About
The Neurovascular Research Group has an experience of almost 20 years in multidisciplinary clinical-translational research in cerebral vascular pathology, with various cutting-edge clinical studies up to preclinical research at the molecular level and mechanisms of stroke.
This group was founded in 2006 by Dr Antoni Dávalos, and has been consolidated as a cerebrovascular diseases research group financed by ISCIII from 2007 onwards. Since 2021, the team is led and coordinated by Dr Mònica Millán, current Head of the Neurology Service of the Department of Neurosciences at the Germans Trias i Pujol Hospital, with the support and clinical sub-coordination of Dr Natalia Pérez de la Ossa, Head section of the Stroke Unit. The group is certified as a research team by AGAUR (2022) and is part of the RICORS-ictus network (2021).
The Stroke Unit of the Hospital Germans Trias i Pujol, accredited by the Spanish Society of Neurology (SEN) and by the European Stroke Organization (ESO), treats more than 1,000 stroke patients a year. It is one of the centres with the highest volume of reperfusion treatment in Catalonia, annually treating 120 patients with intravenous therapy and 150 patients with thrombectomy, with optimal intrahospital organisation and time metrics.
The general objectives of the Neurovascular Research Group are to carry out research of excellence, to develop and participate in clinical trials, to deepen the knowledge of the results achieved so far in basic and clinical research, to communicate to society and to the scientific community, and most importantly, to transfer the maximum of our knowledge to clinical practice in the care of patients with cerebrovascular diseases. Thus, the group’s researchers aim for socially responsible research and innovation, prioritizing research with the greatest potential to generate benefit for society, patients and their families.
Keywords: Stroke, thrombolysis, mechanical thrombectomy, endovascular treatment, intracranial hemorrhage, pre-hospital organization, neuroimaging, ischemia biomarkers, neuroprotection, post-stroke care, cognition.
Team
Alejandro Bustamante Rangel(ELIMINAR)
María Hernández Pérez(ELIMINAR)
Meritxell Gomis Cortina(ELIMINAR)
Laura Dorado Bouix(ELIMINAR)
Marina Martínez Sánchez(ELIMINAR)
Belén Flores-Pina(ELIMINAR)
Antoni Dávalos Errando(ELIMINAR)
Alicia Martínez Piñeiro(ELIMINAR)
Lucia Muñoz Narbona(ELIMINAR)
Martí Boix Coll(ELIMINAR)
Patricia Cuadras Collsamanta(ELIMINAR)
Paloma Puyalto De Pablo(ELIMINAR)
Cynthia María Cáceres Aguilar(ELIMINAR)
Carlos Hernán Castaño Duque(ELIMINAR)
Sebastià Remollo Friedemann(ELIMINAR)
Isabel Rodríguez Caamaño(ELIMINAR)
Carlos J. Domínguez Alonso(ELIMINAR)
Ana Rodríguez Hernández(ELIMINAR)
Alberto Blanco Ibañez(ELIMINAR)
Research lines
Therapies in patients with acute stroke
Neuroprotection
- Development of a neuroprotective agent (aptamer) in phase IIa-IIb clinical trial to demonstrate the safety and clinical benefit in patients with ischemic stroke candidates for endovascular treatment (APRIL Study).
- Co-leading the RACETOLL study to evaluate the safety of the same aptamer drug as a neuroprotectant administered in the ambulance in the pre-hospital phase.
- Develop a phase IIa/IIb clinical trial to evaluate the safety, dose determination and proof of concept of the benefit of apotransferrin in the treatment of ischemic stroke in patients treated with endovascular treatment.
Intravenous thrombolytic agents
- Participation and direction of multicentric studies that will demonstrate the therapeutic benefit of new intravenous thrombolytic agents such as tenecteplase (TNK-CAT study).
Endovascular treatment
- Demonstrate the safety of different technology and approaches for mechanical thrombectomy in acute stroke: AQUAS (Aperio Stent+ QTM Distal Aspiration Catheter), SEMTIC.
- Demonstrate the benefit of intra-arterial tPA post-complete recanalization in stroke patients treated with mechanical thrombectomy as a collaborating center of the CHOICE-2 study.
- Evaluate the benefit of mechanical thrombectomy in new indications within international clinical trials such as in patients with extensive signs of incipient ischemia (LASTE, SELECT), mild symptoms (MOSTE) or distal occlusions (DISTAL trial).
- Development of electrophysiological device to identify patients with favorable response to mechanical thrombectomy (PROMISE20).
Intracranial haemorrhage
- Improve the prediction of mortality and functional prognosis to favor therapeutic decisions: Design and external validation of a novel and easier prognostic scale for mortality and functional recovery of patients with cerebral hemorrhage. To compare the prognostic performance of the new scale with published and more widely used prognostic scales.
- Leadership in the development of a study of minimally invasive surgery.
- Demonstrate the benefit of therapies with coagulation factors (recombinant FVII) as a collaborating center of the FASTEST trial study.
Territorial organization for stroke care
Pre-hospital triage
- Development of new tools for pre-hospital triage to identify stroke sub-type (ischemic, hemorrhage and mimic-stroke) in the ambulance, as an evolution of the RACE scale, developed and validated by our group (RACE-PLUS project).
- Define the most effective pre-hospital transfer circuits and algorithms depending on the patient's own characteristics, logistics, geography, etc... based on substudies of the RACECAT trial.
- Collaborate in international projects for the creation of artificial mathematical models through geomapping to define the optimal circuits in different geographical territories.
Multimodal neuroimaging techniques (CT and MR in acute stroke)
Patient selection for reperfusion treatment
- To determine the best multimodal neuroimaging (CT or MRI) for the selection of stroke patients with criteria for mechanical thrombectomy.
- To determine whether simple imaging techniques offer the same safety profile as advanced multimodal techniques in selecting patients for mechanical thrombectomy in an extended treatment window (VESTA trial).
- To establish new neuroimaging algorithms to improve patient selection.
Radiological biomarkers
- Study of mechanisms associated with cerebral infarction progression quantified with DWI lesion volume and radiological markers associated with clinical response and reperfusion damage (FURIAS trial).
Diagnostic and prognostic clinical and biological markers of stroke and its complications
Pneumonia associated with stroke (ELITE-SAP project)
- To validate a panel of blood biomarkers for the prediction and diagnosis of stroke-associated pneumonia.
- To evaluate pulmonary ultrasound for the prediction and diagnosis of pneumonia associated with stroke.
- To characterize the bronchoalveolar lavage fluid in animal models of stroke and its relationship with the development of pulmonary infections.
- To evaluate new therapeutic targets and drugs for the prevention of pneumonia associated with stroke through the modulation of pulmonary immunity.
Cerebral thrombus analysis
- Validation of software for the radiological assessment of thrombus using artificial intelligence techniques that allow predicting the composition of the thrombus, the resistance to recanalization, with the aim of being able to establish the optimal treatment approach, as well as the etiology of the stroke and origin of the thrombus (ITACAT trial).
Neurocardiology
Neurological complications of invasive cardiac procedures
- Advanced neuropsychological and neuroimaging evaluation of the impact of cognitive impairment associated with different cardiac surgery techniques: aortic valve replacement through cardiac surgery vs transcatheter implantation (TAVI) (ARTICO study).
Identification of cardiac arrhythmias as a cause of stroke
- SRA (Stroke Risk Analysis) technology. To determine the incidence of paroxysmal atrial fibrillation in patients with undetermined etiology of the stroke in the follow-up detected with the SRA system and with the insertable device.
- Identify echocardiographic factors in combination with factors obtained in cardiac monitoring using the SRA system that allow predicting patients with atrial fibrillation.
Brain recovery and post-stroke care
- Implement and evaluate integrated multilevel care systems to pursue improvement in post-stroke care at discharge, early detection of complications and uncovered needs, and improvement in quality of life and health status.
- Incorporate technological systems integrated into the IT systems that allow communication with the patient and family, management of expectations and collection of clinical results (PROMS and PREMS).
- Collaborate in a multicenter study to homogenize the care process and determine the clinical results focused on the value (HARMONICS).
Active projects
Grup de Recerca Neurovascular Germans Trias i Pujol (GRNV-GT)
PI: Mònica Millán Torné
Funding agency: Agència de Gestió d'Ajuts Universitaris i de Recerca (AGAUR)
Agency code: 2021 SGR 00925
Start date: 2022
End date: 2025
RICORS-ICTUS
PI: Mònica Millán Torné
Funding agency: Instituto de Salud Carlos III (ISCIII)
Agency code: RD21/0006/0024
Start date: 2022
End date: 2024
Fecal incontinence after acute stroke (FINISH Study): understanding pathophysiological mechanisms and new frontiers in its treatment
PI: Mònica Millán Torné
Funding agency: Fundació La Marató TV3
Agency code: 201718.10
Start date: 2018
End date: 2022
Project RACE / RACE-PLUS
PI: Natalia Pérez de la Ossa
Promoted by Health/AI Program (Sistema de Salut Catalunya)
Start date: 2023
Clinical trial to evaluate the administration of ApTOLL in ambulances and the neuroprotective effect in stroke patients. RACETOLL
PI: Natalia Pérez de la Ossa
Funding agency: Ministerio de Ciencia e Innovación
Agency code: CPP2021-008378
Start date: 2022
End date: 2024
Geospatial modeling for stroke care
PI: Natalia Pérez de la Ossa
Funding agency: NIH-National Institute of Neurological Disorders and Stroke
Agency code: 1R01NS127114-01
Start date: 2022
End date: 2027
NeuroToll - Desarrollo y validación clínica de un aptámero terapéutico para tratamiento del ictus isquémico agudo
PI: Antoni Dávalos Errando
Funding agency: Ministerio de Ciencia, Innovación y Universidades
Agency code: RTC-2017-6651-1
Start date: 2018
End date: 2022
Evaluación Neuropsicológica y por Neuroimagen Avanzada del impacto del Deterioro Cognitivo en la Sustitución Valvular Aórtica Convencional comparada con el Implante Transcatéter
PI: Meritxell Gomis Cortina
Funding agency: Instituto de Salud Carlos III (ISCIII)
Agency code: PI19/01397
Start date: 2020
End date: 2022
BraiN20, the new standard of care to improve the management of Acute Ischemic Stroke (AIS) patients
PI: Alicia Martínez Piñeiro
Funding agency: Fundació "La Caixa"
Agency code: CC21-10016
Start date: 2021
End date: 2023
Tratamiento del ictus en Ventana Extendida: optimización de la Selección radiológica y el modelo de TrAslado en los pacientes con un ictus de 6-24h (estudio VESTA)
PI: María Hernández Pérez
Funding agency: Instituto de Salud Carlos III (ISCIII)
Agency code: PI21/01548
Start date: 2022
End date: 2024
Evaluación del daño pulmonar como diana terapéutica contra la neumonía asociada al ictus (ELITE-SAP)
PI: Alejandro Bustamante Rangel
Funding agency: Instituto de Salud Carlos III (ISCIII)
Agency code: PI21/00939
Start date: 2022
End date: 2024
ITACAT: Impact of Thrombus Analysis in stroke patients in CATalonia
PI: Laura Dorado Bouix
Funding agency: Fundació La Marató TV3
Agency code: 201719.31
Start date: 2018
End date: 2022
Blood-brain barrier dysfunction an oxidative stress modulation in brain arteriovenous malformations: a translational study of secondary injury after surgical resection
PI: Laura Dorado Bouix
Funding agency: Fundació La Marató TV3
Agency code: 202035.32
Start date: 2021
End date: 2024
Cirugía precoz y mínimamente invasiva en hematomas intracraneales: estudio translacional multicéntrico del papel de los biomarcadores iniciales en el daño cerebral secundario subagudo
PI: Ana Rodríguez Hernández
Funding agency: Instituto de Salud Carlos III (ISCIII)
Agency code: PI22/01290
Start date: 2023
End date: 2025
Scientific publications
Krishnamoorthy S, Singh G, Jose K J, Soman B, Foerch C, Kimberly WT, Millán M, Świtońska M, Maestrini I, Bordet R, Malhotra K, Mechtouff L, Sylaja PN. Biomarkers in the Prediction of Hemorrhagic Transformation in Acute Stroke: A Systematic Review and Meta-Analysis. Cerebrovasc Dis. 2022;51(2):235-247. DOI: 10.1159/000518570.
Renú A, Millán M, San Román L, Blasco J, Martí-Fàbregas J, Terceño M, Amaro S, Serena J, Urra X, Laredo C, Barranco R, Camps-Renom P, Zarco F, Oleaga L, Cardona P, Castaño C, Macho J, Cuadrado-Godía E, Vivas E, López-Rueda A, Guimaraens L, Ramos-Pachón A, Roquer J, Muchada M, Tomasello A, Dávalos A, Torres F, Chamorro Á; CHOICE Investigators. Effect of Intra-arterial Alteplase vs Placebo Following Successful Thrombectomy on Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke: The CHOICE Randomized Clinical Trial. JAMA. 2022 Mar 1;327(9):826-835. DOI: 10.1001/jama.2022.1645.
Millán M, Ramos-Pachón A, Dorado L, Bustamante A, Hernández-Pérez M, Rodríguez-Esparragoza L, Gomis M, Remollo S, Castaño C, Werner M, Wenger D, Rubio S, Domínguez-Lizarbe M, Terceño M, Paipa AJ, Rodríguez-Vázquez A, Boned S, Camps-Renom P, Cánovas D, Giralt E, López-Cancio E, Dávalos A, Ros-Roig J, Pérez de la Ossa N; Cat-SCR Consortium. Predictors of Functional Outcome After Thrombectomy in Patients With Prestroke Disability in Clinical Practice. Stroke. 2022 Mar;53(3):845-854. DOI: 10.1161/STROKEAHA.121.034960.
Martín-Aguilar L, Paré-Curell M, Dorado L, Pérez de la Ossa-Herrero N, Ramos-Pachón A, López-Cancio E, Fernández-Nofrerias E, Rodríguez-Leor O, Castaño C, Remollo S, Puyalto P, Cuadras P, Millán M, Dávalos A, Hernández-Pérez M. Ischaemic stroke as a complication of cardiac catheterisation. Clinical and radiological characteristics, progression, and therapeutic implications. Neurologia (Engl Ed). 2022 Apr;37(3):184-191. DOI: 10.1016/j.nrleng.2018.12.020.
Pérez de la Ossa N, Abilleira S, Jovin TG, García-Tornel Á, Jimenez X, Urra X, Cardona P, Cocho D, Purroy F, Serena J, San Román Manzanera L, Vivanco-Hidalgo RM, Salvat-Plana M, Chamorro A, Gallofré M, Molina CA, Cobo E, Davalos A, Ribo M; RACECAT Trial Investigators. Effect of Direct Transportation to Thrombectomy-Capable Center vs Local Stroke Center on Neurological Outcomes in Patients With Suspected Large-Vessel Occlusion Stroke in Nonurban Areas: The RACECAT Randomized Clinical Trial. JAMA. 2022 May 10;327(18):1782-1794. DOI: 10.1001/jama.2022.4404. Erratum in: JAMA. 2023 Apr 4;329(13):1123.
Cárcel-Márquez J, Muiño E, Gallego-Fabrega C, Cullell N, Lledós M, Llucià-Carol L, Sobrino T, Campos F, Castillo J, Freijo M, Arenillas JF, Obach V, Álvarez-Sabín J, Molina CA, Ribó M, Jiménez-Conde J, Roquer J, Muñoz-Narbona L, Lopez-Cancio E, Millán M, Diaz-Navarro R, Vives-Bauza C, Serrano-Heras G, Segura T, Ibañez L, Heitsch L, Delgado P, Dhar R, Krupinski J, Delgado-Mederos R, Prats-Sánchez L, Camps-Renom P, Blay N, Sumoy L, de Cid R, Montaner J, Cruchaga C, Lee JM, Martí-Fàbregas J, Férnandez-Cadenas I. A Polygenic Risk Score Based on a Cardioembolic Stroke Multitrait Analysis Improves a Clinical Prediction Model for This Stroke Subtype. Front Cardiovasc Med. 2022 Jul 8;9:940696. DOI: 10.3389/fcvm.2022.940696.
García-Tornel Á, Seró L, Urra X, Cardona P, Zaragoza J, Krupinski J, Gómez-Choco M, Sala NM, Catena E, Palomeras E, Serena J, Hernandez-Perez M, Boned S, Olivé-Gadea M, Requena M, Muchada M, Tomasello A, Molina CA, Salvat-Plana M, Escudero M, Jimenez X, Davalos A, Jovin TG, Purroy F, Abilleira S, Ribo M, de la Ossa NP; RACECAT trial investigators. Workflow Times and Outcomes in Patients Triaged for a Suspected Severe Stroke. Ann Neurol. 2022 Dec;92(6):931-942. DOI: 10.1002/ana.26489.
Natalia Pérez de la Ossa’s publications
Alejandro Bustamante’s publications
Maria Hérnandez’s publications
Alicia Martinez's publications
Sebastià Remollo's publications
Additional information
- Group members participate in other research activities as members of various scientific committees or clinical trial safety committees, are part of scientific societies and collaborate as editors of international journals (Frontiers in Neurology, SVIN, others).
- Some of the team members participate in advisory activities to biomedical and pharmaceutical companies in the development of diagnostic devices and therapeutic strategies, such as the company Methinks, ApataTargets. They also actively participates in training activities, presentations, and advisory activities for different initiatives as the Angels Initiative which acts at a global level in the establishment of health systems and training professionals for the improvement of care stroke.
News
Traslladar als pacients amb ictus hemorràgic al centre més proper millora el seu pronòstic
Un estudi coliderat per investigadores de l'IGTP, IIB Sant Pau i IDIBGI conclou que el transport directe a un centre de referència per al tractament endovascular podria no ser la millor opció per als pacients amb diagnòstic final d'hemorràgia intracerebral o ictus hemorràgic.
La tercera edició del PERIS torna a finançar un projecte de Germans Trias i Pujol
El Departament de Salut ha lliurat aquest dimarts els ajuts de les convocatòries 2018 i 2019 del Pla Estratègic de Recerca i Innovació en Salut (PERIS). En l'edició d'enguany, la neuròloga de Germans Trias Natalia Pérez de la Ossa ha obtingut un ajut pel projecte d'atenció prehospitalària de pacients amb ictus agut. També el metge Daniel Fuster, que va rebre un ajut en la segona edició del PERIS, ha recollit aquest dimarts el guardó.
Contact
Mònica Millán
(+34) 93 497 89 11
Natalia Pérez de la Ossa
More links
Mònica Millán Torné - HUGTiP webpage · Natalia Pérez de la Ossa - HUGTiP webpage · Donate via Amics de Can Ruti