Nervous System Diseases

Heart and Blood Diseases

All Conditions

Symptoms and General Pathology

Rare Diseases

Stroke

Ischemic Stroke

Ischemia

Infarction

Cerebral Infarction

Cerebrovascular Disorders

Brain Diseases

Central Nervous System Diseases

Vascular Diseases

Brain Infarction

Brain Ischemia

Necrosis

Acute Graft Versus Host Disease

Eighty patients previously or currently suffering from manifest cancer on or not on cancer treatment who developed stroke

Eighty patients with acute ischemic stroke without cancer

Risk factors: modifiable and unmodifiable risk factors

Risk factors

Esmael M Ahmed, MD

Stroke is a part of circulatory diseases which are the primary cause of death in Egypt. It accounts 14% of all deaths thus ranks the 2nd after ischemic heart disease. Cancer accounts 9% of population mortality in Egypt. Nearly 108,600 Egyptians newly diagnosed with cancer each year. The interrelationship between stroke and cancer is complex. Cancer may directly or indirectly lead to stroke via: hypercoagulability, nonbacterial thrombotic endocarditis (NBTE), direct tumor compression of blood vessels or treatment-related effects which potentiate stroke.

The risk of ischemic stroke after chemotherapy is largely increased by the use of certain types of chemotherapy not only by cancer histologic type. Brain infarction usually a subsequent complication appears sometimes shortly after chemotherapy. Chronic radiation vasculopathy that affects medium and large intra- and extra-cranial arteries is characterized by increasing rates of hemodynamic significant stenosis with time after radiotherapy.

The study aims to clarify the relation between cancer and its treatment with ischemic stroke by discussing the different mechanisms by which a vascular insult happen causing neurological deficit. The study provides more information about cancer patients with higher risk to develop ischemic stroke more than other patients by identifying co morbidities and dosage of cancer treatment that causes cerebrovascular insults.

* Retrospective study was conducted on patients diagnosed with cancer receiving chemotherapy or radiotherapy to evaluate the relation between cancer or cancer therapies and ischemic stroke development.
* Patients had been recruited from the oncology center, nuclear medicine department and neurology department in Mansoura University and private centers.

After obtaining informed consent, patients are subjected to the following:

1. Detailed History taking of previous cerebrovascular insults and cancer diagnosis onset and therapies.
2. Determination of major cerebrovascular risk factors as :

   * Hypertension: which is diagnosed when a patient had received antihypertensive treatment or when hypertension is diagnosed during the hospital stay by repeated detection of blood pressure of 140/90 mm Hg .
   * Diabetes mellitus (DM): diagnosis based on history of DM with or without current treatment or random blood glucose is 200mg/dl or higher.
   * Hypercholesterolemia: diagnosis based on history of hypercholesterolemia with current treatment or serum cholesterol level \>220mg/dl.
   * Smoking: is coded when the patient is a current smoker or an ex-smoker within 5 years.
   * Cardiac abnormality
3. Physical and neurological examination.
4. Investigations:

   * Laboratory investigations as complete blood count, lipid profile, coagulation profile, CRP , D dimer .
   * Radiological investigations: MRI brain to detect vascular abnormalities that may be associated with cancer such as: lacunar infarction , white matter changes and microbleeds.
5. For all patients in the prospective group the duration and type of chemotherapy, dose of radiotherapy was recorded.

Mechanism and Outcome of Acute Ischemic Stroke in Cancer Patients

The modified Rankin Scale (mRS) is a commonly used scale for measuring the degree of disability or dependence in the daily activities of people who have suffered a stroke or other causes of neurological disability. It has become the most widely used clinical outcome measure for stroke clinical trials.

Mansoura University Hospital

Assistant Prof of Neurology

Diseases and Abnormalities at or Before Birth

Neoplasms

Myocardial Infarction

Atrial Fibrillation

Endocarditis

Foramen Ovale, Patent

Embolic Stroke

Heart Neoplasms

Arrhythmias, Cardiac

Heart Diseases

Coronary Artery Disease

Myocardial Ischemia

Heart Septal Defects

Heart Septal Defects, Atrial

Heart Defects, Congenital

Congenital Abnormalities

Cardiovascular Abnormalities

Thoracic Neoplasms

Heart Tumor

Natriuretic Agents

All Drugs and Chemicals

Natriuretic Peptide, Brain

N,N-dimethylarginine

Enzyme Inhibitors

Patients with stroke of undetermined cause age 18-65

ADMA, NTproBNP, IL-6, Adiponectina, Leptine, Syndecan, Resistin

ADMA (asymmetric dimethylarginine) , NTproBNP (N-terminal pro b-type natriuretic peptide), IL-6 (Interleukin 6), Adiponectina, Leptine, Syndecan, Resistin

A stroke is the second cause of deaths after heart attack, one of the most important causes of malfunction as far as adults are concerned and the second as for the frequency cause of dementia. In spite of a possibility of the therapy of stroke ( tissue plasminogen activator) and recognized most of risk factors there is expected that incidence rate on stroke connected with ageing of the society will be growing. It will cause medical and social consequences.

There are many of potential causes of cardiac strokes, which are not entirely examined.

More over many cryptogenic strokes are presumed to have an embolic etiology, and the frequent cause of these kind of strokes at young age is probably the mechanism of paradoxical embolism through patent foramen ovale.

As far as the investigators are concerned, at present there is lack of any recommendations for these scientific hypothesis.

A stroke is the second cause of deaths after heart attack, one of the most important causes of malfunction as far as adults are concerned and the second as for the frequency cause of dementia. In spite of a possibility of the therapy of stroke ( tissue plasminogen activator) and recognized most of risk factors there is expected that incidence rate on stroke connected with ageing of the society will be growing. It will cause medical and social consequences.

The risk factors of stroke can be divided into alterable and not alterable. Importantly, the not alterable factors are: age, sex, race and genetic factors. After the age of 55 the risk of stroke grows twice in every decade of life. Moreover, it was alleged that incidence rate on stroke is more frequent at women than at men. At the black race the incidence rate on stroke is twice more frequent than at white race.

Well- known are also genetic syndromes connected with strokes like s. MELAS or CADASIL.

Well- known alterable factors are:

* hypertension
* coronary disease
* atrial fibrillation
* hypercholesterolemia
* diabetes
* nicotinism
* blood clotting disorder
* alcoholism
* TIA (transient ischemic attack) or previous former stroke
* asymptomatic stenosis of internal carotid artery

Cardiogenic stroke is a stroke caused by embolic material, which was created in cardiac cavities or on cardiac valves. They comprised 11% of all strokes and 25% of ischemic strokes. Additionally, among patients over 80 years old cardiac causes are responsible for even 40% of all ischemic strokes and half of cardiogenic strokes is caused of atrial fibrillation. Among young people (below 45 years old) about 50% of strokes are cardiogenic and are connected with paradoxical embolism at patients with patent foramen ovale.

Furthermore, cardiac- brain embolism is a result of:

* structural defect of cavities and valves of heart
* arrhythmia
* disturbances of movability of walls of the heart and function of endocardium which leads to increased risk of the risk of parietal thrombus
* cardiac insufficiency

There are many of potential causes of cardiac strokes, which are not entirely examined as for example:

* small pockets of intra- atrial septum
* structures in dextral atrium like Eustachian valve or Chiari network
* there is also a theory that even enlargement of left atrium may be the cause of brain stroke
* aneurysm of intra- atrial septum.

As far as the investigators are concerned, at present there is lack of any recommendations for these scientific hypothesis.

Available data suggest that in the comparison with atherosclerosis and lacunar strokes cardiogenic strokes characterize with high mortality ranging of 27%. Also the risk of relapse is higher than in strokes of other etiology.

Nevertheless, unfortunately, in spite of wide diagnostics at about 25-30% of patients with ischemic stroke the cause is unknown. This kind of stroke is called cryptogenic stroke or stroke with undefined etiology.

They constitute almost half of all ischemic stroke at young patients (below 55 years old). Many cryptogenic strokes are presumed to have an embolic etiology, and the frequent cause of these kind of strokes at young age is probably the mechanism of paradoxical embolism through patent foramen ovale.

To conclude, currently there aren't researches defining recommendations for long- lasting treatment patients with rare causes of strokes.

Biomarkers, Hemodynamic and Echocardiographic Predictors of Ischemic Strokes and Their Influence on the Course and Prognosis

NTproB (N-terminal pro b-type natriuretic peptide)

Medical University of Lodz

Principal Investigator

Wounds and Injuries

Hemorrhage

Brain Neoplasms

Headache

Intracranial Hemorrhages

Craniocerebral Trauma

Pain

Neurologic Manifestations

Trauma, Nervous System

patients suffering from ischemic stroke diagnosed by clinical examination and CT-scan

patients diagnosed with a brain tumor diagnosed by clinical examination and CT-scan or MRI

patients that have undergone brain surgery

patients with intracranial hemorrhage diagnosed by clinical examination and CT-scan

patients with headache complaints and a normal CT-scan of the brain

patients with head trauma and a normal CT-scan of the brain

bilateral measurement cerebral blood flow with near infrared spectroscopy using the Infrascanner on the frontal, temporal, parietal and occipital region of the head.

Infrascanner

Pascal Vanelderen, MD, PhD

The investigators prospectively want to use the Infrascanner in patients with ischemic stroke, patients with brain surgery, patients with brain tumors, patients with intracranial hemorrhage and patients with a normal CT scan of the brain as part of a diagnostic work-up after head trauma or headache to determine to positive and negative predictive value of the Infrascanner in these different settings.

Infrascanner is a portable device initially designed to detect intracranial hemorrhage in battlefield traumas. Infrascanner uses near infrared spectroscopy to measure cerebral blood flow non-invasively. This is achieved by putting the device against the scalp in 4 different areas (frontal, temporal, parietal, occipital) on the left and right side and by comparing both sides.This allows for the detection of intracranial hemorrhages with a volume upwards of 3.5ml and to a depth of 2.5cm. However, little is known about the influence of other intracranial conditions that could confound the measurements of the Infrascanner (e.g. ischemic stroke, brain surgery, brain tumors,...).

Therefore, the investigators prospectively want to use the Infrascanner in patients with ischemic stroke, patients with brain surgery, patients with brain tumors, patients with intracranial hemorrhage and patients with a normal CT scan of the brain as part of a diagnostic work-up after head trauma or headache to determine the positive and negative predictive value of the Infrascanner in these different settings.

Confounding Factors in the Detection of Intracranial Hemorrhage With the Infrascanner

A Prospective Study to Determine Confounding Factors in the Detection of Intracranial Hemorrhage With the Infrascanner

Ziekenhuis Oost-Limburg

Prof. Dr.

Blood and Lymph Conditions

Hemostatic Disorders

Blood Coagulation Disorders

Coagulants

Fibrin fragment D

Acute ischemic stroke patients at high-risk for underlying occult cancer (elevated D-dimer and suspicion of ESUS at admission)

Simon Jung, MD

Morin Beyeler, MD

Michel Patrik

Davide Strambo

Mira Katan, MD

Johannes Frenger

INVISIBLE-1 aims to prospectively follow patients up to one year after ischemic stroke to:

1. Determine the cumulative incidence of occult cancer in patients with embolic stroke of undetermined source (ESUS) and elevated D-dimer
2. Describe occult cancer characteristics and spontaneous course of occult cancer

Methodology

The investigators will include 370 stroke patients with elevated D-dimer (≥ 820 μg/L) at the time of stroke, suspicion of ESUS after initial workup and without known cancer. The investigators will perform a follow-up telephone interview at one year to assess the occurrence of a new cancer and characterize the course of the disease.

Significance

Determining the real incidence of occult cancer in high-risk patients will help support the implementation of screening trials in the future. Faster detection and treatment of occult cancers would significantly impact patient' outcomes by offering faster cancer treatment and optimal secondary stroke prevention.

INVISIBLE-1 is the first prospective study conducting a 1-year post-stroke follow-up telephone interview in preselected stroke patients at high-risk for occult cancer.

INVISIBLE-1 aims to:

1. Prospectively determine the cumulative incidence of occult cancer in patients with elevated D-dimer and ESUS within 1 year after the ischemic stroke
2. Describe occult cancer characteristics and spontaneous course of occult cancer

Hypothesis

Elevated D-dimer and suspicion of ESUS at admission may predict an underlying unknown cancer at the time of index stroke. The investigators hypothesize that the cumulative incidence of newly diagnosed cancer within 1 year after stroke reaches 15% in patients presenting these characteristics. This percentage is higher than the 10% currently known according to available retrospective studies.

Project design

To ensure the recruitment of the majority of potential occult cancer patients, the investigators set the D-dimer cut-off for inclusion of ≥ 820 μg/L at admission, based on our intern retrospective analyses of 1001 patients (OCCULT-5 score). In patients with ESUS, this cut-off was associated with a sensitivity of 91% and a specificity of 56% for the presence of an occult cancer diagnosed within 1 year after the index-stroke.

As suggested by the current evidence, the investigators decided to set the limit for diagnosis of new cancer at 1 year after the index stroke. Beyond this period, the causality is questionable in our opinion.

Discovery of New Cancer in the 1-year Follow-up After Ischemic Stroke in Patients at Risk: The INVISIBLE-1 Study

The description of the specific characteristics of occult cancers is defined by the location of the cancer, the histological type of cancer, the date of suspicion of cancer (e.g. via imaging), the type of investigation leading to the suspicion of cancer, the date of final diagnosis via histology, the presence of metastases at diagnosis, the type of treatment provided and the date of start of treatment.

The mRS measures the degree of disability or dependence in the daily activities of people who have suffered a stroke or other causes of neurological disability. The higher the mRS score, the more disabled or dependent the patient (mRS 6 represents death).

NIHSS is used to quantify stroke severity. It ranges from 0 to a maximum of 42 points. The higher the score, the more extensive the stroke.

Insel Gruppe AG, University Hospital Bern

Dept. of Neurology, Inselspital Bern

Skin and Connective Tissue Diseases

Behaviors and Mental Disorders

Urinary Tract, Sexual Organs, and Pregnancy Conditions

Eye Diseases

Nutritional and Metabolic Diseases

Breast Neoplasms

Alzheimer Disease

Prostatic Neoplasms

Macular Degeneration

Parkinson Disease

Hemorrhagic Stroke

Parkinsonian Disorders

Ganglion Cysts

Synovial Cyst

Basal Ganglia Diseases

Movement Disorders

Synucleinopathies

Neurodegenerative Diseases

Dementia

Tauopathies

Neurocognitive Disorders

Mental Disorders

Psychotic Disorders

Retinal Degeneration

Retinal Diseases

Familial Alzheimer Disease

Quality of Life

Caregivers randomized in intervention arm will receive an information booklet (which informs about existing structures and actions) and will receive support provided by a social worker schedule every 6 months during two years. The support duration will be one hour and will be defined as two parts: administration of the LASA questionnaire, and a standardized semi directive interview to assess needs.

Support provided by social worker

Caregivers will only receive an information booklet (which informs about existing structures and actions)

Information booklet receipt

Virginie NERICH, Dr

Medical progress and modification of lifestyles have prolonged life expectancy, despite the development of chronic diseases. The support and care are often provided by a network of informal caregivers composed of family, friends, and neighbors. They became essential to help maintening the elderly persons to live at home. It has been demonstrated that the importance and the diversity of informal tasks may jeopardize their own physical, mental and social well-being.

The aim of the Informal Carers of Elderly Cohort is to define, through a longitudinal study of their life course, the profiles of caregivers of patients with a diagnosis of one of the following diseases: cancer (breast, prostate, colon-rectum), neuro-degenerative diseases (Parkinson's disease, Alzheimer's and similar diseases), neuro-vascular diseases (Cerebrovascular Accident (CVA)), Age-related Macular Degeneration(AMD) and heart disease (heart failure), aged ≥ 60 years old and living in Burgundy or Franche-Comte. By following the different phases of the caregiving relationship from the announcement of the diagnosis, it will be possible to assess the quality of life of caregivers and evaluate the implementation of a pragmatic social action to help informal caregivers through a randomized intervention trial nested in the cohort.

Thanks to an analytical and longitudinal definition of the profiles of informal caregivers, this study could gather precise information on their life courses and their health trajectory by identifying the consequences associated with the concept of their role of aid in care. In addition, the randomized intervention trial will explore the efficacy, in terms of quality of life, and efficiency of a social action to support the caregivers. These data will allow to identify strategies that could be used to improve the existing sources of aid and to propose new approaches to help caregivers. This study will provide the opportunity to identify the most relevant means of support and to give an impulse for new healthcare policies.

Multicenter Prospective Cohort of Informal Caregivers in Burgundy and Franche-Comté

Multicenter Prospective Cohort of Informal Caregivers in Burgundy-Franche-Comté. ICE Cohort (Informal Caregivers of Elderly)

The main objective of the randomized study is to compare the Health Related Quality of Life based on summaries score the MOS SF36 one year after randomization according to the allocated intervention.

The main objective of the observational study is to define the longitudinal profiles of patient's caregivers according to the evaluation of their HRQoL using the MOS SF36 questionnaire

the aim of the observational study is to define the longitudinal profiles of cancer patient's caregivers according to the evaluation of their HRQoL using the CarGoQoL questionnaire

The aim of the observational study is to define the longitudinal profiles of patient's caregivers according to the evaluation of their coping strategies using the Borteyrou, Rascle and Truchot Questionnaire.

The aim of the observational study is to define the longitudinal profiles of patient's caregivers according to the evaluation of their anxiety and depression according to the HADs questionnaire.

The aim of the observational study is to define the longitudinal profiles of patient's caregivers according to the evaluation of their social support using the SSQ6 questionnaire.

The aim of the observational study is to define the longitudinal profiles of patient's caregivers according to the evaluation burden using the Zarit burden inventory

To compare the Health Related Quality of Life based on summaries score the MOS SF36 two years after randomization according to the allocated intervention.

To compare longitudinally all dimensions of HRQoL using the MOS SF36 questionnaire according to the allocated intervention.

To compare longitudinally the HRQoL of cancer patients' caregivers, according to the allocated intervention, using the CarGoQol questionnaire.

To compare longitudinally the coping strategies of patients' caregivers, according to the allocated intervention, using the Borteyrou, Rascle and Truchot Questionnaire.

To compare longitudinally the feelings of anxiety and depression of patients' caregivers, according to the allocated intervention, using the HADs Questionnaire.

To compare longitudinally the social support of patients' caregivers, according to the allocated intervention, using the SSQ6 questionnaire.

To compare longitudinally the burden of patients' caregivers, according to the allocated intervention, using the Zarit burden inventory.

The efficiency of the intervention of a social worker for caregivers will be assessed using a cost-utility analysis, aiming at comparing in terms of costs and utility the intervention versus the absence of intervention of a social worker

to evaluate the caregivers/patients' relationship and the changes of the relationship using a qualitative approach (semi-structure interview), to describe the specificity of the care and of the help from people carrying diseases with behavioral disorders (Alzheimer-type dementia in particular)

to study the situations generating a rupture in their role of caregiver (entry into an institution or death, disease remission) using a qualitative approach (semi-structure interview)

Methodological and quality of life unit in oncology (CHRU de Besançon)

University of Franche-Comté

University of Burgundy

Pôle de Gérontologie Interrégional Bourgogne et Franche-Comté

CARSAT Bourgogne et Franche-Comté

CCAS of Dijon

CCAS of Besançon

CCAS of Montbéliard

Burgundy Regional Council

Franche-Comté Regional Council

The Municipality of Besançon

The Municipality of Dijon

General Council of the Doubs

General Council of the Territoire de Belfort

Collectif Inter Associatif Sur la Sante Bourgogne

Union Régionale Interfédérale des Œuvres et Organismes Privés Sanitaires Bourgogne

Association Gérontopôle Pierre Pfitzenmeyer

Pôle de compétitivité Vitagora Goût-Nutrition-Santé

National Old Age Insurance Fund for Employees (CNAVTS)

Sheerbrooke Gérontopôle

France Alzheimer

Institut Régional de Vieillissement (IRV)

Novartis Pharmaceuticals

Roche Foundation

Ligue contre le cancer, France

National Cancer Institute, France

Quality of life and cancer clinical research platform

National Research Agency, France

Centre Hospitalier Universitaire de Besancon

Subarachnoid Hemorrhage

Cerebral Hemorrhage

Hydrocephalus

Neurocritical patients including those sustaining head injury, cerebrovascular events (such as intracerebral hemorrhage, subarachnoid hemorrhage, etc.), brain tumor, or hydrocephalus.

Yi-Hsin Tsai, M.D.

The purpose of this study is to use transcranial Doppler (TCD) to predict intracranial pressure (ICP) and clinical outcome of neurocritical patients.

Transcranial Doppler (TCD) and Transcranial color-coded duplex sonography (TCCS) play an important part in neurocritical monitoring systems. Currently there are studies using flow velocities and pulsatility index (PI) to predict intracranial pressure (ICP) and clinical outcome. But the use of B-mode in such prediction is not yet investigated. The purposes of this study are to establish the correlation among clinical data, CT findings and information collected by TCCS, and to predict ICP and neurological outcome using such information. The focus would be on 3rd ventricle size, midline shift and anteroposterior-transverse ration of midbrain (midbrain index) obtained by B-mode of TCCS. This study is a prospective clinical study targeting on 30 neurocritical patients admitted to intensive care units in one year. The timing of performance of TCCS will be (1) within 6 hours after admission, (2) within 6 hours after each CT examination, and (3) when ICP is higher than 20 mmHg for more than 5 minutes. Glasgow coma scale (GCS), heart rate, blood pressure (systolic, diastolic, and mean), body temperature, central venous pressure (CVP), brain temperature, ICP, cerebral perfusion pressure (CPP), mean velocity (MV) of bilateral middle cerebral arteries (MCAs), PI, midline shift, 3rd ventricular dimension, anteroposterior to transverse ratio of midbrain (midbrain index, MI) are recorded. The latter three parameters are also obtained from CT scans, and compared with those obtained from TCCS. Outcome is evaluated with extended Glasgow outcome scale (GOSE), and analyzed with previous records. This study is going to prove that TCCS is a safe, convenient, real-time and cheap tool in clinical care for neurocritical patients. It also provides prediction of ICP and clinical outcome.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Mechanism and Outcome of Acute Ischemic Stroke in Cancer Patients	NCT04195048	Ischemic Stroke Cancer	Risk factors	25 Years - 89 Years	Mansoura University Hospital
Biomarkers, Hemodynamic and Echocardiographic Predictors of Ischemic Strokes and Their Influence on the Course and Prognosis	NCT03377465	Embolic Stroke ... Ischemic Stroke Atrial Fibrilla... Myocardial Infa... Cardiac Tumor Endocarditis Patent Foramen ...	ADMA (asymmetri...	18 Years - 65 Years	Medical University of Lodz
Confounding Factors in the Detection of Intracranial Hemorrhage With the Infrascanner	NCT02809651	Ischemic Stroke Brain Tumor Brain Surgery Intracranial He... Headache Head Trauma	Infrascanner	-	Ziekenhuis Oost-Limburg
Discovery of New Cancer in the 1-year Follow-up After Ischemic Stroke in Patients at Risk: The INVISIBLE-1 Study	NCT06100718	Cancer-related ... Paraneoplastic ... Occult Cancer Ischemic Stroke Embolic Stroke ... D-dimer		18 Years -	Insel Gruppe AG, University Hospital Bern
Multicenter Prospective Cohort of Informal Caregivers in Burgundy and Franche-Comté	NCT02626377	Breast Cancer Colorectal Canc... Prostate Cancer Alzheimer Disea... Age-related Mac... Parkinson Disea... Cardiac Disease Ischemic Stroke Hemorrhagic Str...	Support provide... Information boo...	60 Years -	Centre Hospitalier Universitaire de Besancon
The Prediction of Intracranial Pressure and Clinical Outcome by Transcranial Doppler in Neurocritical Patients	NCT00886054	Head Injury Intracerebral H... Ischemic Stroke Subarachnoid He... Brain Tumor Hydrocephalus		16 Years - 80 Years	National Taiwan University Hospital
Biomarkers, Hemodynamic and Echocardiographic Predictors of Ischemic Strokes and Their Influence on the Course and Prognosis	NCT03377465	Embolic Stroke ... Ischemic Stroke Atrial Fibrilla... Myocardial Infa... Cardiac Tumor Endocarditis Patent Foramen ...	ADMA (asymmetri...	18 Years - 65 Years	Medical University of Lodz
Sphenopalatine Ganglion Block for the Treatment of Post-Stroke Headache	NCT05365880	Headache Stroke Ischemic Stroke	Liquid Lidocain... Placebo	18 Years -	University of Utah
Androgen-Deprivation Therapy and Cardiovascular Risk: A Nationwide Population-based Cohort Study	NCT02895230	Prostate Cancer Androgen-depriv...	Standard care	18 Years -	Rennes University Hospital

Spots Global Cancer Trial Database for ischemic stroke