valavanis/Dept. of Neuroradiology USZ Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
Prof. Buxton and Prof. Wong/ UCSD CFMRI United States of America (North America)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Prof. B. Weber/Institute of Pharmacology and Toxicology UZH Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
- Exchange of personnel
Prof. Catherine Gebhard/ Gender Medicine UZH and Nuclear Medicine USZ Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Prof. Hoehn/MPI for Metabolism Research Cologne Germany (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Prof. Arnold/ Neurology Inselspital Bern Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
Prof. Menze/TU Munich Informatics Germany (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
Prof. James Faber UNC Chapel Hill United States of America (North America)
- in-depth/constructive exchanges on approaches, methods or results
Prof. D. Razansky/INstitute of Pharmacology and Toxicology UZH Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
Prof. Gralla and Prof. Wiest/Neuroradiology Inselspital Bern Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
Stroke Cluster Group InselSpital Bern Individual talk Machine learning and prediction of stroke outcome 05.10.2021 Bern, Switzerland Wegener Susanne;
European Stroke Organization Conference Talk given at a conference AI for Stroke outcome prediction 02.09.2021 Helsinki, Finland Herzog Lisa; Wegener Susanne;
European Stroke organization Conference Talk given at a conference 10 Year Trends in cardiovascular risk factors in Switzerland: non-traditional risk factors are on the rise in women more than in men 01.09.2021 Helsinki (virtual), Finland Hänsel Martin; Wegener Susanne;
International Stroke Conference Talk given at a conference LMC function in recanalization of stroke 17.03.2021 Los Angeles (virtual), United States of America Binder Nadine Felizitas; El Amki Mohamad; Wegener Susanne;
Kopfwehsymposium USZ Talk given at a conference Migräne und Schlaganfallrisiko 04.02.2021 Zürich, Switzerland Wegener Susanne;
ESO ESMINT ESNR Stroke Winter School Talk given at a conference Perfusion imaging and prediction of outcome 02.02.2021 Berne (virtual), Switzerland Wegener Susanne;
SNG Jahrestagung Talk given at a conference Imaging in Stroke Management 19.11.2020 Interlaken, Switzerland Wegener Susanne;
DGN Jahrestagung Talk given at a conference Schlaganfall kompakt und kontrovers: Bypass pro 04.11.2020 Berlin (virtuell), Germany Wegener Susanne;
Bypass Anniversary Talk given at a conference Acute Stroke & Penumbra: The Concept of Salvageable Tissue 09.01.2020 Zürich, Switzerland Wegener Susanne;
SHG Jahrestagung Talk given at a conference "New evidence in stroke - decision making by machine learning – ready to go?" 08.01.2020 St Gallen, Switzerland Kook Lucas; Hamann Janne Marie; Wegener Susanne; Herzog Lisa;
Symposium Neurointensivmedizin Talk given at a conference Der instabile Patient mit akuutem Schlaganfall 10.10.2019 Zürich, Switzerland Wegener Susanne;
Mismatch Symposium Neurochirurgie Talk given at a conference Das Mismatch in MRT und CT 20.03.2019 Zürich, Switzerland Wegener Susanne;
Fortbildung Anästhesie/ Intensivmedizin USZ Talk given at a conference TICH-NOAC Studie 09.01.2019 Zürich, Switzerland Wegener Susanne;
Seniorenuniverstät Zürich Talk given at a conference Neues aus der personalisierten Schlaganfalltherapie 29.11.2018 Zürich, Switzerland Wegener Susanne;
Seniorenuniversität Winterthur Individual talk Neue Ansätze zur personalisierten Schlaganfalltherapie 14.11.2018 Winterthur ZHAW, Switzerland Wegener Susanne;
Swiss Neurological Society Annual Conference Talk given at a conference Women in Neurology 27.09.2018 Montreux, Switzerland Herzog Lisa; Wegener Susanne; El Amki Mohamad;
ZNZ Annual Symposium Poster 2 posters: Stroke detection using deep learning approaches/ The impact of collaterals on reperfusion in stroke 13.09.2018 Zürich, Switzerland Wegener Susanne; El Amki Mohamad; Herzog Lisa;
Europen Stroke Conference Poster 3Posters: Crossed cerebellar diaschisis after stroke/ Quantitative Susceptibility Mapping in Ischemic stroke patients/Anticipating intracranial hypertension before it can harm: Optic nerve sonography to monitor intracranial pressure aftzer stroke 16.05.2018 Gotheborg, Sweden Wegener Susanne;
30+1 Years of In-vivo-NMR Symposium Talk given at a conference The other side of stroke 27.04.2018 Köln, Germany Wegener Susanne;


Self-organised

Title Date Place
Session of ESOC: Artificial Intelligence in Stroke 08.11.2020 Vienna (virtualI), Austria
CRPP kick-off Symposium 03.10.2019 Zürich, Switzerland
Workshop: The interplay of microcirculation and plasticity after ischemic stroke 12.09.2019 Zürich, Switzerland
KNZ Research Day 22.08.2019 Zürich, Switzerland
Symposium Hot techniques in neuroimaging of cerebrovascular disease 05.07.2019 Yokohama, Japan
NKO (Neuro-Kopf) Research Day 17.06.2019 Zürich, Switzerland
KNZ Research day 05.09.2018 Zürich, Switzerland
Kontroversen in der Schlaganfalltherapie 09.11.2017 Zürich, Switzerland

Knowledge transfer events

Active participation

Title Type of contribution Date Place Persons involved
USZ Forum Gendermedizin Talk 06.10.2021 Zürich, Switzerland Wegener Susanne;
Erste Sitzung Kommission für sexuelle Gesundheit und Gendermedizin (KSGG-FS) Talk 16.08.2021 Berne, Switzerland Wegener Susanne;


Self-organised

Title Date Place
CAS Sex and Gender in Medicine Module Neurology/ Psychiatry 04.09.2021 Zürich, Switzerland
100 ways of thinking/Kunsthalle UZH 17.10.2018 Zürich, Switzerland

Communication with the public

Communication Title Media Place Year
Talks/events/exhibitions Forum Kopfschmerz USZ German-speaking Switzerland 2021
Talks/events/exhibitions USZ Forum Gendermedizin German-speaking Switzerland 2021
Talks/events/exhibitions Forum Schlaganfall (USZ) German-speaking Switzerland 2020
Talks/events/exhibitions Seniorenuniversität German-speaking Switzerland 2019
Talks/events/exhibitions 100 ways of thinking/Kunsthalle UZH German-speaking Switzerland 2018

Associated projects

Number Title Start Funding scheme
200703 The role of collaterals in counteracting reperfusion injury in stroke 01.01.2022 Project funding (Div. I-III)
202663 Predicting outcome after stroke: broaden the perspective 01.09.2021 SNSF Professorships
189776 SAFIR - From the Prototype to the Full-Scale Scanner 01.09.2020 R'EQUIP

Abstract

Despite improvements in primary prophylaxis and acute recanalization treatments, stroke remains one of the leading causes of death and disability worldwide. In order to achieve the best outcome possible for the individual patient, therapies have to be administered rapidly. However, the longer the time from symptom onset, the lower the efficacy and the higher the risk of treatment side effects. Although brain imaging is the mainstay of acute stroke diagnostics, current imaging strategies that aim to predict therapeutic success or failure in acute stroke patients remain insufficient. Here, we propose a novel prediction approach that is based on immediate and long-term vascular adaptations affecting the contralateral side of stroke. From data obtained through animal models of stroke and imaging in patients with proximal vessel occlusions, contralateral cerebral blood flow (CBF) appears to be particularly suited to predict clinical benefit from recanalization therapies. Contralateral CBF and related perfusion parameters may indicate the ability of the individual to withstand longer durations of ischemia. In the experimental part of the project, we will use a thrombin-injection stroke model that does not artificially impact collateral supply. Reperfusion will be achieved through intravenous injection of recombinant tissue plasminogen activator (rtPA). To assess CBF and ischemic tissue damage, repeated magnetic resonance imaging (MRI) combined with positron emission tomography (PET) will be performed during ischemia, after reperfusion and in the chronic phase of stroke along with behavioral assessments. In the same stroke model, processes influencing CBF on the microvascular level will be directly observed using advanced optical imaging methods. Structural adaptations of the microvascular bed as well as gene and protein expression profiles contralateral to stroke will be analyzed in brain samples. In the clinical part of the project, we will analyze stroke patient imaging data in relation to clinical outcome. In addition to a traditional region-of interest (ROI) based analysis we will apply a novel, “unbiased” machine learning algorithm to extract relevant outcome predictors from patient imaging data.Using a translational approach we aim for a mechanistic characterization of the concept of contralateral flow changes in stroke, and will generate and apply imaging predictors to clinical patient data. With the multidisciplinary study proposed here, I envision i) to deepen the understanding of the basic mechanisms regulating brain perfusion after ischemic stroke, and ii) to improve therapeutic decision-making in acute stroke patients.
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