Ole Morten Rønning

• Jahr, Silje Holt; Koubaa, Nojoud; Hillestad, Vigdis; Larsen, Kristin Tveitan; Selseth, Maiken Nordahl & Lied-Herland, Trine [Vis alle 10 forfattere av denne artikkelen] (2026). Incidence, clinical characteristics and outcome of spontaneous cerebellar intracerebral haemorrhage in a Norwegian population. European Stroke Journal. ISSN 2396-9873. 11(7). doi: 10.1093/esj/aakag073. Fulltekst i vitenarkiv
• Eilertsen, Helle; Larsen, Kristin Tveitan; Forfang, Elisabeth; Pennlert, Johanna; Glader, Eva Lotta & Kruuse, Christina [Vis alle 19 forfattere av denne artikkelen] (2026). Study of Antithrombotic Treatment After Intracerebral Haemorrhage-Antiplatelets: A Randomized Trial. Stroke. ISSN 0039-2499. 57(8), s. 2287–2294. doi: 10.1161/STROKEAHA.125.054990. Fulltekst i vitenarkiv Vis sammendrag

  BACKGROUND: Patients surviving spontaneous intracerebral hemorrhage (ICH) who have indications for antithrombotic treatment face increased risks of both hemorrhagic and ischemic events. The aim of STATICH (Study of Antithrombotic Treatment After Intracerebral Haemorrhage) was to assess the safety and efficacy of long-term antithrombotic treatment after ICH. METHODS: STATICH Antiplatelets (EudraCT 2014-002636-13; Unique identifier: NCT03186729) was a randomized, multicenter, open, blinded end point parallel-group trial, including adults with an indication for antiplatelet treatment to either start or avoid antiplatelet treatment. The target sample size was 500 participants. Patients were allocated 1:1 by a Web-based randomization system and followed for a minimum of 2 years. Outcome assessments were done by personnel blinded to treatment. Participants were not blinded. The primary safety outcome was recurrent symptomatic ICH. RESULTS: The trial was stopped early due to slow recruitment. Sixty-nine patients were included between August 2018 and December 2022: 34 were randomized to start antiplatelet treatment, and 35 were randomized to avoid antiplatelet treatment. No patients were excluded from analyses. The median age was 75 (Q1–Q3, 66–80) years, and 43 (75%) had previous ischemic stroke or transient ischemic attack. Five patients in the start antiplatelet treatment group (15% [95% CI, 6%–31%]), and 1 in the avoid group (3% [95% CI, 0%–18%]) experienced recurrent ICH, while 3 (9% [95% CI, 3%–24%]) and 7 (20% [95% CI, 10%–37%]), respectively, experienced a major ischemic event. A total of 88 serious adverse events and no suspected unexpected serious adverse reactions were registered. CONCLUSIONS: There were numerically more recurrent ICHs and fewer ischemic events in patients starting antiplatelet treatment after ICH compared with those avoiding antiplatelet treatment. The slow recruitment might be due to clinicians being certain of the best treatment strategy or patients being too frail to participate. STATICH will contribute to a planned collaborative individual patient-data meta-analysis to resolve this dilemma.

• Jahr, Silje Holt; Selseth, Maiken Nordahl; Larsen, Kristin Tveitan; REICHENBACH, ANTJE; Altmann, Marianne & Sundseth, Antje [Vis alle 14 forfattere av denne artikkelen] (2026). Diagnostic performance of prehospital large-vessel occlusion detection scales in patients with suspected acute stroke: a retrospective validation study. The Akershus Study of Ischemic Stroke and Thrombolysis. European Stroke Journal. ISSN 2396-9873. 11(6). doi: 10.1093/esj/aakag067. Fulltekst i vitenarkiv
• Koldeus-Falch, Jannicke; Thommessen, Bente; Sundseth, Antje; Strøm, Loreta Skrebelyte; Næss, Halvor & Thomas, Owen Matthew Truscott [Vis alle 7 forfattere av denne artikkelen] (2026). Cryptogenic stroke in women: impact of insertable cardiac monitoring in the STROKEWISE cohort study. Europace. ISSN 1099-5129. 28(4). doi: 10.1093/europace/euag056. Fulltekst i vitenarkiv
• Ihle-Hansen, Håkon; Walle-Hansen, Marte; Berge, Trygve; Ihle-Hansen, Hege Beate; Rønningen, Peter Selmer & Omland, Torbjørn [Vis alle 16 forfattere av denne artikkelen] (2026). Burden of atherosclerosis, cardiovascular risk factors and atrial fibrillation in individuals with covert brain infarcts in late midlife: the Akershus Cardiac Examination 1950 Study. BMJ Open. 16(3). doi: 10.1136/bmjopen-2025-114232. Fulltekst i vitenarkiv Vis sammendrag

  Background Current expert consensus statements generally suggest cardiovascular risk assessment, including atrial fibrillation (AF) screening, on detection of covert brain infarctions (CBIs). However, evidence to guide management of CBI remains limited. In the absence of randomised clinical trials specifically targeting CBI populations, observational studies comparing individuals with and without CBI can provide insights into the prevalence and burden of cardiovascular risk factors. Objectives We aimed to compare the burden of atherosclerosis and cardiovascular risk factors in participants with CBI to those without, and to explore the yield of AF screening in individuals with CBI. Design A prospective population-based birth cohort study including men and women born in 1950 and resident in Akershus County, Norway. Setting The two hospitals serving the population of Akershus county, Norway. Participants Participants included in the Akershus Cardiac Examination (ACE) 1950 study who also underwent a subsequent MRI examination were eligible for this study. Outcome measures Cardiovascular risk assessment was performed at study inclusion (2012–2015). Carotid ultrasound was used to quantify atherosclerosis through a carotid plaque score, and CHA₂DS₂-VA and Systematic COronary Risk Evaluation 2 (SCORE2) scores were calculated to estimate cardiovascular risk. Brain MRI was performed in a randomly selected, blood pressure-stratified subset of participants (2016–2024). CBI was defined as focal lesions consistent with ischaemia in the absence of clinical stroke. Participants with CBI were offered 72-hour ambulatory ECG monitoring for AF detection. Results MRI was performed in 414 of 3706 (11%) participants in the ACE 1950 Study. The mean age at the time of the MRI examination was 70.2±2.3 years, and 165 (41%) were women. CBI was identified in 54 participants (13%), of whom 45 (83%) completed 72-hour ambulatory ECG monitoring. There were no differences in mean carotid plaque score, SCORE2 or CHA₂DS₂-VA score between participants with CBI compared with those with normal MRI findings. AF was detected in one (2%) participant with CBI. Conclusions In this community-based cohort of individuals in late midlife, individuals with CBI did not have an increased cardiovascular risk compared with those without, as indicated by SCORE2, CHA₂DS₂-VA score, age-appropriate carotid plaque burden and a low prevalence of AF. Trial registration number URL: https://www.clinicaltrials.gov . Unique identifier: NCT01555411 .

• Yaghi, Shadi; Sposato, Luciano A.; Shu, Liqi; García-Rodríguez, Daniel; Urda, Victor Castro & Kreimer, Fabienne [Vis alle 36 forfattere av denne artikkelen] (2025). Device-Detected Atrial Fibrillation in Patients With and Without Cryptogenic Ischemia: The ANTARCTICA Pooled Analysis. Stroke. ISSN 0039-2499. 56(10), s. 2895–2903. doi: 10.1161/strokeaha.125.051749. Fulltekst i vitenarkiv Vis sammendrag

  BACKGROUND: Insertable cardiac monitoring (ICM) detects atrial fibrillation (AF) in substantial proportions of cryptogenic stroke, noncryptogenic ischemic stroke without known AF, and nonstroke patients who are at risk of underlying AF. Given differences in patient characteristics across studies, there may be differences in AF detection rates on ICM across these subgroups that have not been identified. We investigate whether AF detection rates on ICM are higher in cryptogenic stroke or transient ischemic attack (C-IS/TIA) patients compared with individuals with noncryptogenic stroke or without stroke, when accounting for differences in study populations. METHODS: This is an individual-participant data meta-analysis of prospective studies and randomized controlled trials of ICM in C-IS/TIA, noncryptogenic ischemic stroke, and nonstroke patients. Multilevel multivariable logistic regression models were used to test whether C-IS/TIA is associated with increased AF detection relative to other categories. We performed multiple imputation to derive values for variables with <20% missing data and used Rubin’s rules to estimate adjusted odds ratios by combining 100 postimputation data sets. The primary outcome was detection of AF. The attributable risk was derived by application of Bayes’ Theorem. RESULTS: Two randomized controlled trials and 12 prospective studies were included with a total of 1562 C-IS/TIA patients and 474 non-C-IS/TIA patients. In adjusted multilevel logistic regression analyses, AF detection was higher in C-IS/TIA patients (adjusted odds ratio, 1.90 [95% CI, 1.18–3.06]; P =0.009), indicating that 47% of AF detected in C-IS/TIA is pathogenic. Limiting the comparator group to ischemic stroke or history of stroke yielded similar results (adjusted odds ratio, 2.83 [95% CI, 1.47–5.44]; P =0.002). Days to AF detection were significantly shorter in C-IS/TIA patients (median 65 versus 169; P <0.001). CONCLUSIONS: In this individual-participant data meta-analysis of patients undergoing ICM, AF detection was higher in C-IS/TIA patients, with shorter time to AF detection compared with noncryptogenic/nonstroke individuals. These findings suggest that some of the AF detected in patients with C-IS/TIA may be pathogenic.

• Jahr, Silje Holt; Sandset, Else Charlotte; Selseth, Maiken Nordahl; Larsen, Kristin Tveitan; Hillestad, Vigdis & Faiz, Kashif Waqar [Vis alle 8 forfattere av denne artikkelen] (2025). Prehospital blood pressure in acute stroke. Emergency Medicine Journal. ISSN 1472-0205. 42(9), s. 593–598. doi: 10.1136/emermed-2024-214462. Fulltekst i vitenarkiv Vis sammendrag

  Background Blood pressure (BP) is a potential target for early stroke treatment and triage, yet our knowledge about prehospital BP is limited. We aimed to investigate whether prehospital BP differs by stroke type and severity in patients with suspected acute stroke and explore associations between prehospital BP and outcomes. Methods This single-centre retrospective study analysed consecutive patients with suspected stroke admitted to a primary hospital within 4.5 hours of symptom onset, comparing prehospital BP by discharge diagnosis, ischaemic stroke subtypes and stroke severity. Associations between prehospital BP and 90-day modified Rankin Scale and National Institutes of Health Stroke Scale (NIHSS) score changes within 24 hours of admission were analysed using logistic and ordinal regression. Results Of the 1165 patients included, 64% (742) had acute stroke and 36% (423) were stroke mimics. Patients who had an acute stroke had higher mean prehospital systolic BP (SBP) than mimics (162±31 mm Hg vs 152±29 mm Hg, p<0.001). Patients with intracerebral haemorrhage (ICH) had the highest SBP (173±34 mm Hg). Among ischaemic strokes, lacunar stroke had higher SBP than non-lacunar stroke (169±33 vs 158±29 mm Hg, p=0.002), and large vessel occlusion (LVO) had lower SBP than non-LVO (150±28 vs 164±30 mm Hg, p<0.001). Patients with NIHSS score >15 had lower SBP than patients with NIHSS score ≤5 (155±34 vs 165±29 mm Hg, p=0.009). In ischaemic stroke, higher SBP was associated with less chance of early neurological improvement (adjusted OR 0.95, (95% CI, 0.91 to 0.98)). Conclusion Prehospital BP varies by stroke subtype and severity and is associated with outcome. Blood pressure was higher in ICH than in ischaemic stroke, with lacunar infarcts showing the highest BP among ischaemic subtypes. The association between prehospital BP and poor outcomes in observational studies highlights the need for further research on early BP management across different stroke subtypes.

• Walle-Hansen, Marte; Hagberg, Guri; Myrstad, Marius; Berge, Trygve; Vigen, Thea & Ihle-Hansen, Hege Beate [Vis alle 14 forfattere av denne artikkelen] (2025). Blood pressure at age 40 and key features of cerebral small vessel disease at age 70: data from the ACE 1950 Study. BMC Cardiovascular Disorders. 25(1). doi: 10.1186/s12872-025-05140-6. Fulltekst i vitenarkiv Vis sammendrag

  Background The separate effects of systolic (SBP) and diastolic blood pressure (DBP) on cerebral small vessel disease (cSVD) development needs elucidation. We investigated the association between SBP and DBP at age 40 and two selected brain magnetic resonance imaging (MRI) features of cSVD (lacunes and white matter hyperintensities [WMHs]) at age 70 in a general Norwegian population cohort. Methods We included individuals from the Akershus Cardiac Examination (ACE) 1950 Study (2012–2015) who had previously participated in the Age 40 Program (1990–1993). A random subset of participants with SBP in the categories of non-elevated (< 120 mmHg), high elevated (130–139 mmHg) or hypertension (≥ 140 mmHg) at age 40 were invited to perform brain MRI for assessment of cSVD (lacunes and WMHs) at age 70 (2016–2024). DBP was categorized as non-elevated (< 70 mmHg), low elevated (70–79 mmHg), high elevated (80–89 mmHg) and hypertension (≥ 90 mmHg). Logistic and ordinal regressions assessed the association between SBP and DBP and lacunes and severity of WMHs (measured with Fazekas scale), adjusting for sex, total cholesterol, smoking, physical activity, diabetes, education, and age at MRI, with non-elevated BP as the reference category. Results A total of 414 participants (167 [40%] women) were included. Participants were 70.2 ± 2.3 years when undergoing brain MRI. Mean Fazekas scale was 1.3 ± 0.8, and 54 (13%) had lacunes. SBP and DPB were not associated with lacunes. DPB of 80–89 mmHg (adjusted OR [95% CI], 1.91 [1.01–3.62]) and ≥ 90 mmHg (2.11 [1.06–4.19]) at age 40 were associated with WMHs. Conclusions Elevated DBP (80–89 mmHg) and diastolic hypertension (> 90 mmHg) at age 40 were associated with WMH burden at age 70, suggesting a long-term association between midlife DBP and cerebrovascular health.

• Bergh, Elin Josefina; Askim, Torunn; Rønning, Ole Morten; Lydersen, Stian; Fjærtoft, Hild & Thommessen, Bente (2025). How achievement of a stroke care pathway is associated with functional outcome after stroke: a national, register-based study. BMC Health Services Research. 25(1). doi: 10.1186/s12913-025-12979-0. Fulltekst i vitenarkiv
• Rønning, Ole Morten; Nordby, Linn Marie; Logallo, Nicola; Kvistad, Christopher Elnan; Kristoffersen, Espen Saxhaug & Ihle-Hansen, Håkon [Vis alle 12 forfattere av denne artikkelen] (2025). Association between blood pressure and outcome in patients with acute ischemic stroke treated with alteplase. Journal of Stroke & Cerebrovascular Diseases. ISSN 1052-3057. 35(1). doi: 10.1016/j.jstrokecerebrovasdis.2025.108518. Fulltekst i vitenarkiv Vis sammendrag

  Background The role of blood pressure (BP) in acute stroke remains unclear. We investigated the impact of BP trajectories during the first 24 hours (h) after hospital admission on outcomes in acute ischemic stroke patients treated with intravenous alteplase. Methods In 424 ischemic stroke patients from the NOR-TEST I trial treated with alteplase, we assessed systolic BP (sBP) at baseline, change in sBP between 0 h and 24 h, and increase in sBP over the same period. Outcomes included modified Rankin Scale (mRS) at 3 months, NIHSS at 24 h, and symptomatic intracerebral haemorrhage (sICH) within 48 h. Logistic and linear regression analyses were used to explore the association of blood pressure trajectories and outcome adjusted for age, sex, time from onset of symptoms to intravenous thrombolysis (IVT) and NIHSS at admittance (NIHSSadm). Results Mean sBP at baseline (admittance), 2 h and 24 h were 155, 147 and 142 mmHg, respectively. An increase in sBP from baseline to 24 h was seen in 115 patients (27 %), while 409 showed an overall change. In unadjusted analyses, sBP increase (but not baseline sBP or change in sBP) was associated with worse mRS at 3 months. This remained significant after adjustment (OR 0.933, 95 %CI 0.876 – 0.993). Higher baseline sBP and sBP increase predicted worse NIHSS at 24 h. sBP increase and baseline sBP were also associated with sICH within 48 h, but only baseline sBP remained significant after adjustment (OR 1.022, 95 % CI 1.003–1.042). Conclusions An increase in sBP within the first 24 h was associated with worse neurological and functional outcomes at 3 months, while higher baseline sBP was linked to worse neurological outcomes and sICH in acute ischemic stroke patients treated with alteplase.

• Bergh, Elin Josefina; Askim, Torunn; Rønning, Ole Morten; Lydersen, Stian & Thommessen, Bente (2025). IMPACT OF A STROKE CARE PATHWAY ON SELF-PERCEIVED HEALTH 3 MONTHS AFTER STROKE. Journal of Rehabilitation Medicine. ISSN 1650-1977. 57. doi: 10.2340/jrm.v57.42443. Fulltekst i vitenarkiv Vis sammendrag

  Background: A national stroke care pathway aiming at reducing time delays in stroke care was implemented in Norway in 2018. This study aimed to investigate the impact of goal attainment in the pre- and intrahospital care pathway on self-perceived health 3 months after stroke. Methods: Data from the Norwegian Stroke Register (NSR) from 2019 were used. Patients were classified into attainment or non-attainment groups, depending on goal achievement of the SCP. Linear regression analyses were used to assess a possible association between goal attainment and self-perceived health evaluated by EQ-5D-5L and EQ-VAS at 3 months post-stroke. Results: Among 4,133 included patients, 908 (22%) were included in the attainment group. We found no effect of goal attainment upon mean EQ-5D-5L. However, when adjusting for stroke severity, attaining the SCP was significantly associated with self-perceived health. Conclusion: In this study, with a cohort of patients with mild to moderate strokes, we found no association between attaining goals of the stroke care pathway and self-perceived health. However, stroke severity might have acted as a suppressor variable underscoring the importance of stroke severity for self-perceived health.

• Strøm, Loreta Skrebelyte; Saberniak, Jørg; Orstad, Eivind Bjørkan; Hilde, Janne Mykland; Rønning, Ole Morten & Steine, Kjetil (2025). Left atrial appendage function by strain and structure is associated with thromboembolic risk in patients with cryptogenic stroke and TIA. Open heart. 12(1). doi: 10.1136/openhrt-2025-003287. Fulltekst i vitenarkiv Vis sammendrag

  Background We investigated the impact of left atrial appendage (LAA) function by LAA strain, LAA morphology and subclinical atrial fibrillation (AF) on LAA thrombus presence and thromboembolic risk conditions (TRC) in patients with cryptogenic stroke and transient ischaemic attack (TIA). Methods 185 patients (mean age 68±13 years, 33% female) were included in this prospective cohort study and underwent clinical evaluation, comprehensive transthoracic and transoesophageal echocardiography shortly after index event. LAA function and morphology were evaluated by monoplane/multiplane/speckle tracking strain and three-dimensional echocardiography. Combination of LAA thrombus and/or spontaneous echo contrast (SEC) was defined as TRC. An insertable cardiac monitor was implanted in all patients to detect subclinical AF. Results LAA function by novel LAA strain and LAA chicken wing were independent predictors of LAA thrombus (OR 0.9 (95% CI 0.8 to 0.95), p<0.01 and OR 2.5 (95% CI 1.1 to 5.8), p=0.04, respectively). LAA chicken wing and multilobate LAA were independent predictors of TRC (OR 2.3 (95% CI 1.2 to 4.5), p=0.01 and OR 2.2 (95% CI 1.2 to 4.2), p=0.02, respectively). LAA morphology was characterised as chicken wing in 79 (43%), windsock in 64 (34%), cactus in 35 (19%), cauliflower in 7 (4%) and multilobate LAA in 115 (62%) patients. LAA thrombus was found in 29 (16%), TRC in 123 (67%) and subclinical AF in 60 (32%) patients. Duration of subclinical AF >6 hours was associated with SEC and recurrent stroke and TIA. Conclusion LAA function by novel LAA strain and LAA structure are independently associated with LAA thrombus and TRC in patients with cryptogenic stroke and TIA. Trial registration number NCT02725944.

• Larsen, Kristin Tveitan; Jahr, Silje Holt; Selseth, Maiken Nordahl; Lied-Herland, Trine; Hillestad, Vigdis & Ihle-Hansen, Hege Beate [Vis alle 9 forfattere av denne artikkelen] (2025). Impact of white matter lesions on associations between prehospital blood pressure and outcomes in spontaneous intracerebral hemorrhage. European Stroke Journal. ISSN 2396-9873. 10(4), s. 1402–1412. doi: 10.1177/23969873251343495. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: There are concerns about the safety of intensive blood pressure (BP) lowering in intracerebral hemorrhage (ICH) patients with white matter lesions (WML). We explored the impact of WML on associations between i) prehospital BP, and ii) BP change, and outcomes in acute, spontaneous ICH. Patients and methods: This retrospective study included consecutive patients with acute spontaneous ICH, admitted 2011–2020. WML on non-contrast computed tomography were categorized as none-to-mild (0–1) or moderate-to-severe (2–3) on the Fazekas scale. The first systolic BP (SBP) and mean arterial pressure (MAP) from the ambulance and admission, and absolute BP change between these time points, were collected. The outcomes were in-hospital mortality, mortality at 180 days, modified Rankin Scale (mRS) scores at 3 months, and hematoma expansion. Results: Of 548 patients, 260 (47%) had moderate-to-severe WML. Compared to patients with none-to-mild WML, these patients had a stronger association between higher prehospital MAP and in-hospital mortality (p interaction 0.017). WML did not modify associations between prehospital BP and other outcomes. WML modified associations between MAP change and in-hospital mortality (p interaction 0.049), MAP change and mRS score 3–6 at 3 months (p interaction 0.032), and SBP change and mRS score 3–6 at 3 months (p interaction 0.022). These outcomes were poorer with greater BP decrease in patients with moderate-to-severe compared to none-to-mild WML. Discussion and conclusion: In acute ICH, WML modified the influence of prehospital BP and BP change on clinical outcomes, with a trend toward worse outcomes associated with higher prehospital BP and greater spontaneous BP decrease.

• Gundersen, Julia Kristine; Gonzalez-Ortiz, Fernando; Karikari, Thomas; Kirsebom, Bjørn-Eivind Seljelid; Mertes, Katrin & Zetterberg, Henrik [Vis alle 11 forfattere av denne artikkelen] (2024). Neuronal plasma biomarkers in acute ischemic stroke. Journal of Cerebral Blood Flow and Metabolism. ISSN 0271-678X. doi: 10.1177/0271678X241293537. Fulltekst i vitenarkiv Vis sammendrag

  Early imaging-based detection of acute ischemic stroke (AIS) has improved in the era of reperfusion therapy. Despite of this, prognosis of outcome after AIS remains a challenge. Therefore, parameters that support clinical decision making are sought. Blood-based biomarkers have the potential to provide valuable information in addition to the established prognostic factors. Neuronal biomarkers of acute or degenerative neuronal injury have shown to be reliably detected in plasma. These biomarkers are well-established in neurodegenerative pathology, such as Alzheimer’s disease. In this study, we explored the association between stroke diameter and plasma biomarkers for neuronal injury and tau pathophysiology (brain-derived tau [BD-tau], phosphorylated-tau-217 [p-tau21] and neurofilament light [NfL]) in patients (n = 193) admitted to the acute ward, Akershus University Hospital. All patients received a final diagnosis of AIS, transient ischemic attack or stroke mimics. Blood samples were obtained the day after admission. We find that levels of BD-tau (p = .004) and NfL (p = .011) were higher after AIS than in patients with stroke mimics. The cortical stroke diameter correlated with BD-tau (tau-b = 0.64, p < .001) and p-tau217 (tau-b = 0.36, p = .003). Linear regression confirmed BD-tau to be the strongest variable associated with stroke diameter, pointing to the potential clinical value of plasma BD-tau in outcome prediction after AIS.

• Siepen, Bernhard M.; Forfang, Elisabeth; Branca, Mattia; Drop, Boudewijn; Mueller, Madlaine & Goeldlin, Martina B. [Vis alle 36 forfattere av denne artikkelen] (2024). Intracerebral haemorrhage in patients taking different types of oral anticoagulants: a pooled individual patient data analysis from two national stroke registries. Stroke and Vascular Neurology. ISSN 2059-8688. doi: 10.1136/svn-2023-002813. Fulltekst i vitenarkiv Vis sammendrag

  Background We investigated outcomes in patients with intracerebral haemorrhage (ICH) according to prior anticoagulation treatment with Vitamin K antagonists (VKAs), direct oral anticoagulants (DOACs) or no anticoagulation. Methods This is an individual patient data study combining two prospective national stroke registries from Switzerland and Norway (2013–2019). We included all consecutive patients with ICH from both registries. The main outcomes were favourable functional outcome (modified Rankin Scale 0–2) and mortality at 3 months. Results Among 11 349 patients with ICH (mean age 73.6 years; 47.6% women), 1491 (13.1%) were taking VKAs and 1205 (10.6%) DOACs (95.2% factor Xa inhibitors). The median percentage of patients on prior anticoagulation was 23.7 (IQR 22.6–25.1) with VKAs decreasing (from 18.3% to 7.6%) and DOACs increasing (from 3.0% to 18.0%) over time. Prior VKA therapy (n=209 (22.3%); adjusted ORs (aOR), 0.64; 95% CI, 0.49 to 0.84) and prior DOAC therapy (n=184 (25.7%); aOR, 0.64; 95% CI, 0.47 to 0.87) were independently associated with lower odds of favourable outcome compared with patients without anticoagulation (n=2037 (38.8%)). Prior VKA therapy (n=720 (49.4%); aOR, 1.71; 95% CI, 1.41 to 2.08) and prior DOAC therapy (n=460 (39.7%); aOR, 1.28; 95% CI, 1.02 to 1.60) were independently associated with higher odds of mortality compared with patients without anticoagulation (n=2512 (30.2%)). Conclusions The spectrum of anticoagulation-associated ICH changed over time. Compared with patients without prior anticoagulation, prior VKA treatment and prior DOAC treatment were independently associated with lower odds of favourable outcome and higher odds of mortality at 3 months. Specific reversal agents unavailable during the study period might improve outcomes of DOAC-associated ICH in the future.

• Ihle-Hansen, Hege Beate; Einvik, Gunnar; Hagberg, Guri; Thommessen, Bente; Rønning, Ole Morten & Vigen, Thea [Vis alle 11 forfattere av denne artikkelen] (2024). Sleep Duration and Cognitive Function: The Akershus Cardiac Examination 1950 Study. Dementia and Geriatric Cognitive Disorders. ISSN 1420-8008. 53(6), s. 338–344. doi: 10.1159/000540273. Fulltekst i vitenarkiv
• Walle-Hansen, Marte; Hagberg, Guri; Myrstad, Marius; Berge, Trygve; Vigen, Thea & Ihle-Hansen, Hege Beate [Vis alle 13 forfattere av denne artikkelen] (2024). Systolic blood pressure at age 40 and 30-year stroke risk in men and women. Open heart. 11(2). doi: 10.1136/openhrt-2024-002805. Fulltekst i vitenarkiv Vis sammendrag

  Background American and European guidelines define hypertension differently and are sex agnostic. Our aim was to assess the impact of different hypertension thresholds at the age of 40 on 30-year stroke risk and to examine sex differences. Methods We included 2608 stroke-free individuals from the Akershus Cardiac Examination 1950 Study, a Norwegian regional study conducted in 2012–2015 of the 1950 birth cohort, who had previously participated in the Age 40 Program, a nationwide health examination study conducted in 1990–1993. We categorised participants by systolic blood pressure (SBP) at age 40 (<120 mm Hg (reference), 120–129 mm Hg, 130–139 mm Hg and ≥140 mm Hg) and compared stroke risk using Cox proportional hazard regressions adjusted for age, sex, smoking, cholesterol, physical activity, obesity and education. Fatal and non-fatal strokes were obtained from the Norwegian Cardiovascular Disease Registry from 1 January 2012 to 31 December 2020, in addition to self-reported strokes. Results The mean age was 40.1±0.3 years (50.4% women) and mean SBP was 128.3±13.5 mm Hg (mean±SD). Stroke occurred in 115 (4.4%) individuals (32 (28%) women and 83 (72%) men) during 29.4±2.9 years of follow-up. SBP between 130 and 139 mm Hg was not associated with stroke (adjusted HR 1.71, 95% CI 0.87 to 3.36) while SBP ≥140 mm Hg was associated with increased stroke risk (adjusted HR 3.11, 95% CI 1.62 to 6.00). The adjusted HR of stroke was 4.32 (95% CI 1.66 to 11.26) for women and 2.66 (95% CI 1.03 to 6.89) for men, with non-significant sex interactions. Conclusions SBP ≥140 mm Hg was significantly associated with 30-year stroke risk in both sexes. A small subgroup of women had SBP ≥140 mm Hg and systolic hypertension was a strong risk factor for stroke in these women.

• Forfang, Elisabeth; Larsen, Kristin Tveitan; Salman, Rustam Al-Shahi; Bell, Simon M.; Wester, Per & Berge, Eivind [Vis alle 8 forfattere av denne artikkelen] (2023). Antithrombotic treatment after intracerebral hemorrhage: Surveys among stroke physicians in Scandinavia and the United Kingdom. Health Science Reports. 6(1), s. 1–8. doi: 10.1002/hsr2.1059. Fulltekst i vitenarkiv Vis sammendrag

  Background and Aims It is unclear whether patients with previous intracerebral hemorrhage (ICH) should receive antithrombotic treatment to prevent ischemic events. We assessed stroke physicians' opinions about this, and their views on randomizing patients in trials assessing this question. Methods We conducted three web-based surveys among stroke physicians in Scandinavia and the United Kingdom. Results Eighty-nine of 205 stroke physicians (43%) responded to the Scandinavian survey, 161 of 180 (89%) to the UK antiplatelet survey, and 153 of 289 (53%) to the UK anticoagulant survey. In Scandinavia, 19 (21%) stroke physicians were uncertain about antiplatelet treatment after ICH for ischemic stroke or transient ischemic attack (TIA) and 21 (24%) for prior myocardial infarction. In the United Kingdom, 116 (77%) were uncertain for ischemic stroke or TIA and 115 (717%) for ischemic heart disease. In Scandinavia, 32 (36%) were uncertain about anticoagulant treatment after ICH for atrial fibrillation, and 26 (29%) for recurrent deep vein thrombosis or pulmonary embolism. In the United Kingdom, 145 (95%) were uncertain about anticoagulants after ICH in at least some cases. In both regions combined, 191 of 250 (76%) would consider randomizing ICH survivors in a trial of starting versus avoiding antiplatelets, and 176 of 242 (73%) in a trial of starting versus avoiding anticoagulants. Conclusion Considerable proportions of stroke physicians in Scandinavia and the United Kingdom were uncertain about antithrombotic treatment after ICH. A clear majority would consider randomizing patients in trials assessing this question. These findings support the need for such trials.

• Larsen, Kristin Tveitan; Sandset, Else Charlotte; Selseth, Maiken Nordahl; Jahr, Silje Holt; Koubaa, Nojoud & Hillestad, Vigdis [Vis alle 8 forfattere av denne artikkelen] (2023). Antithrombotic Treatment, Prehospital Blood Pressure, and Outcomes in Spontaneous Intracerebral Hemorrhage. Journal of the American Heart Association (JAHA). 12(5), s. 1–12. doi: 10.1161/JAHA.122.028336. Fulltekst i vitenarkiv Vis sammendrag

  Background In acute intracerebral hemorrhage, both elevated blood pressure (BP) and antithrombotic treatment are associated with poor outcome. Our aim was to explore interactions between antithrombotic treatment and prehospital BP. Methods and Results This observational, retrospective study included adult patients with spontaneous intracerebral hemorrhage diagnosed by computed tomography within 24 hours, admitted to a primary stroke center during 2012 to 2019. The first recorded prehospital/ambulance systolic and diastolic BP were analyzed per 5 mm Hg increment. Clinical outcomes were in‐hospital mortality, shift on the modified Rankin Scale at discharge, and mortality at 90 days. Radiological outcomes were initial hematoma volume and hematoma expansion. Antithrombotic (antiplatelet and/or anticoagulant) treatment was analyzed both together and separately. Modification of associations between prehospital BP and outcomes by antithrombotic treatment was explored by multivariable regression with interaction terms. The study included 200 women and 220 men, median age 76 (interquartile range, 68–85) years. Antithrombotic drugs were used by 252 of 420 (60%) patients. Compared with patients without, patients with antithrombotic treatment had significantly stronger associations between high prehospital systolic BP and in‐hospital mortality (odds ratio [OR], 1.14 versus 0.99, P for interaction 0.021), shift on the modified Rankin Scale (common OR, 1.08 versus 0.96, P for interaction 0.001), and hematoma volume (coef. 0.03 versus −0.03, P for interaction 0.011). Conclusions In patients with acute, spontaneous intracerebral hemorrhage, antithrombotic treatment modifies effects of prehospital BP. Compared with patients without, patients with antithrombotic treatment have poorer outcomes with higher prehospital BP. These findings may have implications for future studies on early BP lowering in intracerebral hemorrhage.

• Ihle-Hansen, Håkon; Vigen, Thea; Berge, Trygve; Walle-Hansen, Marte; Hagberg, Guri & Ihle-Hansen, Hege Beathe [Vis alle 12 forfattere av denne artikkelen] (2023). Carotid Plaque Score for Stroke and Cardiovascular Risk Prediction in a Middle-Aged Cohort From the General Population. Journal of the American Heart Association (JAHA). 12(17), s. 1–10. doi: 10.1161/JAHA.123.030739. Fulltekst i vitenarkiv Vis sammendrag

  Background We aimed to explore the predictive value of the carotid plaque score, compared with the Systematic Coronary Risk Evaluation 2 (SCORE2) risk prediction algorithm, on incident ischemic stroke and major adverse cardiovascular events and establish a prognostic cutoff of the carotid plaque score. Methods and Results In the prospective ACE 1950 (Akershus Cardiac Examination 1950 study), carotid plaque score was calculated with ultrasonography at inclusion in 2012 to 2015. The largest plaque diameter in each extracranial segment of the carotid artery on both sides was scored from 0 to 3 points. The sum of points in all segments provided the carotid plaque score. The cohort was followed up by linkage to national registries for incident ischemic stroke and major adverse cardiovascular events (nonfatal ischemic stroke, nonfatal myocardial infarction, and cardiovascular death) throughout 2020. Carotid plaque score was available in 3650 (98.5%) participants, with mean±SD age of 63.9±0.64 years at inclusion. Only 462 (12.7%) participants were free of plaque, and and 970 (26.6%) had a carotid plaque score of >3. Carotid plaque score predicted ischemic stroke (hazard ratio [HR], 1.25 [95% CI, 1.15–1.36]) and major adverse cardiovascular events (HR, 1.21 [95% CI, 1.14–1.27]) after adjustment for SCORE2 and provided strong incremental prognostic information to SCORE2. The best cutoff value of carotid plaque score for ischemic stroke was >3, with positive predictive value of 2.5% and negative predictive value of 99.3%. Conclusions The carotid plaque score is a strong predictor of ischemic stroke and major adverse cardiovascular events, and it provides incremental prognostic information to SCORE2 for risk prediction. A cutoff score of >3 seems to be suitable to discriminate high‐risk subjects.

• Cochrane, Alexia; Chen, Chen; Stephen, Jacqueline; Rønning, Ole Morten; Anderson, Craig S & Hankey, Graeme J [Vis alle 7 forfattere av denne artikkelen] (2023). Antithrombotic treatment after stroke due to intracerebral haemorrhage. Cochrane Database of Systematic Reviews. 2023(1). doi: 10.1002/14651858.CD012144.pub3. Fulltekst i vitenarkiv
• Meinel, Thomas R.; Wilson, Duncan; Gensicke, Henrik; Scheitz, Jan F.; Ringleb, Peter & Goganau, Ioana [Vis alle 50 forfattere av denne artikkelen] (2023). Intravenous thrombolysis in patients with ischemic stroke and recent ingestion of direct oral anticoagulants. JAMA Neurology. ISSN 2168-6149. 80(3), s. 233–243. doi: 10.1001/jamaneurol.2022.4782. Fulltekst i vitenarkiv
• Saberniak, Jørg; Strøm, Loreta Skrebelyte; Orstad, Eivind Bjørkan; Hilde, Janne Mykland; Solberg, Magnar Gangås & Rønning, Ole Morten [Vis alle 8 forfattere av denne artikkelen] (2023). Left atrial appendage strain predicts subclinical atrial fibrillation in embolic strokes of undetermined source. European Heart Journal Open (EHJ Open). 3(3). doi: 10.1093/ehjopen/oead039. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Aims Left atrial (LA) strain is promising in prediction of clinical atrial fibrillation (AF) in stroke patients. However, prediction of subclinical AF is critical in patients with embolic strokes of undetermined source (ESUS). The aim of this prospective study was to investigate novel LA and left atrial appendage (LAA) strain markers in prediction of subclinical AF in ESUS patients. Methods and results A total of 185 patients with ESUS, mean age 68 ± 13years, 33% female, without diagnosed AF, were included. LAA and LA function by conventional echocardiographic parameters and reservoir strain (Sr), conduit strain (Scd), contraction strain (Sct), and mechanical dispersion (MD) of Sr were assessed with transoesophageal and transthoracic echocardiography. Subclinical AF was detected by insertable cardiac monitors during follow-up. LAA strain was impaired in 60 (32%) patients with subclinical AF compared to those with sinus rhythm: LAA-Sr, 19.2 ± 4.5% vs. 25.6 ± 6.5% (P &amp;lt; 0.001); LAA-Scd, −11.0 ± 3.1% vs. −14.4 ± 4.5% (P &amp;lt; 0.001); and LAA-Sct, −7.9 ± 4.0% vs. −11.2 ± 4% (P &amp;lt; 0.001), respectively, while LAA-MD was increased, 34 ± 24 ms vs. 26 ± 20 ms (P = 0.02). However, there was no significant difference in phasic LA strain or LA-MD. By ROC analyses, LAA-Sr was highly significant in prediction of subclinical AF and showed the best AUC of 0.80 (95% CI 0.73–0.87) with a sensitivity of 80% and a specificity of 73% (P &amp;lt; 0.001). LAA-Sr and LAA-MD were both independent and incremental markers of subclinical AF in ESUS patients. Conclusion LAA function by strain and mechanical dispersion predicted subclinical AF in ESUS patients. These novel echocardiographic markers may improve risk stratification in ESUS patients.

• MacIntosh, Bradley; Liu, Qinghui; SCHELLHORN, TILL; Beyer, Mona K.; Groote, Inge Rasmus & Morberg, Pål [Vis alle 20 forfattere av denne artikkelen] (2023). Radiological features of brain hemorrhage through automated segmentation from computed tomography in stroke and traumatic brain injury. Frontiers in Neurology. 14. doi: 10.3389/fneur.2023.1244672. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Radiological assessment is necessary to diagnose spontaneous intracerebral hemorrhage (ICH) and traumatic brain injury intracranial hemorrhage (TBI-bleed). Artificial intelligence (AI) deep learning tools provide a means for decision support. This study evaluates the hemorrhage segmentations produced from three-dimensional deep learning AI model that was developed using non-contrast computed tomography (CT) imaging data external to the current study. Methods Non-contrast CT imaging data from 1263 patients were accessed across seven data sources (referred to as sites) in Norway and Sweden. Patients were included based on ICH, TBI-bleed, or mild TBI diagnosis. Initial non-contrast CT images were available for all participants. Hemorrhage location frequency maps were generated. The number of estimated haematoma clusters was correlated with the total haematoma volume. Ground truth expert annotations were available for one ICH site; hence, a comparison was made with the estimated haematoma volumes. Segmentation volume estimates were used in a receiver operator characteristics (ROC) analysis for all samples (i.e., bleed detected) and then specifically for one site with few TBI-bleed cases. Results The hemorrhage frequency maps showed spatial patterns of estimated lesions consistent with ICH or TBI-bleed presentations. There was a positive correlation between the estimated number of clusters and total haematoma volume for each site (correlation range: 0.45–0.74; each p -value &amp;lt; 0.01) and evidence of ICH between-site differences. Relative to hand-drawn annotations for one ICH site, the VIOLA-AI segmentation mask achieved a median Dice Similarity Coefficient of 0.82 (interquartile range: 0.78 and 0.83), resulting in a small overestimate in the haematoma volume by a median of 0.47 mL (interquartile range: 0.04 and 1.75 mL). The bleed detection ROC analysis for the whole sample gave a high area-under-the-curve (AUC) of 0.92 (with sensitivity and specificity of 83.28% and 95.41%); however, when considering only the mild head injury site, the TBI-bleed detection gave an AUC of 0.70. Discussion An open-source segmentation tool was used to visualize hemorrhage locations across multiple data sources and revealed quantitative hemorrhage site differences. The automated total hemorrhage volume estimate correlated with a per-participant hemorrhage cluster count. ROC results were moderate-to-high. The VIOLA-AI tool had promising results and might be useful for various types of intracranial hemorrhage.

• Bergh, Elin; Askim, Torunn; Rønning, Ole Morten; Benth, Jurate Saltyte; Fjærtoft, Hild & Thommessen, Bente (2022). Does implementation of a standardized pathway of stroke care affect functional outcome after stroke? International Journal of Stroke. ISSN 1747-4930. doi: 10.1177/17474930221126592. Fulltekst i vitenarkiv Vis sammendrag

  Background: A stroke care pathway (SCP) was introduced in Norway in 2018. The goal of the pathway was to avoid delay in treatment and diagnostics of acute stroke and to secure treatment according to national guidelines. In this study, we aimed to evaluate how the implementation of the SCP affects outcome after stroke. Methods: We performed a register-based study using data from the Norwegian Stroke Register that covers 87% of acute stroke patients in Norway. Patients included 1 year before and 1 year after the introduction of the care pathway were compared (2017 vs 2019). Change in functional outcome, the proportion of independent patients 90 days post-stroke, discharge destination, proportions admitted to stroke units and 90 days mortality were compared. Functional outcome was measured using modified Rankin Scale (mRS) and functional independence was defined as mRS 0–2. Results: In total, 11,009 patients with 90 days follow-up data were analyzed. Comparing the cohorts from 2017 and 2019, there was no change in demographics or stroke characteristics. No statistically significant differences in mRS, admission to thrombolysis time, or 90 days mortality were found. However, the proportion of patients discharged directly home and treated in a stroke unit increased from 2017 to 2019. Conclusion: The implementation of a standardized pathway of stroke care in Norway did not lead to improvement in functional outcome or a reduction in 90 days mortality. However, the proportion of patients discharged directly home increased, and more patients were treated in stroke units in 2019 compared with 2017.

• Walle-Hansen, Marte; Berge, Trygve; Vigen, Thea; Myrstad, Marius; Hagberg, Guri & Ihle-Hansen, Hege Beathe [Vis alle 14 forfattere av denne artikkelen] (2022). Systolic blood pressure at age 40 and cognitive function 25 years later: The Akershus Cardiac Examination (ACE) 1950 Study. Journal of Hypertension. ISSN 0263-6352. 41(1), s. 132–139. doi: 10.1097/HJH.0000000000003312. Fulltekst i vitenarkiv
• Strøm, Loreta Skrebelyte; Rønning, Ole Morten; Dahl, Fredrik Andreas; Steine, Kjetil & Kjekshus, Harald (2022). Prediction of occult atrial fibrillation in patients after cryptogenic stroke and transient ischaemic attack: PROACTIA. Europace. ISSN 1099-5129. 24(12), s. 1881–1888. doi: 10.1093/europace/euac092. Fulltekst i vitenarkiv Vis sammendrag

  Aims Studies with implantable cardiac monitors (ICMs) show that one-third of patients with cryptogenic stroke/transient ischaemic attack (TIA) have episodes of subclinical atrial fibrillation (SCAF) and benefit switching from antiplatelet- to anticoagulant therapy. However, ICMs are costly and resource demanding. We aimed to build a score based on participant’s baseline characteristics that could assess individual risk of SCAF. Methods and results In a prospective study, 236 eligible patients with a final diagnosis of cryptogenic stroke/TIA had an ICM implantated during the index hospitalization. Pre-specified evaluated variables were: CHA2DS2-VASc, P-wave duration, P-wave morphology, premature atrial beats (PAC)/24 h, supraventricular tachycardia/24 h, left atrial end-systolic volume index (LAVI), Troponin-T, NT-proBNP, and D-dimer. SCAF was detected in 84 patients (36%). All pre-specified variables were significantly associated with SCAF detection in univariate analysis. P-wave duration, followed by PAC/24 h, NT-proBNP, and LAVI, had the largest ratio of SCAF prevalence between its upper and lower quartiles (3.3, vs. 3.2, vs. 3.1 vs. 2.8, respectively). However, in a multivariate analysis, only PAC/24t, P-wave duration, P-wave morphology, and LAVIs remained significant predictors and were included in the PROACTIA score. Subclinical atrial fibrillation prevalence was 75% in the highest vs. 10% in the lowest quartile of the PROACTIA score with a 10-fold higher number of patients with an atrial fibrillation burden >6 h in the highest vs. the lowest quartile. Conclusion The PROACTIA score can identify patients with cryptogenic stroke/TIA at risk of subsequent SCAF detection. The large difference in SCAF prevalence between groups may provide a basis for future tailored therapy. Clinical trial registration Clinical Trial Registration: ClinicalTrials.gov; NCT02725944.

• Øverberg, Linda Thøring; Lugg, Elise Fritsch; Gaarder, Mona; Langhammer, Birgitta; Thommessen, Bente & Rønning, Ole Morten [Vis alle 7 forfattere av denne artikkelen] (2022). Plasma levels of BDNF and EGF are reduced in acute stroke patients. Heliyon. 8(6). doi: 10.1016/j.heliyon.2022.e09661. Fulltekst i vitenarkiv Vis sammendrag

  Stroke affects almost 14 million people worldwide each year. It is the second leading cause of death and a major cause of acquired disability. The degree of initial impairment in cognitive and motor functions greatly affects the recovery, but idiosyncratic factors also contribute. These are largely unidentified, which contributes to making accurate prediction of recovery challenging. Release of soluble regulators of neurotoxicity, neuroprotection and repair are presumably essential. Here we measured plasma levels of known regulators of neuroprotection and repair in patients with mild acute ischemic stroke and compared them to the plasma levels in healthy age and gender matched controls. We found that the levels of BDNF and EGF were substantially lower in stroke patients than in healthy controls, while the levels of bFGF and irisin did not differ between the groups. The lower levels of growth factors highlight that during the acute phase of stroke, there is a mismatch between the need for neuroprotection and repair, and the brain's ability to induce these processes. Large individual differences in growth factor levels were seen among the stroke patients, but whether these can be used as predictors of long-term prognosis remains to be investigated.

• Nguyen, Thanh; Qureshi, Muhammad M.; Klein, Piers; Yamagami, Hiroshi; Mikulik, Robert & Czlonkowska, Anna [Vis alle 50 forfattere av denne artikkelen] (2022). Global Effect of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events A 1-Year Follow-up. Neurology. ISSN 0028-3878. 100(4), s. e408–e421. doi: 10.1212/WNL.0000000000201426. Fulltekst i vitenarkiv Vis sammendrag

  Background and Objectives Declines in stroke admission, IV thrombolysis (IVT), and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the effect of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), IVT, and mechanical thrombectomy over a 1-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year (March 1, 2019, to February 29, 2020). Methods We conducted a longitudinal retrospective study across 6 continents, 56 countries, and 275 stroke centers. We collected volume data for COVID-19 admissions and 4 stroke metrics: ischemic stroke admissions, ICH admissions, IVT treatments, and mechanical thrombectomy procedures. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. Results There were 148,895 stroke admissions in the 1 year immediately before compared with 138,453 admissions during the 1-year pandemic, representing a 7% decline (95% CI [95% CI 7.1–6.9]; p < 0.0001). ICH volumes declined from 29,585 to 28,156 (4.8% [5.1–4.6]; p < 0.0001) and IVT volume from 24,584 to 23,077 (6.1% [6.4–5.8]; p < 0.0001). Larger declines were observed at high-volume compared with low-volume centers (all p < 0.0001). There was no significant change in mechanical thrombectomy volumes (0.7% [0.6–0.9]; p = 0.49). Stroke was diagnosed in 1.3% [1.31–1.38] of 406,792 COVID-19 hospitalizations. SARS-CoV-2 infection was present in 2.9% ([2.82–2.97], 5,656/195,539) of all stroke hospitalizations. Discussion There was a global decline and shift to lower-volume centers of stroke admission volumes, ICH volumes, and IVT volumes during the 1st year of the COVID-19 pandemic compared with the prior year. Mechanical thrombectomy volumes were preserved. These results suggest preservation in the stroke care of higher severity of disease through the first pandemic year.

• Bergh, Elin; Jahr, Silje Holt; Rønning, Ole Morten; Askim, Torunn; Thommessen, Bente & Kristoffersen, Espen Saxhaug (2022). Reasons and predictors of non-thrombolysis in patients with acute ischemic stroke admitted within 4.5 h. Acta Neurologica Scandinavica. ISSN 0001-6314. 146(1), s. 61–69. doi: 10.1111/ane.13622. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Objectives Thrombolytic treatment in acute ischemic stroke (AIS) reduces stroke-related disability. Nearly 40% of all patients with AIS (<4.5 h) receive thrombolysis, but there is a large variation in the use between hospitals. Little is known about reasons and predictors for not giving thrombolytic treatment. Therefore, we aimed to investigate reasons for non-thrombolysis in patients admitted within 4.5 h. Methods All patients with AIS (<4.5 h) admitted to Akershus University Hospital, Norway, between January 2015 and December 2017 were examined. Patient characteristics and reasons for not giving thrombolysis were registered. Descriptive statistics and logistic regression analyses were performed. Results Of 535 patients admitted with AIS (<4.5 h), 250 (47%) did not receive thrombolysis and of these only 26% had an absolute contraindication to treatment. Among the 74% with relative contraindications, the most common reasons given were mild and improving symptoms. Previous stroke (OR 3.32, 95%CI 1.99–5.52), arriving between 3 h and 4.5 h after onset (OR 7.76, 95%CI 3.73–16.11) or having mild symptoms (OR 2.33, 95%CI 1.56–3.49) were all significant predictors of not receiving thrombolytic treatment in the multivariable logistic regression model. Conclusion A large proportion of patients with AIS do not receive thrombolysis. This study highlights up-to-date findings that arriving late in the time window, mild symptoms, and previous stroke are strong predictors of non-treatment. It is uncertain whether there is an underuse of thrombolysis in AIS. Increasing the utility of thrombolysis in the 4.5 h time window must be weighed against possible harms.

• Larsen, Kristin Tveitan; Selseth, Maiken Nordahl; Jahr, Silje Holt; Hillestad, Vigdis; Koubaa, Nojoud & Sandset, Else Charlotte [Vis alle 8 forfattere av denne artikkelen] (2022). Prehospital Blood Pressure and Clinical and Radiological Outcomes in Acute Spontaneous Intracerebral Hemorrhage. Stroke. ISSN 0039-2499. 53(12), s. 3633–3641. doi: 10.1161/STROKEAHA.121.038524. Fulltekst i vitenarkiv
• Dahl, Fredrik Andreas; Barra, Mathias; Faiz, Kashif Waqar; Ihle-Hansen, Hege; Næss, Halvor & Rand, Kim [Vis alle 10 forfattere av denne artikkelen] (2022). Stroke unit demand in Norway – present and future estimates. BMC Health Services Research. 22(1). doi: 10.1186/s12913-021-07385-1. Fulltekst i vitenarkiv Vis sammendrag

  Background All stroke patients should receive timely admission to a stroke unit (SU). Consequently, most patients with suspected strokes – including stroke mimics (SM) are admitted. The aim of this study was to estimate the current total demand for SU bed capacity today and give estimates for future (2020–2040) demand. Methods Time trend estimates for stroke incidence and time constant estimates for length of stay (LOS) were estimated from the Norwegian Patient Registry (2010–2015). Incidence and LOS models for SMs were based on data from Haukeland University Hospital (2008–2017) and Akershus University Hospital (2020), respectively. The incidence and LOS models were combined with scenarios from Statistic Norway’s population predictions to estimate SU demands for each health region. A telephone survey collected data on the number of currently available SU beds. Results In 2020, 361 SU beds are available, while demand was estimated to 302. The models predict a reduction in stroke incidence, which offsets projected demographic shifts. Still, the estimated demand for 2040 rose to 316, due to an increase in SMs. A variation of this reference scenario, where stroke incidence was frozen at the 2020-level, gave a 2040-demand of 480 beds. Conclusions While the stroke incidence is likely to continue to fall, this appears to be balanced by an increase in SMs. An important uncertainty is how long the trend of decreasing stroke incidence can be expected to continue. Since the most important uncertainty factors point toward a potential increase, which may be as large as 50%, we would recommend that the health authorities plan for a potential increase in the demand for SU bed capacity.

• Aamodt, Anne Hege; Taubøll, Erik; Ele, Tom Eich; Romundstad, Luis Georg; Sorteberg, Angelika & Wallace, Sean Ciaran [Vis alle 24 forfattere av denne artikkelen] (2021). Brain monitoring in hospitals needs to be strengthened. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 141(15), s. 1–8. doi: 10.4045/tidsskr.21.0412. Fulltekst i vitenarkiv
• Ihle-Hansen, Håkon; Sandset, Else Charlotte; Ihle-Hansen, Hege; Hagberg, Guri; Thommessen, Bente & Rønning, Ole Morten [Vis alle 12 forfattere av denne artikkelen] (2021). Sex differences in the Norwegian Tenecteplase Trial (NOR-TEST). European Journal of Neurology. ISSN 1351-5101. 29, s. 609–614. doi: 10.1111/ene.15126. Fulltekst i vitenarkiv Vis sammendrag

  Background and purpose Sex differences in acute ischemic stroke is of increasing interest in the era of precision medicine. We aimed to explore sex disparities in baseline characteristics, management and outcomes in patients treated with intravenous thrombolysis included in the Norwegian Tenecteplase trial (NOR-TEST). Methods NOR-TEST was an open-label, randomized, blinded endpoint trial, performed from 2012 to 2016, comparing treatment with tenecteplase to treatment with alteplase within 4.5 h after acute ischemic stroke symptom onset. Sex differences at baseline, treatment and outcomes were compared using multivariable logistic regression models. Heterogeneity in treatment was evaluated by including an interaction term in the model. Results Of 1100 patients enrolled, 40% were women, and in patients aged >80 years, the proportion of women was greater than men (19% vs. 14%; p = 0.02). Women had a lower burden of cardiovascular risk factors, such as diabetes mellitus (11% vs. 15%; p = 0.05) and a higher mean high-density lipoprotein cholesterol level (1.7 ± 0.6 mmol/L vs. 1.3 ± 0.4 mmol/L; p < 0.001), and a higher proportion of women had never smoked (45% vs. 33%; p < 0.001) compared with men. While there was no sex difference in time from onset of symptoms to admission, door to needle time or in-hospital workup, women were admitted with more severe stroke (National Institutes of Health Stroke Scale [NIHSS] score 6.2 ± 5.6 vs. 5.3 ± 5.1; p = 0.01). Stroke mimic diagnosis was more common in women (21% vs. 15%; p = 0.01). There were no significant sex differences in clinical outcome, measured by the NIHSS, the modified Rankin Scale, intracranial hemorrhage and mortality. Conclusion Women were underrepresented in number in NOR-TEST. The included women had a lower cardiovascular risk factor burden and more severe strokes.

• Kristoffersen, Espen Saxhaug; Jahr, Silje Holt; Faiz, Kashif Waqar; Thommessen, Bente & Rønning, Ole M. (2021). Stroke admission rates before, during and after the first phase of the COVID-19 pandemic. Neurological Sciences. ISSN 1590-1874. 42(3), s. 791–798. doi: 10.1007/s10072-021-05039-y. Fulltekst i vitenarkiv
• Thomassen, Lars; Kurz, Friedrich Martin Wilhelm & Rønning, Ole Morten (2021). Hjerneslag som eget fagfelt. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 141(17). doi: 10.4045/tidsskr.21.0618. Fulltekst i vitenarkiv
• Lyngbakken, Magnus; Vigen, Thea; Ihle-Hansen, Håkon; Brynildsen, Jon; Berge, Trygve & Rønning, Ole M. [Vis alle 9 forfattere av denne artikkelen] (2021). Cardiac troponin I measured with a very high sensitivity assay predicts subclinical carotid atherosclerosis: The Akershus Cardiac Examination 1950 Study. Clinical Biochemistry. ISSN 0009-9120. 93, s. 59–65. doi: 10.1016/j.clinbiochem.2021.04.005. Fulltekst i vitenarkiv Vis sammendrag

  Aims Concentrations of cardiac troponin I (cTnI) are associated with incident ischemic stroke and predict the presence and severity of coronary atherosclerosis. Accordingly, we hypothesized that concentrations of cTnI measured with a very high sensitivity (hs-) assay would be associated with subclinical stages of carotid atherosclerosis in the general population. Methods We measured hs-cTnI on the Singulex Clarity System in 1745 women and 1666 men participating in the prospective observational Akershus Cardiac Examination 1950 Study. All study participants were free from known coronary heart disease and underwent extensive cardiovascular phenotyping at baseline, including carotid ultrasound. We quantified carotid atherosclerosis by the carotid plaque score, carotid intima-media thickness (cIMT) and the presence of hypoechoic plaques. Results Concentrations of hs-cTnI were measurable in 99.8% of study participants and were significantly associated with increased carotid plaque score (odds ratio for quartile 4 of hs-cTnI 1.59, 95% CI 1.22 to 2.07, p for trend < 0.001) and cIMT (odds ratio for quartile 4 of hs-cTnI 1.57, 95% CI 1.02 to 2.42, p for trend = 0.036), but not with the presence of hypoechoic plaques. hs-cTnI concentrations significantly improved reclassification and discrimination models in predicting carotid plaques when added to cardiovascular risk factors, no improvements were evident in predicting cIMT or hypoechoic plaques. Conclusion Concentrations of cTnI measured with a very high sensitivity assay are predictive of carotid atherosclerotic burden, a phenomenon likely attributable to common risk factors of subclinical myocardial injury, coronary and carotid atherosclerosis.

• Chandra, Anupam; Røsjø, Helge; Svensson, My Hanna Sofia; Vigen, Thea; Ihle-Hansen, Håkon & Orstad, Eivind Bjørkan [Vis alle 14 forfattere av denne artikkelen] (2020). Plasma linoleic acid levels and cardiovascular risk factors: results from the Norwegian ACE 1950 Study. European Journal of Clinical Nutrition. ISSN 0954-3007. doi: 10.1038/s41430-020-0641-4. Fulltekst i vitenarkiv Vis sammendrag

  Background A high intake of linoleic acid (LA), the major dietary polyunsaturated fatty acid (PUFA), has previously been associated with reduced cardiovascular (CV) morbidity and mortality in observational studies. However, recent secondary analyses from clinical trials of LA-rich diet suggest harmful effects of LA on CV health. Methods A total of 3706 participants, all born in 1950, were included in this cross-sectional study. We investigated associations between plasma phospholipid levels of LA and CV risk factors in a Norwegian general population, characterized by a relative low LA and high marine n-3 PUFA intake. The main statistical approach was multivariable linear regression. Results Plasma phospholipid LA levels ranged from 11.4 to 32.0 wt%, with a median level of 20.8 wt% (interquartile range 16.8–24.8 wt%). High plasma LA levels were associated with lower serum low-density lipoprotein cholesterol levels (standardized regression coefficient [Std. β-coeff.] −0.04, p = 0.02), serum triglycerides (Std. β-coeff. −0.10, p < 0.001), fasting plasma glucose (Std. β-coeff. −0.10, p < 0.001), body mass index (Std. β-coeff. −0.13, p < 0.001), systolic and diastolic blood pressure (Std. β-coeff. −0.04, p = 0.03 and Std. β-coeff. −0.02, p = 0.02, respectively) and estimated glomerular filtration rate (Std. β-coeff. −0.09, p < 0.001). We found no association between plasma LA levels and high-density lipoprotein cholesterol levels, glycated hemoglobin, carotid intima-media thickness, or C-reactive protein. Conclusion High plasma LA levels were favorably associated with several CV risk factors in this study of a Norwegian general population.

• Chandra, Anupam; Lyngbakken, Magnus; Eide, Ivar Anders; Røsjø, Helge; Vigen, Thea & Ihle-Hansen, Håkon [Vis alle 13 forfattere av denne artikkelen] (2020). Plasma trans fatty acid levels, cardiovascular risk factors and lifestyle: Results from the Akershus cardiac examination 1950 study. Nutrients. 12(5). doi: 10.3390/nu12051419. Fulltekst i vitenarkiv Vis sammendrag

  Intake of industrially produced trans fatty acids (iTFAs) has previously been associated with dyslipidemia, insulin resistance, hypertension and inflammation, as well as increased cardiovascular (CV) morbidity and mortality. iTFA intake declined in Norway after the introduction of legislative bans against iTFA consumption. However, the relationship between the current iTFA intake and CV health is unclear. The aim of the present study was to investigate the association between current iTFA intake, reflected by plasma iTFA levels, and established CV risk factors. We also examined the associations between plasma ruminant TFA levels and CV risk factors. In this cross-sectional study, we included 3706 participants from a Norwegian general population, born in 1950 and residing in Akershus County, Norway. The statistical method was multivariable linear regression. Plasma iTFA levels were inversely associated with serum triglycerides (p &lt; 0.001), fasting plasma glucose (p &lt; 0.001), body mass index (p &lt; 0.001), systolic and diastolic blood pressure (p = 0.001 and p = 0.03) and C-reactive protein (p = 0.001). Furthermore, high plasma iTFA levels were associated with higher education and less smoking and alcohol consumption. We found that plasma ruminant trans fatty acids (rTFA) levels were favorably associated with CV risk factors. Furthermore, plasma iTFA levels were inversely associated with CV risk factors. However, our results might have been driven by lifestyle factors. Overall, our findings suggest that the current low intake of iTFAs in Norway does not constitute a threat to CV health.

• Kristoffersen, Espen Saxhaug; Jahr, Silje Holt; Thommessen, Bente & Rønning, Ole M. (2020). Effect of COVID-19 pandemic on stroke admission rates in a Norwegian population. Acta Neurologica Scandinavica. ISSN 0001-6314. 142, s. 632–636. doi: 10.1111/ane.13307. Fulltekst i vitenarkiv Vis sammendrag

  Objectives There are concerns that public anxiety around COVID‐19 discourages patients from seeking medical help. The aim of this study was to see how lockdown due to the pandemic affected the number of admissions of acute stroke. Methods All patients discharged from Akershus University Hospital with a diagnosis of transient ischemic attack (TIA) or acute stroke were identified by hospital chart review. January 3 to March 12 was defined as before, and March 13 to April 30 as during lockdown. Results There were 21.8 admissions/week before and 15.0 admissions/week during the lockdown (P < .01). Patients had on average higher NIHSS during the lockdown than before (5.9 vs. 4.2, P = .041). In the multivariable logistic regression model for ischemic stroke (adjusted for sex, age, living alone and NIHSS ≤ 5), there was an increased OR of 2.05 (95% CI 1.10‐3.83, P = .024) for not reaching hospital within 4.5 hours during the lockdown as compared to the period before the lockdown. Conclusion There was a significant reduction in number of admissions for stroke and TIAs during the lockdown due to the COVID‐19 pandemic in Norway.

• Thommessen, Bente; Næss, Halvor; Logallo, Nicola; Kvistad, Christopher Elnan; Waje-Andreassen, Ulrike & Ihle-Hansen, Hege [Vis alle 9 forfattere av denne artikkelen] (2020). Tenecteplase versus alteplase after acute ischemic stroke at high age. International Journal of Stroke. ISSN 1747-4930. doi: 10.1177/1747493020938306. Fulltekst i vitenarkiv
• Labberton, Angela Susan; Rønning, Ole M.; Thommessen, Bente & Barra, Mathias (2019). Changes in survival and characteristics among older stroke unit patients-1994 versus 2012. Brain and Behavior. 9(1). doi: 10.1002/brb3.1175. Fulltekst i vitenarkiv Vis sammendrag

  Objectives Treatment on organized stroke units (SUs) improves survival after stroke, and stroke mortality has decreased worldwide in recent decades; however, little is known of survival trends among SU patients specifically. This study investigates changes in survival and characteristics of older stroke patients receiving SU treatment. Materials & Methods We compared 3‐year all‐cause mortality and baseline characteristics in two cohorts of stroke patients aged ≥60 consecutively admitted to the same comprehensive SU in 1994 (n = 271) and 2012 (n = 546). Results Three‐year survival was 53.9% in 1994 and 56.0% in 2012, and adjusted hazard ratio (HR) was 0.99 (95% CI: 0.77–1.28). Adjusted 30‐day case fatality was slightly higher in 2012, 18.9% versus 16.2%, HR 1.68 (95% CI: 1.14–2.47). There were no significant between‐cohort differences in survival beyond 30 days. Patients in 2012 were older (mean age: 78.8 vs. 76.7 years) and more often admitted from nursing homes. There were higher rates of atrial fibrillation (33.7% vs. 21.4%) and malignancy (19.2% vs. 8.9%), and prescription of antiplatelets (46.9% vs. 26.2%) and warfarin (16.3% vs. 5.5%) at admission. Stroke severity was significantly milder in 2012, proportion with mild stroke 66.1% versus 44.3%. Conclusions Three‐year survival in older Norwegian stroke patients treated on an SU remained stable despite improved treatment in the last decades. Differences in background characteristics may explain this lack of difference; patients in 2012 were older, more often living in supported care, and had higher prestroke comorbidity; however, their strokes were milder and risk factors more often treated.

• Barra, Mathias; Labberton, Angela Susan; Faiz, Kashif Waqar; Lindstrøm, Jonas Christoffer; Rønning, Ole M. & Viana, Joe [Vis alle 8 forfattere av denne artikkelen] (2019). Stroke incidence in the young: evidence from a Norwegian register study. Journal of Neurology. ISSN 0340-5354. s. 1–17. doi: 10.1007/s00415-018-9102-6. Fulltekst i vitenarkiv
• Faiz, Kashif Waqar; Sundseth, Antje; Thommessen, Bente & Rønning, Ole M. (2019). The knowing-doing gap in acute stroke - Does stroke knowledge translate into action? Brain and Behavior. doi: 10.1002/brb3.1245. Fulltekst i vitenarkiv
• Rand, Kim; Dahl, Fredrik Andreas; Viana, Joe; Rønning, Ole M.; Faiz, Kashif Waqar & Barra, Mathias (2019). Fewer ischemic strokes, despite an ageing population: stroke models from observed incidence in Norway 2010–2015. BMC Health Services Research. 19(1). doi: 10.1186/s12913-019-4538-7. Fulltekst i vitenarkiv Vis sammendrag

  Background Stroke incidence rates have fallen in high-income countries over the last several decades, but findings regarding the trend over recent years have been mixed. The aim of the study was to describe and model temporal trends in incidence of stroke by age and sex between 2010 and 2015 in Norway, and to generate incidence projections towards year 2040. Methods All recorded strokes in Norway between 2010 and 2015 were extracted from the National Patient Registry and the National Cause of Death Registry. We report incidence by age, sex, and year; in raw numbers, per 100,000 person-years, by WHO and European standard populations; and generated statistical models by stroke type, age, sex, and year; and projected stroke incidence toward year 2040. Results The data covered 30.1 million person-years at risk, 53431 unique individuals hospitalized with a primary stroke diagnosis, and 6315 additional individuals registered as dead due to stroke. From 2010 to 2015, individuals suffering stroke per 100,000 person-years dropped from 239 to 195 (208 to 177 excluding immediate deaths). The decline was driven by ischemic strokes, with a statistically non-significant time trend for hemorrhagic stroke. Conclusions The age-dependent incidence of ischemic strokes in Norway is declining rapidly, and more than compensates for the growth and ageing of the population. Comparisons with historic incidence statistics show that the reduction in incidence rates has accelerated over the last two decades.

• Chandra, Anupam; Røsjø, Helge; Eide, Ivar Anders; Vigen, Thea; Ihle-Hansen, Håkon & Orstad, Eivind Bjørkan [Vis alle 13 forfattere av denne artikkelen] (2019). Plasma marine n-3 polyunsaturated fatty acids and cardiovascular risk factors: data from the ACE 1950 study. European Journal of Nutrition. ISSN 1436-6207. s. 1–11. doi: 10.1007/s00394-019-02007-3. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Purpose A high intake of marine n-3 polyunsaturated fatty acids (PUFAs) might improve cardiovascular (CV) health. We conducted a cross-sectional study to investigate associations between plasma phospholipid levels of marine n-3 PUFAs and CV risk factors, educational level, physical activity and smoking habits. Methods A total of 3706 individuals from a general population, all born in 1950 and residing in Akershus County, Norway, were included in this study. The main statistical approach was multivariable adjusted linear regression. Results Plasma marine n-3 PUFA levels ranged from 2.7 to 20.3 wt%, with a median level of 7.7 wt% (interquartile range 4.3–11.1 wt%). High levels of plasma marine n-3 PUFAs were associated with lower serum triglycerides [Standardized regression coefficient (Std.β-coeff.) − 0.14, p < 0.001], body mass index (Std. β-coeff. −0.08, p < 0.001), serum creatinine (Std. β-coeff. -0.03, p = 0.05), C-reactive protein levels (Std. β-coeff. – 0.03, p = 0.04), higher levels of serum high-density lipoprotein cholesterol (Std. β-coeff. 0.08, p < 0.001) and low-density lipoprotein cholesterol (Std. β-coeff. 0.04, p = 0.003). High levels of plasma marine n-3 PUFAs were also associated with lower glycated hemoglobin (Std. β-coeff. – 0.04, p = 0.01), however, only in individuals without diabetes. We found no associations between plasma marine n-3 PUFA levels and fasting plasma glucose or carotid intima-media thickness. High levels of plasma marine n-3 PUFAs were associated with higher educational level, more physical activity and lower prevalence of smoking. Conclusion In this cross-sectional study of Norwegian individuals born in 1950, high levels of plasma marine n-3 PUFAs were favourably associated with several CV risk factors, suggesting that fish consumption might improve CV health.

• Vigen, Thea; Ihle-Hansen, Håkon; Lyngbakken, Magnus; Berge, Trygve; Thommessen, Bente & Ihle-Hansen, Hege [Vis alle 11 forfattere av denne artikkelen] (2019). Carotid Atherosclerosis is Associated with Middle Cerebral Artery Pulsatility Index. Journal of Neuroimaging (JON). ISSN 1051-2284. doi: 10.1111/jon.12684. Fulltekst i vitenarkiv Vis sammendrag

  BACKGROUND AND PURPOSE Pulsatility index (PI) in the middle cerebral artery (MCA) is considered a measure of peripheral vascular resistance. Several established cardiovascular risk factors are common for both MCA PI and carotid atherosclerosis. Accordingly, in the present study we hypothesized an association between ultrasound‐derived indices of carotid atherosclerosis and MCA PI. METHODS All residents in Akershus County, born in 1950, were invited to a cardiovascular examination, The Akershus Cardiac Examination (ACE) 1950 Study (2012‐2015). A thorough ultrasound examination was performed to assess indices of atherosclerosis in the carotid arteries, and PI in the MCAs. In all, 3154 (85.1%) had adequate transcranial and carotid data. Associations between indices of carotid atherosclerosis and MCA PI were assessed by regression analyses adjusted for established cardiovascular risk factors. RESULTS Mean age was 64 (standard deviation [SD]: .6) years, and 1,357 (43%) were women. Mean MCA PI was .97 (SD: .17). Participants in the upper quartile of MCA PI had higher pulse pressure, more frequently hypertension, diabetes mellitus, and a history of coronary artery disease. Both carotid plaque score (B .007 [95% CI: .003‐.010]) and carotid intimamedia thickness (B .173 [95% CI: .120‐.226]) were significantly associated with MCA PI in adjusted analysis. The model R 2 was .055. CONCLUSION In a population‐based sample of middle‐aged adults, ultrasound‐derived indices of carotid atherosclerosis were independently associated with MCA PI. However, the overall explained variance of MCA PI was low, suggesting other factors than atherosclerosis and cardiovascular risk factors to play an important role for MCA PI.

• Vigen, Thea; Ihle-Hansen, Håkon; Lyngbakken, Magnus; Berge, Trygve; Thommessen, Bente & Ihle-Hansen, Hege [Vis alle 12 forfattere av denne artikkelen] (2019). Blood pressure at age 40 predicts carotid atherosclerosis two decades later: Data from the Akershus Cardiac Examination 1950 Study. Journal of Hypertension. ISSN 0263-6352. 37(10), s. 1982–1990. doi: 10.1097/HJH.0000000000002131. Fulltekst i vitenarkiv Vis sammendrag

  Objective: We assessed the impact of a single time-point measurement of SBP, DBP and pulse pressure at the age of 40, on carotid plaque burden, echolucent plaques and carotid intima–media thickness late midlife. Methods: Individuals participating in two separate studies, 23 years apart, defined our cohort (n = 2714). ‘The Age 40 Program’, a nationwide Norwegian cardiovascular screening survey, performed 1985–1999, assessed cardiovascular risk factors and lifestyle variables at age 40. ‘The ACE 1950 Study’, a population-based cohort study on individuals born in 1950, performed 2012–2015, included ultrasound examinations of the carotid arteries. Blood pressure (BP) determinants of carotid atherosclerosis were assessed by regression models adjusted for cardiovascular risk factors at age 40, and late midlife BP. Results: The participants, 50.3% women, had a mean age of 40 (SD 0.3) years in the first study, and 64 (SD 0.6) years in the second. At age 40, mean SBP was 128 (SD 14) mmHg, mean DBP was 78 (SD 10) mmHg and mean pulse pressure was 50 (SD 9) mmHg. SBP and DBP at age 40 predicted carotid plaque burden in late midlife. Only DBP predicted echolucent plaques, and none of the BP components predicted carotid intima–media thickness. Conclusion: A single time-point measurement of SBP and DBP at age 40 is associated with carotid plaque burden late midlife, also after adjustment for other cardiovascular risk factors at age 40, and of late midlife BP. Our findings emphasize the strong association between BP and atherosclerosis.

• Faiz, Kashif Waqar; Labberton, Angela Susan; Thommessen, Bente; Rønning, Ole M. & Barra, Mathias (2019). Stroke-Related Knowledge and Lifestyle Behavior among Stroke Survivors. Journal of Stroke & Cerebrovascular Diseases. ISSN 1052-3057. s. 1–7. doi: 10.1016/j.jstrokecerebrovasdis.2019.104359. Fulltekst i vitenarkiv
• Ihle-Hansen, Håkon; Vigen, Thea; Berge, Trygve; Hagberg, Guri; Engedal, Knut & Rønning, Ole M. [Vis alle 12 forfattere av denne artikkelen] (2019). Carotid Atherosclerosis and Cognitive Function in a General Population Aged 63-65 Years: Data from the Akershus Cardiac Examination (ACE) 1950 Study. Journal of Alzheimer's Disease. ISSN 1387-2877. 70(4), s. 1041–1049. doi: 10.3233/JAD-190327. Fulltekst i vitenarkiv Vis sammendrag

  Background:Studies on the relationship between carotid atherosclerosis and cognitive function in subjects from the general population are few and results have been inconsistent. Objective:We aimed to investigate the association between carotid atherosclerotic burden and cognitive function in a cross-sectional analysis of a population-based cohort aged 63–65 years. Methods:All habitants born in 1950 from Akershus County, Norway were invited to participate. A linear regression model was used to assess the association between carotid atherosclerosis and cognitive function. We used carotid plaque score as a measure of carotid atherosclerotic burden and the Montreal Cognitive Assessment (MoCA) for global cognitive function. Results:We analyzed 3,413 individuals aged 63–65 with mean MoCA score 25.3±2.9 and 87% visible carotid plaques. We found a negative correlation between carotid plaque score and MoCA score (r = –0.14, p < 0.001), but this association was lost in multivariable analysis. In contrast, diameter or area of the thickest plaque was independently associated with MoCA score. Lower educational level, male sex, current smoking, and diabetes were also associated with lower MoCA score in multivariable analysis. Conclusion:Carotid atherosclerotic burden was, unlike other measures of advanced carotid atherosclerosis, not independently associated with global cognitive function.

• Labberton, Angela Susan; Barra, Mathias; Rønning, Ole M.; Thommessen, Bente; Churilov, Leonid & Cadilhac, Dominique A. [Vis alle 7 forfattere av denne artikkelen] (2019). Patient and service factors associated with referral and admission to inpatient rehabilitation after the acute phase of stroke in Australia and Norway. BMC Health Services Research. 19:871. doi: 10.1186/s12913-019-4713-x. Fulltekst i vitenarkiv Vis sammendrag

  Background Unequal access to inpatient rehabilitation after stroke has been reported. We sought to identify and compare patient and service factors associated with referral and admission to an inpatient rehabilitation facility (IRF) after acute hospital care for stroke in two countries with publicly-funded healthcare. Methods We compared two cohorts of stroke patients admitted consecutively to eight acute public hospitals in Australia in 2013–2014 (n = 553), and to one large university hospital in Norway in 2012–2013 (n = 723). Outcomes were: referral to an IRF; admission to an IRF if referred. Logistic regression models were used to identify and compare factors associated with each outcome. Results Participants were similar in both cohorts: mean age 73 years, 40–44% female, 12–13% intracerebral haemorrhage, ~ 77% mild stroke (National Institutes of Health Stroke Scale < 8). Services received during the acute admission differed (Australia vs. Norway): stroke unit treatment 82% vs. 97%, physiotherapy 93% vs. 79%, occupational therapy 83% vs. 77%, speech therapy 78% vs. 13%. Proportions referred to an IRF were: 48% (Australia) and 37% (Norway); proportions admitted: 35% (Australia) and 28% (Norway). Factors associated with referral in both countries were: moderately severe stroke, receiving stroke unit treatment or allied health assessments during the acute admission, living in the community, and independent pre-stroke mobility. Directions of associations were mostly congruent; however younger patients were more likely to be referred and admitted in Norway only. Models for admission among patients referred identified few associated factors suggesting that additional factors were important for this stage of the process. Conclusions Similar factors were associated with referral to inpatient rehabilitation after acute stroke in both countries, despite differing service provision and access rates. Assuming it is not feasible to provide inpatient rehabilitation to all patients following stroke, the criteria for the selection of candidates need to be understood to address unwanted biases.

• Rønning, Ole M.; Logallo, Nicola; Thommessen, Bente; Tobro, Håkon; Novotny, Vojtech & Kvistad, Christopher Elnan [Vis alle 10 forfattere av denne artikkelen] (2019). Tenecteplase versus alteplase between 3 and 4.5 hours in low national institutes of health stroke scale. Stroke. ISSN 0039-2499. 50(2), s. 498–500. doi: 10.1161/STROKEAHA.118.024223. Fulltekst i vitenarkiv
• Chandra, Anupam; Røsjø, Helge; Eide, Ivar Anders; Vigen, Thea; Ihle-Hansen, Håkon & Orstad, Eivind Bjørkan [Vis alle 13 forfattere av denne artikkelen] (2019). Plasma marine n-3 polyunsaturated fatty acids and cardiovascular risk factors: data from the ACE 1950 study. European Journal of Nutrition. ISSN 1436-6207. doi: 10.1007/s00394-019-02007-3. Fulltekst i vitenarkiv
• Kvistad, Christopher Elnan; Novotny, Vojtech; Kurz, Martin; Rønning, Ole M.; Thommessen, Bente & Carlsson, Maria [Vis alle 10 forfattere av denne artikkelen] (2019). Safety and Outcomes of Tenecteplase in Moderate and Severe Ischemic Stroke. Stroke. ISSN 0039-2499. 50(5), s. 1279–1281. doi: 10.1161/STROKEAHA.119.025041. Fulltekst i vitenarkiv
• Faiz, Kashif Waqar; Labberton, Angela Susan; Thommessen, Bente; Rønning, Ole M.; Dahl, Fredrik Andreas & Barra, Mathias (2018). The Burden of Stroke Mimics: Present and Future Projections. Journal of Stroke & Cerebrovascular Diseases. ISSN 1052-3057. 27(5), s. 1288–1295. doi: 10.1016/j.jstrokecerebrovasdis.2017.12.011. Fulltekst i vitenarkiv
• Faiz, Kashif Waqar; Sundseth, Antje; Thommessen, Bente & Rønning, Ole M. (2018). Patient knowledge on stroke risk factors, symptoms and treatment options. Vascular Health and Risk Management. ISSN 1176-6344. 14, s. 37–40. doi: 10.2147/VHRM.S152173. Fulltekst i vitenarkiv Vis sammendrag

  Background: Public campaigns focus primarily on stroke symptom and risk factor knowledge, but patients who correctly recognize stroke symptoms do not necessarily know the reason for urgent hospitalization. The aim of this study was to explore knowledge on stroke risk factors, symptoms and treatment options among acute stroke and transient ischemic attack patients. Methods: This prospective study included patients admitted to the stroke unit at the Department of Neurology, Akershus University Hospital, Norway. Patients with previous cerebrovascular disease, patients receiving thrombolytic treatment and patients who were not able to answer the questions in the questionnaire were excluded. Patients were asked two closed-ended questions: “Do you believe that stroke is a serious disorder?” and “Do you believe that time is of importance for stroke treatment?”. In addition, patients were asked three open-ended questions where they were asked to list as many stroke risk factors, stroke symptoms and stroke treatment options as they could. Results: A total of 173 patients were included, of whom 158 (91.3%) confirmed that they regarded stroke as a serious disorder and 148 patients (85.5%) considered time being of importance. In all, 102 patients (59.0%) could not name any treatment option. Forty-one patients (23.7%) named one or more adequate treatment options, and they were younger (p<0.001) and had higher educational level (p<0.001), but had a nonsignificant shorter prehospital delay time (p=0.292). Conclusion: The level of stroke treatment knowledge in stroke patients seems to be poor. Public campaigns should probably also focus on information on treatment options, which may contribute to reduce prehospital delay and onset-to-treatment-time.

• Ihle-Hansen, Håkon; Vigen, Thea; Ihle-Hansen, Hege; Rønning, Ole M.; Berge, Trygve & Thommessen, Bente [Vis alle 12 forfattere av denne artikkelen] (2018). Prevalence of carotid plaque in a 63- to 65-Year-Old Norwegian cohort from the general population: The ACE (Akershus Cardiac Examination) 1950 study. Journal of the American Heart Association (JAHA). 7(10). doi: 10.1161/JAHA.118.008562. Fulltekst i vitenarkiv Vis sammendrag

  Background New data on extracranial carotid atherosclerosis are needed, as improved ultrasound techniques may detect more atherosclerosis, the definition of plaque has changed over the years, and better cardiovascular risk control in the population may have changed patterns of carotid arterial wall disease and actual prevalence of established cardiovascular disease. We investigated the prevalence of atherosclerotic carotid plaques and carotid intima–media thickness (cIMT) and their relation to cardiovascular risk factors in a middle‐aged cohort from the general population. Methods and Results We performed carotid ultrasound in 3683 participants who were born in 1950 and included in a population‐based Norwegian study. Carotid plaque and cIMT were assessed according to the Mannheim Carotid Intima–Media Thickness and Plaque Consensus, and a carotid plaque score was used to calculate atherosclerotic burden. The participants were aged 63 to 65 years, and 49% were women. The prevalence of established cardiovascular disease was low (10%), but 62% had hypertension, 53% had hypercholesterolemia, 11% had diabetes mellitus, and 23% were obese. Mean cIMT was 0.73±0.11 mm, and atherosclerotic carotid plaques were present in 87% of the participants (median plaque score: 2; interquartile range: 3). Most of the cardiovascular risk factors, with the exception of diabetes mellitus, obesity and waist–hip ratio, were independently associated with the plaque score. In contrast, only sex, hypertension, obesity, current smoking, and cerebrovascular disease were associated with cIMT. Conclusions We found very high prevalence of carotid plaque in this middle‐aged population, and our data support a greater association between cardiovascular risk factors and plaque burden, compared with cIMT.

• Labberton, Angela Susan; Faiz, Kashif Waqar; Rønning, Ole M.; Thommessen, Bente & Barra, Mathias (2018). Differences in and Determinants of Prehospital Delay Times among Stroke Patients?1994 Versus 2012. Journal of Stroke & Cerebrovascular Diseases. ISSN 1052-3057. 27(9), s. 2398–2404. doi: 10.1016/j.jstrokecerebrovasdis.2018.04.030. Fulltekst i vitenarkiv Vis sammendrag

  Objectives Prehospital delay is a challenge for stroke treatment and the delivery of time-critical treatments. Few studies have examined secular trends in prehospital delay, and results vary. This study investigates how prehospital delay among Norwegian stroke patients has changed over the last 2 decades. Methods We compared time from symptom onset to admission in 2 cohorts of stroke patients admitted to Akershus University Hospital, Norway, in 1994 (n = 550) and 2012 (n = 522), and constructed predictive models for arrival within 3 hours for each cohort. Results More patients arrived within 3 hours of symptom onset in 2012 compared to 1994 (proportion, 47.1% versus 19.3%, P < .001), also after adjusting for age, sex, and baseline differences; odds ratio (OR) was 5.14 (95% confidence interval [CI] 3.69-7.15). Stroke severity was the only predictor examined that was independently associated with early arrival during both periods. For patients with moderate strokes the overall OR was 2.06 (95% CI 1.41-3.00) and for severe strokes 4.52 (95% CI 2.97-6.87), compared to those with mild strokes. In the 1994 cohort additional predictors of early arrival were living with others and not being admitted from nursing home. Conclusions Prehospital delay in Norway has decreased considerably over the last 2 decades and since the availability of time-critical treatments. However, there is still an urgent need to reduce the number of delayed admissions as a large proportion of patients continue to arrive too late to benefit from these

• Vigen, Thea; Thommessen, Bente & Rønning, Ole M. (2018). Stroke Risk Is Low after Urgently Treated Transient Ischemic Attack. Journal of Stroke & Cerebrovascular Diseases. ISSN 1052-3057. 27(2), s. 291–295. doi: 10.1016/j.jstrokecerebrovasdis.2017.08.037. Fulltekst i vitenarkiv
• Faiz, Kashif Waqar & Rønning, Ole M. (2018). Hjerneslag. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 138(3), s. 279–280. Fulltekst i vitenarkiv
• Rønning, Ole M. & Tornes, K.D. (2017). Need for symptomatic management in Advanced multiple sclerosis. Acta Neurologica Scandinavica. ISSN 0001-6314. 135(5), s. 529–532. doi: 10.1111/ane.12631. Fulltekst i vitenarkiv
• Perry, Luke A.; Berge, Eivind; Bowditch, Joshua; Forfang, Elisabeth; Rønning, Ole M. & Hankey, Graeme J. [Vis alle 8 forfattere av denne artikkelen] (2017). Antithrombotic treatment after stroke due to intracerebral haemorrhage. Cochrane Database of Systematic Reviews. 2017:CD012144(5), s. 1–45. doi: 10.1002/14651858.CD012144.pub2. Fulltekst i vitenarkiv
• Logallo, Nicola; Novotny, Vojtech; Assmus, Jörg; Kvistad, Christopher Elnan; Alteheld, Lars Holger & Rønning, Ole M. [Vis alle 21 forfattere av denne artikkelen] (2017). Tenecteplase versus alteplase for management of acute ischaemic stroke (NOR-TEST): a phase 3, randomised, open-label, blinded endpoint trial. Lancet Neurology. ISSN 1474-4422. 16(10), s. 781–788. doi: 10.1016/S1474-4422(17)30253-3. Fulltekst i vitenarkiv
• Ihle-Hansen, Håkon; Vigen, Thea; Berge, Trygve; Einvik, Gunnar; Aarsland, Dag & Rønning, Ole M. [Vis alle 10 forfattere av denne artikkelen] (2017). Montreal Cognitive Assessment in a 63- to 65-year-old Norwegian Cohort from the General Population: Data from the Akershus Cardiac Examination 1950 Study. Dementia and Geriatric Cognitive Disorders Extra. 7(3), s. 318–327. doi: 10.1159/000480496. Fulltekst i vitenarkiv Vis sammendrag

  Aims: To investigate Montreal Cognitive Assessment (MoCA) test scores in a cohort aged 63–65 years from a general population in relation to the proposed cut-off score of 26 for mild cognitive impairment (MCI) and to explore the impact of education. Methods: MoCA scores were assessed in the Akershus Cardiac Examination 1950 Study, a cross-sectional cohort study of all men and women born in 1950 living in Akershus County, Norway. The participants were aged 63–65 at the time of data collection. Results: MoCA scores were available in 3,413 participants, of which 47% had higher education (>12 years). The mean MoCA score was 25.3 (95% confidence interval [CI] 25.2–25.4), and 49% had a score below the suggested cut-off of 26 points. Those with higher education had significantly higher scores (mean 26.2, 95% CI 26.1–26.3 vs. 24.4, 95% CI 24.3–24.6, p < 0.001). Conclusions: Approximately 50% scored below the cut-off score of 26 points, suggesting that the cut-off score may have been set too high to distinguish normal cognitive function from MCI. Educational level had a significant impact on MoCA scores.

• Faiz, Kashif Waqar; Sundseth, Antje; Thommessen, Bente & Rønning, Ole M. (2017). Prehospitalt forløp ved akutt hjerneslag. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 137(11), s. 798–802. doi: 10.4045/tidsskr.16.0512. Fulltekst i vitenarkiv
• Altmann, Marianne; Thommessen, Bente; Rønning, Ole M.; Benth, Jurate Saltyte; REICHENBACH, ANTJE & Fure, Brynjar (2016). Middle Cerebral Artery Pulsatility Index is Associated with Cognitive Impairment in Lacunar Stroke. Journal of Neuroimaging (JON). ISSN 1051-2284. 26(4), s. 431–435. doi: 10.1111/jon.12335. Fulltekst i vitenarkiv Vis sammendrag

  ABSTRACT BACKGROUND AND PURPOSE Pulsatility index (PI) of the middle cerebral artery is postulated to reflect the vascular resistance in the artery distal of the probe, and has been reported to increase in small vessel disease, diabetes mellitus, ageing, and dementia. Lacunar infarcts are considered to be related to cognitive impairment. We therefore conducted a study to assess the association between cognitive impairment and PI in patients with a lacunar infarct. METHODS Consecutive patients presenting with an acute lacunar syndrome who were admitted to the stroke unit were enrolled. The patients were examined with Doppler ultrasonography of the intracranial arteries, and the PI of the middle cerebral artery was recorded. Cognitive function was evaluated by mini-mental state examination (MMSE), clock drawing test, and trail making test (TMT) A and B. RESULTS Among the 113 patients included, 85 patients had an acute lacunar infarct and 28 had one or more nonlacunar infarcts. The mean PI was 1.46 (SD = .33). PI was significantly (P < .05) associated with MMSE, TMT A and TMT B in patients with lacunar infarct, even after adjustment for multiple patient characteristics (age, sex, prestroke hypertension, smoking, previous stroke, and diabetes). CONCLUSIONS PI was associated with the cognitive performance in patients with lacunar infarcts and a lacunar syndrome. An elevated PI may be related to impairment in several cognitive domains. These findings suggest that transcranial Doppler ultrasonography could be an adjunct tool for early diagnosis of cognitive impairment after stroke.

• Perry, Luke A.; Berge, Eivind; Bowditch, Joshua; Forfang, Elisabeth; Rønning, Ole M. & Hankey, Graeme J. [Vis alle 8 forfattere av denne artikkelen] (2016). Antithrombotic treatment after intracerebral haemorrhage. Cochrane Database of Systematic Reviews. 2016(4). doi: 10.1002/14651858.CD012144. Fulltekst i vitenarkiv
• Evensen, Kristin; Aulie, Hanne Aaserud; Rønning, Ole M.; Flatø, Berit & Russell, David (2016). Carotid atherosclerosis in adult patients with persistently active juvenile idiopathic arthritis compared with healthy controls. Journal of Rheumatology. ISSN 0315-162X. 43(4), s. 810–815. doi: 10.3899/jrheum.150499. Fulltekst i vitenarkiv Vis sammendrag

  Objective. Juvenile idiopathic arthritis (JIA) is the most common inflammatory rheumatic disease in childhood. It is regarded as a systemic inflammatory disease with possible increased risk of cardiovascular disease (CVD). The aim of this study was to assess carotid intima-media thickness (IMT) and carotid stenosis as surrogate measures for CVD in adults with longterm active JIA and healthy age- and sex-matched controls. Methods. Seventy-five patients with JIA (age 28–45 yrs) with persistently active disease at least 15 years after disease onset were reexamined after a median of 29 years and compared with 75 matched controls. Patients and controls were examined by color duplex ultrasound of the carotid arteries to compare carotid IMT and carotid stenosis in the 2 groups. Results. Patients with JIA did not have increased carotid IMT values compared with the controls (mean ± SD: 0.56 mm ± 0.09 vs 0.58 mm ± 0.07, p = 0.289). Patients with a higher disease activity indicated by the Juvenile Arthritis Disease Activity Score value above the median value had increased carotid IMT compared with the patients with a lower value, but not statistically different compared with controls. No carotid stenoses were detected in patients or controls. Conclusion. We found similar carotid IMT values in adult patients with JIA and controls.

• Nacu, Aliona; Kvistad, Christopher Elnan; Logallo, Nicola; Næss, Halvor; Waje-Andreassen, Ulrike & Aamodt, Anne Hege [Vis alle 13 forfattere av denne artikkelen] (2015). A pragmatic approach to sonothrombolysis in acute ischaemic stroke: The Norwegian randomised controlled sonothrombolysis in acute stroke study (NOR-SASS). BMC Neurology. 15:110. doi: 10.1186/s12883-015-0359-4. Fulltekst i vitenarkiv Vis sammendrag

  Background: Ultrasound accelerates thrombolysis with tPA (sonothrombolysis). Ultrasound in the absence of tPA also accelerates clot break-up (sonolysis). Adding intravenous gaseous microbubbles may potentiate the effect of ultrasound in both sonothrombolysis and sonolysis. The Norwegian Sonothrombolysis in Acute Stroke Study aims in a pragmatic approach to assess the effect and safety of contrast enhanced ultrasound treatment in unselected acute ischaemic stroke patients. Methods/Design: Acute ischaemic stroke patients ≥18 years, with or without visible arterial occlusion on computed tomography angiography (CTA) and treatable ≤ 4½ hours after symptom onset, are included in NOR-SASS. NOR-SASS is superimposed on a separate trial randomising patients with acute ischemic stroke to either tenecteplase or alteplase (The Norwegian Tenecteplase Stroke Trial NOR-TEST). The NOR-SASS trial has two arms: 1) the thrombolysis-arms (NOR-SASS A and B) includes patients given intravenous thrombolysis (tenecteplase or alteplase), and 2) the no-thrombolysis-arm (NOR-SASS C) includes patients with contraindications to thrombolysis. First step randomisation of NOR-SASS A is embedded in NOR-TEST as a 1:1 randomisation to either tenecteplase or alteplase. Second step NOR-SASS randomisation is 1:1 to either contrast enhanced sonothrombolysis (CEST) or sham CEST. Randomisation in NOR-SASS B (routine alteplase group) is 1:1 to either CEST or sham CEST. Randomisation of NOR-SASS C is 1:1 to either contrast enhanced sonolysis (CES) or sham CES. Ultrasound is given for one hour using a 2-MHz pulsed-wave diagnostic ultrasound probe. Microbubble contrast (SonoVue®) is given as a continuous infusion for ~30 min. Recanalisation is assessed at 60 min after start of CEST/CES. Magnetic resonance imaging and angiography is performed after 24 h of stroke onset. Primary study endpoints are 1) major neurological improvement measured with NIHSS score at 24 h and 2) favourable functional outcome defined as mRS 0–1 at 90 days. Discussion: NOR-SASS is the first randomised controlled trial designed to test the superiority of contrast enhanced ultrasound treatment given ≤4½ hours after stroke onset in an unselected acute ischaemic stroke population eligible or not eligible for intravenous thrombolysis, with or without a defined arterial occlusion on CTA. If a positive effect and safety can be proven, contrast enhanced ultrasound treatment will be an option for all acute ischaemic stroke patients. EudraCT No 201200032341; www.​clinicaltrials.​gov NCT01949961.

• Altmann, Marianne; Thommessen, Bente; Rønning, Ole M.; REICHENBACH, ANTJE & Fure, Brynjar (2015). Blood pressure differences between patients with lacunar and nonlacunar infarcts. Brain and Behavior. 5(8). doi: 10.1002/brb3.353. Fulltekst i vitenarkiv Vis sammendrag

  Background Elevated blood pressure is frequently seen in acute stroke, and patients with lacunar and nonlacunar infarcts may have different underlying mechanisms for increase in blood pressure. The impact of hypertension as a risk factor may also vary. The aims of the present study were to investigate blood pressure in patients presenting with lacunar syndromes but with different anatomical subtypes of stroke, to explore the impact of subtype on blood pressure, and to identify stroke-related factors associated with hypertension. Methods Consecutive patients presenting with an acute lacunar syndrome were enrolled. Patients were classified into a lacunar or nonlacunar group based on radiological verified infarcts. Blood pressure was measured. Between-group differences were analyzed by χ2-test, t-test, and Mann–Whitney U test, as appropriate. We performed linear regression to analyze the association between blood pressure and lacunar infarct, and multiple linear regression to adjust for other covariates. Results One hundred thirteen patients were included. Seventy five percent had lacunar and 25% nonlacunar infarcts. There was no significant difference in clinical severity between the two groups. In the linear regression model, we found a significant association between blood pressure and lacunar infarct. No other factor was significantly associated with blood pressure in the two groups. Conclusions Lacunar infarcts may be independently associated with higher blood pressure compared to nonlacunar infarcts with the same clinical severity. Blood pressure differences between different subtypes of stroke may not be related to clinical severity but to the underlying cause of stroke.

• Evensen, Kristin; Dahl, Arve; Rønning, Ole M. & Russell, David (2015). The Assessment of Carotid Atherosclerosis Using a New Multipurpose Ultrasound Probe. Journal of Neuroimaging (JON). ISSN 1051-2284. 25(2), s. 232–237. doi: 10.1111/jon.12105. Fulltekst i vitenarkiv
• Buchten, Daniela; Egeberg, Erik Haakon; Holtsmark, Sven Gabriel; Rønning, Ole M. & Sørbye, Yngvild (2015). Kultur, kunst og propaganda. I Holtsmark, Sven Gabriel (Red.), Naboer i frykt og forventning. Norge og Russland 1917-2014. Pax Forlag. ISSN 9788253037509. s. 173–197. Fulltekst i vitenarkiv
• Logallo, Nicola; Kvistad, Christopher Elnan; Nacu, Aliona; Næss, Halvor; Waje-Andreassen, Ulrike & Assmus, Jørg [Vis alle 13 forfattere av denne artikkelen] (2014). The Norwegian tenecteplase stroke trial (NOR-TEST): Randomised controlled trial of tenecteplase vs. alteplase in acute ischaemic stroke. BMC Neurology. 14(1:106). doi: 10.1186/1471-2377-14-106. Fulltekst i vitenarkiv Vis sammendrag

  Background: Alteplase is the only approved thrombolytic agent for acute ischaemic stroke. The overall benefit from alteplase is substantial, but some evidence indicates that alteplase also has negative effects on the ischaemic brain. Tenecteplase may be more effective and less harmfull than alteplase, but large randomised controlled phase 3 trials are lacking. The Norwegian Tenecteplase Stroke Trial (NOR-TEST) aims to compare efficacy and safety of tenecteplase vs. alteplase. Methods/Design: NOR-TEST is a multi-centre PROBE (prospective randomised, open-label, blinded endpoint) trial designed to establish superiority of tenecteplase 0.4 mg/kg (single bolus) as compared with alteplase 0.9 mg/kg (10% bolus + 90% infusion/60 minutes) for consecutively admitted patients with acute ischaemic stroke eligible for thrombolytic therapy, i.e. patients a) admitted <4½ hours after symptoms onset; b) admitted <4½ hours after awakening with stroke symptoms c) receiving bridging therapy before embolectomy. Randomisation tenecteplase:alteplase is 1:1. The primary study endpoint is favourable functional outcome defined as modified Rankin Scale 0–1 at 90 days. Secondary study endpoints are: 1) haemorrhagic transformation (haemorrhagic infarct/haematoma); 2) symptomatic cerebral haemorrhage on CT 24–48 hours; 3) major neurological improvement at 24 hours; 4) recanalisation at 24–36 hours; 5) death. Discussion: NOR-TEST may establish a novel approach to acute ischaemic stroke treatment. A positive result will lead to a more effective, safer and easier treatment for all acute ischaemic stroke pasients. NOR-TEST is reviewed and approved by the Regional Committee for Medical and Health Research Ethics (2011/2435), and The Norwegian Medicines Agency (12/01402). NOR-TEST is registered with EudraCT No 2011-005793-33 and in ClinicalTrials.gov (NCT01949948).

• Evensen, Kristin; Sarvari, Sebastian Imre; Rønning, Ole M.; Edvardsen, Thor & Russell, David (2014). Carotid artery intima-media thickness is closely related to impaired left ventricular function in patients with coronary artery disease: A single-centre, blinded, non-randomized study. Cardiovascular Ultrasound. 12(1). doi: 10.1186/1476-7120-12-39. Fulltekst i vitenarkiv Vis sammendrag

  Background Atherosclerosis is the underlying cause of the majority of myocardial infarctions and ischemic strokes. Carotid intima-media thickness (IMT) is a surrogate measure of atherosclerotic cardiovascular disease. Left ventricular (LV) function can be accurately assessed by 2D speckle-tracking strain echocardiography (2D-STE). The aim of this study was to assess the relationship between carotid IMT and LV dysfunction assessed by strain echocardiography in patients with coronary artery disease (CAD). Methods Thirty-one patients with symptoms of CAD were examined with coronary angiography, cardiac echocardiography and carotid ultrasound. Layer-specific longitudinal strains were assessed from endo-, mid- and epicardium by 2D-STE. LV global longitudinal strain (LVGLS) was averaged from 16 longitudinal LV segments in all 3 layers. LVGLS results were compared with coronary angiography findings in a receiver operating curve (ROC) to determine the cut-off for normal and pathological strain values. The calculated optimal strain value was compared to maximal carotid IMT measurements. Results The ROC analysis for strain versus coronary angiography was: area under curve (AUC) = 0.91 (95% CI 0.80 – 1.0), cut-off value for endocardial LVGLS: -16.7%. Further analyses showed that increased carotid IMT correlated with low absolute strain values (p = 0.006) also when adjusted for hypertension, smoking, hyperlipidemia, diabetes and BMI (p = 0.02). Conclusions In this study increased carotid IMT values were associated with decreased LV function assessed by strain measurements. These findings support the use of carotid IMT measurements to predict the risk of coronary heart disease.

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• Altmann, Marianne; Rønning, Ole Morten; Fure, Brynjar; Selnes, Per; Reichenbach, Antje & Kristoffersen, Espen Saxhaug [Vis alle 7 forfattere av denne artikkelen] (2022). SHORT- AND LONG-TERM MORTALITY AFTER LACUNAR INFARCT. Fulltekst i vitenarkiv
• Larsen, Kristin Tveitan; Selseth, Maiken Nordahl; Jahr, Silje Holt; Hillestad, Vigdis; Koubaa, Nojoud & Sandset, Else Charlotte [Vis alle 8 forfattere av denne artikkelen] (2022). IMPACT OF ANTITHROMBOTIC TREATMENT ON ASSOCIATIONS BETWEEN PREHOSPITAL SYSTOLIC BLOOD PRESSURE AND OUTCOMES IN ACUTE, SPONTANEOUS INTRACEREBRAL HAEMORRHAGE. Fulltekst i vitenarkiv
• Koubaa, Nojoud; Larsen, Kristin Tveitan; Hillestad, Vigdis; Selseth, Maiken Nordahl; Jahr, Silje Holt & Faiz, Kashif Waqar [Vis alle 13 forfattere av denne artikkelen] (2022). EPIDEMIOLOGY AND CLINICAL PRESENTATION OF SPONTANEOUS CEREBELLAR HEMORRHAGE IN A NORWEGIAN POPULATION. Fulltekst i vitenarkiv
• Bjerkreim, Anna Therese; Jahr, Silje Holt; Faiz, Kashif Waqar; Larsen, Kristin Tveitan; Hillestad, Vigdis & Selseth, Maiken Nordahl [Vis alle 14 forfattere av denne artikkelen] (2022). TIME ON SCENE BEFORE ADMISSION OF ACUTE STROKE AND STROKE MIMICS: THE AKERSHUS STUDY OF ISCHEMIC STROKE AND THROMBOLYSIS-1. Fulltekst i vitenarkiv
• Jahr, Silje Holt; Sandset, Else Charlotte; Faiz, Kashif Waqar; Larsen, Kristin Tveitan; Hillestad, Vigdis & Selseth, Maiken Nordahl [Vis alle 11 forfattere av denne artikkelen] (2022). PRE-HOSPITAL SYSTOLIC BLOOD PRESSURE AND DIAGNOSIS IN SUSPECTED STROKE: THE AKERSHUS STUDY OF ISCHEMIC STROKE AND THROMBOLYSIS-1. Fulltekst i vitenarkiv
• Rønning, Ole Morten; Carlsson, Maria Kristin; Ihle-Hansen, Hege; Aamodt, Anne Hege; Tveiten, Arnstein & Eltoft, Agnethe [Vis alle 9 forfattere av denne artikkelen] (2022). Overvåkning etter akutt hjerneslag bør bli bedre. 142(14), s. 1–6. doi: 10.4045/tidsskr.22.0401. Fulltekst i vitenarkiv
• Larsen, Kristin Tveitan; Forfang, Elisabeth; Pennlert, Johanna; Glader, Eva-Lotta; Kruuse, Christina & Wester, Per [Vis alle 12 forfattere av denne artikkelen] (2020). STudy of Antithrombotic Treatment after IntraCerebral Haemorrhage: Protocol for a randomised controlled trial. European Stroke Journal. ISSN 2396-9873. 5(4), s. 414–422. doi: 10.1177/2396987320954671. Fulltekst i vitenarkiv Vis sammendrag

  Background and aims - Many patients with prior intracerebral haemorrhage have indications for antithrombotic treatment with antiplatelet or anticoagulant drugs for prevention of ischaemic events, but it is uncertain whether such treatment is beneficial after intracerebral haemorrhage. STudy of Antithrombotic Treatment after IntraCerebral Haemorrhage will assess (i) the effects of long-term antithrombotic treatment on the risk of recurrent intracerebral haemorrhage and occlusive vascular events after intracerebral haemorrhage and (ii) whether imaging findings, like cerebral microbleeds, modify these effects.<p> <p>Methods - STudy of Antithrombotic Treatment after IntraCerebral Haemorrhage is a multicentre, randomised controlled, open trial of starting versus avoiding antithrombotic treatment after non-traumatic intracerebral haemorrhage, in patients with an indication for antithrombotic treatment. Participants with vascular disease as an indication for antiplatelet treatment are randomly allocated to antiplatelet treatment or no antithrombotic treatment. Participants with atrial fibrillation as an indication for anticoagulant treatment are randomly allocated to anticoagulant treatment or no anticoagulant treatment. Cerebral CT or MRI is performed before randomisation. Duration of follow-up is at least two years. The primary outcome is recurrent intracerebral haemorrhage. Secondary outcomes include occlusive vascular events and death. Assessment of clinical outcomes is performed blinded to treatment allocation. Target recruitment is 500 participants.

• Kristoffersen, Espen Saxhaug; REICHENBACH, ANTJE; Faiz, Kashif Waqar; Bergh, Elin; Baar, Anette & Altmann, Marianne [Vis alle 9 forfattere av denne artikkelen] (2019). Prehospital tidsbruk ved hjerneslag. Tid brukt på hentested. Fulltekst i vitenarkiv
• Kristoffersen, Espen Saxhaug; REICHENBACH, ANTJE; Faiz, Kashif Waqar; Altmann, Marianne; Sundseth, Antje & Thommessen, Bente [Vis alle 7 forfattere av denne artikkelen] (2019). IS IT POSSIBLE TO DETECT LARGE-VESSEL OCCLUSIONS IN ACUTE ISCHEMIC STROKE USING CLINICAL SCREENING SCALES? European Stroke Journal. ISSN 2396-9873. 4. doi: 10.1177/2396987319845578. Fulltekst i vitenarkiv
• Kristoffersen, Espen Saxhaug; REICHENBACH, ANTJE; Faiz, Kashif Waqar; Altmann, Marianne; Sundseth, Antje & Thommessen, Bente [Vis alle 7 forfattere av denne artikkelen] (2019). Is it possible to detect large-vessel occlusions in acute ischemic stroke using screening scales? European Journal of Neurology. ISSN 1351-5101. 26. Fulltekst i vitenarkiv
• Barra, Mathias; Labberton, Angela Susan; Faiz, Kashif Waqar; Lindstrøm, Jonas Christoffer; Rønning, Ole M. & Viana, Joe [Vis alle 9 forfattere av denne artikkelen] (2019). Slaginsidens i alle aldre – tidstrender og fremskrivninger. Fulltekst i vitenarkiv
• Kristoffersen, Espen Saxhaug; REICHENBACH, ANTJE; Faiz, Kashif Waqar; Altmann, Marianne; Sundseth, Antje & Thommessen, Bente [Vis alle 7 forfattere av denne artikkelen] (2018). Is it possible to identify acute ischemic stroke patients with large-vessel occlusions using clinical screening scales? Fulltekst i vitenarkiv
• Kristoffersen, Espen Saxhaug; REICHENBACH, ANTJE; Faiz, Kashif Waqar; Altmann, Marianne; Sundseth, Antje & Thommessen, Bente [Vis alle 7 forfattere av denne artikkelen] (2018). Kan pasienter med akutt storkarokklusjon identifiseres med kliniske skåringsverktøy? Fulltekst i vitenarkiv
• Aamodt, Anne Hege; Kurz, Friedrich Martin Wilhelm; Jacobsen, Eva Astrid; Totland, Jon Andre; Rønning, Ole Morten & Thomassen, Lars [Vis alle 8 forfattere av denne artikkelen] (2018). Indikasjonsstillingen ved trombektomi :. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 138(17), s. 1592–1592. doi: 10.4045/tidsskr.18.0771. Fulltekst i vitenarkiv
• Jahr, Silje Holt; Rønning, Ole M.; Sundseth, Antje; Skrebelyte-Strøm, Loreta & Thommessen, Bente (2018). En mann i 40-årene med residiverende hjerneinfarkt. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 138(11), s. 1033–1036. doi: 10.4045/tidsskr.17.0853. Fulltekst i vitenarkiv
• Labberton, Angela Susan; Rønning, Ole M.; Thommessen, Bente & Barra, Mathias (2018). Changes in survival, risk factors and stroke characteristics among older Norwegian stroke unit patients. Fulltekst i vitenarkiv
• Labberton, Angela Susan; Rønning, Ole M.; Thommessen, Bente & Barra, Mathias (2018). Survival in older Norwegian stroke patients. Fulltekst i vitenarkiv
• Labberton, Angela Susan; Rønning, Ole M.; Thommessen, Bente & Barra, Mathias (2018). Patterns and predictors of referral to rehabilitation among older Norwegian stroke unit patients. Fulltekst i vitenarkiv
• Labberton, Angela Susan; Rønning, Ole M.; Thommessen, Bente & Barra, Mathias (2018). Access to hospital-based rehabilitation among older Norwegian stroke unit patients. Fulltekst i vitenarkiv
• Labberton, Angela Susan; Faiz, Kashif Waqar; Thommessen, Bente; Rønning, Ole M. & Barra, Mathias (2017). TRENDS IN STROKE SEVERITY AND BASELINE RISK PROFILE IN PATIENTS TREATED ON A COMPREHENSIVE STROKE UNIT IN NORWAY IN 1994 VERSUS 2012. Fulltekst i vitenarkiv
• Labberton, Angela Susan; Faiz, Kashif Waqar; Thommessen, Bente; Rønning, Ole M. & Barra, Mathias (2017). Differences in pre-hospital delay times among Norwegian stroke patients - 1994 versus 2012. Fulltekst i vitenarkiv
• Labberton, Angela Susan; Faiz, Kashif Waqar; Thommessen, Bente; Rønning, Ole M. & Barra, Mathias (2017). Differences in pre-hospital delay times in greater Oslo and Akershus County in 1994 versus 2012. Fulltekst i vitenarkiv
• Faiz, Kashif Waqar; Labberton, Angela Susan; Thommessen, Bente; Rønning, Ole M.; Dahl, Fredrik Andreas & Barra, Mathias (2017). THE BURDEN OF STROKE MIMICS - THE PRESENT AND FUTURE PROJECTIONS. Fulltekst i vitenarkiv
• Rønning, Ole M. (2016). Ultralyd av halspulsårer. I Aakhus, Svend (Red.), Medisinsk ultralyddiagnostikk. Klinisk basisbok.. Gyldendal Akademisk. ISSN 9788205490178. s. 149–162. Fulltekst i vitenarkiv
• Rønning, Ole M. (2016). Reperfusjonsbehandling ved ukjent slagdebut :. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 136(16), s. 1333–1333. doi: 10.4045/tidsskr.16.0626. Fulltekst i vitenarkiv
• Altmann, Marianne; Fure, Brynjar; Rønning, Ole M. & Thommessen, Bente (2016). Lacunar infarcts. Clinical syndromes, risk factors and diagnostic aspects. Universitetet i Oslo. Fulltekst i vitenarkiv

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