Prof. Dr. med. Urs Fischer

Prof. Urs Fischer is a clinician scientist, interested in stroke and brain health and he aims to answer clinical relevant questions with randomised controlled trials, individual participant data meta-analyses and large registries. He served as principal investigator for several international multicenter academic trials on the management of patients with ischaemic and haemorrhagic stroke, such as the SWIFT DIRECT (The Lancet, PMID: 35810756), ELAN (NEJM, PMID: 37222476), SWITCH (The Lancet, PMID: 38761811) and DISTAL (NEJM) trials. He is the Co-PI of the TECNO and ICARUS trials and part of the steering committee of the ELASPE, EMINENT-ICH and DO IT trials.

The SWIFT DIRECT trial (NCT03192332) assessed whether adding intravenous thrombolysis to mechanical thrombectomy improves the patient outcome compared to direct mechanical thrombectomy alone.

The ELAN trial (NCT03148457) assesses when oral anticoagulation with direct oral anticoagulants in stroke patients with atrial fibrillation can be introduced.

The SILENT2 (NCT04449523) study assess the incidence of silent atrial fibrillation in patients with silent brain infarction. Rhythm monitoring will be done by an implantable cardiac monitor capable of remote transmission of all recorded episodes.

The SWITCH trial (NCT02258919) investigates whether decompressive craniectomy in addition to best medical treatment is superior to best medical treatment alone for patients with intracerebral haemorrhage.

The DISTAL trial (NCT05029414) aims to assess, whether mechanical thrombectomy in addition to best medical treatment in patients with distal, medium vessel occlusion (dMEVO, defined as an occlusion of the co- or non-dominant M2, M3 or M4, A2 or A3, P1, P2 or P3) is superior to best medical treatment alone.

The TECNO trial (NCT05499832) aims to determine the safety and efficacy of intraarterial Tenecteplase in patients experiencing an acute ischemic stroke due to a large vessel occlusion with incomplete reperfusion with residual occlusions after mechanical thrombectomy.

The ICARUS trial (NCT06472336) evaluates if early endovascular therapy with intracranial stenting compared to conventional endovascular therapy is beneficial regarding the prevention of disability and dependency in daily activities in large vessel occlusion stroke patients with absence of early recanalization (TIMI score of 0-1) due to intracranial atherosclerotic disease.

The DO IT trial (NCT06571149) evaluates whether intravenous thrombolysis is safe and improves clinical outcomes in patients with an acute ischemic stroke and recent direct oral anticoagulants intake in comparison to patients treated with standard of care.

The ELAPSE trial (NCT05976685) evaluates whether in patients with atrial fibrillation and acute stroke, despite optimal anticoagulation, a combination of percutaneous left ventricular appendix occlusion plus direct oral anticoagulants after the intervention reduces the risk of recurrent ischemic strokes, systemic embolism and cardiovascular death compared to direct oral anticoagulants alone.

The EMINENT ICH trial (NCT05681988) aims to show superiority of early minimally invasive image-guided hematoma evacuation additionally to best medical treatment compared to best medical treatment alone in functional outcome rates at 6 months in patients with spontaneous supratentorial intracerebral haemorrhage.

Research fields

• Acute stroke management
• Endovascular stroke treatment
• Intracerebral hemorrhage
• Anticoagulation and stroke
• Brain-heart axis
• Sinus venous thrombosis
• Stroke prevention

1. Fischer U, et al.; SWIFT DIRECT Collaborators. Thrombectomy alone versus intravenous alteplase plus thrombectomy in pa- tients with stroke: an open-label, blinded-outcome, randomised non-inferiority trial. Lancet. 2022 Jul 9;400(10346):104-115.
2. Majoie CB, …, Fischer U; IRIS collaborators. Value of intravenous thrombolysis in endovascular treatment for large-vessel anterior circulation stroke: individual participant data meta-analysis of six randomised trials. Lancet. 2023 Sep 16;402(10406):965- 974.
3. Kaesmacher J, … Fischer U, Roos Y, Gralla J (equal last authors); IRIS Collaborators. Time to Treatment With Intravenous Thrombolysis Before Thrombectomy and Functional Outcomes in Acute Ischemic Stroke: A Meta-Analysis. JAMA. 2024 Mar 5;331(9):764-777.
4. Fischer U, et al; ELAN Investigators. Early versus Later Anticoagulation for Stroke with Atrial Fibrillation. N Engl J Med. 2023 Jun 29;388(26):2411-2421.
5. Beck J,…,, Fischer U. Decompressive craniectomy plus best medical treatment versus best medical treatment alone for spontaneous severe deep supratentorial intracerebral haemorrhage: a randomised controlled clinical trial. Lancet. 2024 Jun 1;403(10442):2395-2404. 

• European Stroke Organisation Trials Alliance
• All stroke units and stroke centers in Switzerland
• Selected partners:
  • University Hospital, Helsinki, Finland
  • Queen Elizabeth University Hospital, Glasgow, UK
  • Universitätsklinikum Hamburg-Eppendorf, Germany
  • Universitätsklinikum Freiburg, Germany
  • Centre Hospitaliaier Universitaire de Toulouse, France
  • National Cerebral and Cardiovascular Center, Osaka, Japan
  • University Center Gasthuisberg, Leuven, Belgium
  • University of Calgary & Foothills Medical Centre, Calgary, Canada

Urs Fischer is actively involved in various National and European Stroke Societies, holding positions such president of the Swiss Neurological Society (SNS), president elect of the European Stroke Organisation (ESO) and former Member of the Programme Committee of the European Academy of Neurology (EAN). He was cofounder of the ESO ESMINT ESNR Stroke Winter School and the Asian Stroke School, and is actively involved in the European Stroke Master Program in Bern, Switzerland.