UCD Neurovascular Research Unit

The HRB SCTNI Project Office is based within the UCD Neurovascular Research Unit, at the Clinical Research Centre at the Mater University Hospital. The Neurovascular Research Unit performs epidemiological research to better understand stroke frequency, risk, and outcomes. It also conducts imaging studies to improve identification of patients at highest risk of first and multiple strokes. These patients can then be identified as those most likely to benefit from intensive treatment to prevent stroke.

North Dublin Population
Stroke Study (NDPSS)

The North Dublin Population Stroke Study was conducted from 2005-2006 with follow up to 2008. Before the study, sources of information regarding stroke occurrence and outcome in Ireland were limited. Designed according to ‘gold-standard’ guidelines, NDPSS aimed to gather accurate data on stroke frequency and outcome in an Irish population-based sample, including all patients over a 12-month period in 7% of the Irish population. 750 patients participated in the study.

Combined with the National Stroke Audit, the NDPSS study provided essential source data for stroke health policy formation in Ireland. Prof Kelly co-authored the national cardiovascular and stroke strategy document for the Irish Department of Health, ‘Changing Cardiovascular Health’.

NDPSS also was valuable for planning service delivery. In 2010, NDPSS data was essential for planning of the Model of Care for Stroke document, the guiding document for service improvements under the Health Service Executive National Stroke Programme, led by Prof Kelly and Prof Joseph Harbison.

Main Findings & Outputs:

  • High rates of stroke incidence in Ireland compared to other European populations.
  • High rates of disability and fatality following stroke in Ireland, broadly in line with other European studies.
  • Research from the study was presented at national and international conferences and published in leading international journals

This Irish quality improvement programme led to a 3-fold increase in stroke thrombolysis rates, reductions in stroke case-fatality and disability of 15-20%, and several other national service improvements for stroke.

NDPSS was also key source data for economic analysis of the Cost of Stroke in Ireland and for analysis of the role of rehabilitation services after stroke, done by the Economic and Social Research Institute.

Funded By : Health Research Board

BIO-Stroke and BIO-TIA studies

Patients with transient ischaemic attack (TIA) and first non-disabling stroke are at high risk of second stroke. The ability to predict which patients are at high risk for recurrent stroke is important to target established and new treatments towards those at greatest risk. In BIO-STROKE/BIO-TIA, we studied clinical, blood biomarker, and MRI characteristics in 900 patients and controls, to improve identification of patients at highest risk of second stroke.

Funded By: Health Research Board

Main Findings & Outputs:

  • Identification of independent predictive utility of carotid atherosclerosis for early second stroke risk compared to the ABCD2 score and atrial fibrillation
  • Identification of high risk of very early recurrence within the 14-day time window currently recommended for endarterectomy.
  • Analysis of blood biomarkers and MRI characteristics to predict future stroke is under way. • Establishment of international TIA collaboration (below)

International TIA Individual-Patient Data (IPD) Collaboration

In 2010 we established the multi-centre TIA Individual-Patient Data Collaboration, working with international colleagues. This is a pooled database of de-identified individual-level data from over 4,000 patients from 11 North American, European, and Asian centres, including Dublin, Harvard and Stanford Universities, UCLA, Calgary, Oxford, Paris, Spain, and Greece. The IPD data provided sufficient statistical power to derive and validate the ABCD3-I score, which includes information from carotid imaging and brain MRI to predict stroke risk after TIA.

In 2016 we collaborated with 16 international centres to assemble a new database of over 3,500 patients with TIA. This new dataset has allowed us to clearly confirm the superiority of the ABCD3-I score to identify patients at highest risk of stroke.

Main Findings & Outputs:

  • Derivation and validation of ABCD3-I (Lancet Neurology, 2010)
  • Re-validation and demonstration of superior performance of ABCD3-I (Lancet Neurology, 2016)
  • Other work from the IPD Collaboration is completed or under

Funded By:
Health Research Board
National funding agencies of member countries

Dublin Carotid Atherosclerosis Stroke Study (DUCASS)

Carotid artery narrowing by atherosclerosis is associated with high risk of second stroke after first minor stroke or TIA. Traditionally, risk has been estimated based on the degree of narrowing (stenosis) of the artery. Recent evidence indicates that inflammation is an important factor leading to unstable atherosclerosis and second strokes. Positron Emission Tomography (PET) imaging identifies inflammation in arteries, independent of narrowing. In DUCASS, we studied whether PET could identify patients at high risk of second stroke. 60 patients with carotid atherosclerosis and recent minor stroke/TIA participated.

This study was the first to clearly link atherosclerotic plaque inflammation with risk of early recurrent stroke, raising the prospect of using imaging of artery inflammation to identify patients for very early treatment.

Main Findings & Outputs:

  • We discovered that carotid artery inflammation (measured by PET imaging) was a strong predictor of recurrent stroke, independently of age and stenosis. The risk of second stroke was increased 6-fold in patients with high inflammation on PET scan.
  • Supporting this finding, microscopic evidence of severe inflammation in surgically-removed atherosclerosis samples was also a strong predictor of early second stroke.

We are validating these imaging findings in the international BIOVASC study (below). We are also investigating whether anti-inflammation treatment may prevent stroke in the CONVINCE trial.

Funded By : Irish Heart Foundation

Biomarkers and Imaging of Vulnerable Atherosclerosis in Symptomatic Carotid Artery Disease (BIOVASC)

In BIOVASC, we are continuing our investigations into using advanced imaging techniques to identify inflammation and other high-risk features of carotid atherosclerosis. This will improve identification of patients at highest risk of second stroke, allowing targeting of treatments towards these high risk patients. BIOVASC is studying PET, CT, plaque MRI, brain MRI, blood biomarkers, and resected atherosclerosis specimens, and relating these to early and late outcomes. BIOVASC is an Irish and international study led from the Neurovascular Research Unit, including Mater, St Vincents and Cork University Hospitals, St James’, Connolly, Beaumont Hospitals, and collaborators from University of Calgary, St-Anne Hospital Paris, Hospital St-Pau Barcelona, and Singapore University Hospital. 242 patients have participated and recruitment is now complete. Analysis is under way.

Funded by: Health Research Board