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3. Safety and efficacy of active blood-pressure reduction to the recommended thresholds for intravenous thrombolysis in patients with acute ischaemic stroke in the Netherlands (TRUTH): a prospective, observational, cluster-based, parallel-group study

Author

Zonneveld, Thomas P, Vermeer, Sarah E, van Zwet, Erik W, Groot, Adrien E D, Algra, Ale, Aerden, Leo A M, Alblas, Kees C L, de Beer, Frank, Brouwers, Paul J A M, de Gans, Koen, van Gemert, H Maarten A, van Ginneken, Bart C A M, Grooters, Gerke S, Halkes, Patricia H A, van der Heijden-Montfroy, Tonny A M H G, Jellema, Korné, de Jong, Sonja W, Lövenich-Ciccarello, Harry, van der Meulen, Willem D M, Peters, Edwin W, van der Ree, Taco C, Remmers, Michel J M, Richard, Edo, Rovers, Jörgen M P, Saxena, Ritu, van Schaik, Sander M, Schonewille, Wouter J, Schreuder, Tobien A H C M L, de Schryver, Els L L M, Schuiling, Wouter J, Spaander, Fianne H, van Tuijl, Julia H, Visser, Marieke C, Zinkstok, Sanne M, Zock, Elles, Dippel, Diederik W J, Kappelle, L Jaap, van Oostenbrugge, Robert J, Roos, Yvo B W E M, Vermeij, Frederique H, Wermer, Marieke J H, van der Worp, H Bart, Nederkoorn, Paul J, and Kruyt, Nyika D

Published
2024
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4. Prevention of infections and fever to improve outcome in older patients with acute stroke (PRECIOUS): a randomised, open, phase III, multifactorial, clinical trial with blinded outcome assessment

Author

Kerkhoff, Henk, Wermer, Marieke JH., Jellema, Korné, Kwa, Vincent IH., Jansen, Ben P., Schreuder, Tobien AHCML., Zinkstok, Sanne M., Moudrous, Walid, Antsov, Katrin, Gross-Paju, Katrin, Kalju, Inga, Hamann, Gerhard F., Rosenkranz, Michael, Gumbinger, Christoph, Royl, Georg, Müller, Susanne, Vassilopoulou, Sophie, Protogerou, Athanasios D., Manios, Efstathios, Bereczki, Dániel, Jakab, Gábor, Nagy, Ferenc, Folyovich, András, Szapáry, László, Gilberti, Nicola, Righetti, Enrico, Bassi, Pietro, Marcheselli, Simona, Giossi, Alessia, Holtan, Anne G., Maini, Sameer, Fryze, Waldemar, Brola, Waldemar, Sobolewski, Piotr, Bilik, Marta, Davies, Ruth, Nair, Anand, Dutta, Dipankar, Cooper, Martin, Rashed, Khalid, Shaw, Louise, Selvarajah, Johann R., Redgrave, Jessica, MacLeod, Mary Joan, Clatworthy, Philip, Papavasileiou, Vasileios, Cvoro, Vera, Halse, Omid, Ghani, Usman, de Jonge, Jeroen C., Sluis, Wouter M., Reinink, Hendrik, Bath, Philip M., Woodhouse, Lisa J., Zweedijk, Berber, van de Beek, Diederik, Aamodt, Anne Hege, Alpers, Iris, Ciccone, Alfonso, Csiba, Laszlo, Demotes, Jacques, Kõrv, Janika, Kurkowska-Jastrzebska, Iwona, Dawson, Jesse, Macleod, Malcolm R., Ntaios, George, Poli, Sven, Milionis, Haralampos, Ricci, Stefano, Cenciarelli, Silvia, Candelaresi, Paolo, de Bruijn, Sebastiaan FTM., Pathansali, Rohan, Krishnan, Kailash, Clarke, Brian, Thomalla, Götz, and van der Worp, H Bart

Published
2024
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6. Endovascular treatment of patients with stroke caused by anterior cerebral artery occlusions

Author

Neurologen, Brain, Circulatory Health, Stroke, Vos, Erik M., Kappelhof, Manon, den Hartog, Sanne J., Coutinho, Jonathan M., Emmer, Bart J., Roozenbeek, Bob, van Zwam, Wim H., van Oostenbrugge, Robert J., van der Worp, H. Bart, Uyttenboogaart, Maarten, van Es, Adriaan C.G.M., Majoie, Charles B.L.M., Dippel, Diederik W.J., Peeters-Scholte, Cacha M.P.C.D., van den Wijngaard, Ido R., Neurologen, Brain, Circulatory Health, Stroke, Vos, Erik M., Kappelhof, Manon, den Hartog, Sanne J., Coutinho, Jonathan M., Emmer, Bart J., Roozenbeek, Bob, van Zwam, Wim H., van Oostenbrugge, Robert J., van der Worp, H. Bart, Uyttenboogaart, Maarten, van Es, Adriaan C.G.M., Majoie, Charles B.L.M., Dippel, Diederik W.J., Peeters-Scholte, Cacha M.P.C.D., and van den Wijngaard, Ido R.

Published
2024

7. Prevention of infections and fever to improve outcome in older patients with acute stroke (PRECIOUS): a randomised, open, phase III, multifactorial, clinical trial with blinded outcome assessment

Author

AIOS Anesthesiologie, Opleiding Neurologie, Neurologen, Brain, Circulatory Health, Stroke, de Jonge, Jeroen C., Sluis, Wouter M., Reinink, Hendrik, Bath, Philip M., Woodhouse, Lisa J., Zweedijk, Berber, van de Beek, Diederik, Aamodt, Anne Hege, Alpers, Iris, Ciccone, Alfonso, Csiba, Laszlo, Demotes, Jacques, Kõrv, Janika, Kurkowska-Jastrzebska, Iwona, Dawson, Jesse, Macleod, Malcolm R., Ntaios, George, Poli, Sven, Milionis, Haralampos, Ricci, Stefano, Cenciarelli, Silvia, Candelaresi, Paolo, de Bruijn, Sebastiaan FTM, Pathansali, Rohan, Krishnan, Kailash, Clarke, Brian, Thomalla, Götz, van der Worp, H. Bart, Kwa, Vincent IH, Müller, Susanne, Protogerou, Athanasios D., the PRECIOUS investigators, AIOS Anesthesiologie, Opleiding Neurologie, Neurologen, Brain, Circulatory Health, Stroke, de Jonge, Jeroen C., Sluis, Wouter M., Reinink, Hendrik, Bath, Philip M., Woodhouse, Lisa J., Zweedijk, Berber, van de Beek, Diederik, Aamodt, Anne Hege, Alpers, Iris, Ciccone, Alfonso, Csiba, Laszlo, Demotes, Jacques, Kõrv, Janika, Kurkowska-Jastrzebska, Iwona, Dawson, Jesse, Macleod, Malcolm R., Ntaios, George, Poli, Sven, Milionis, Haralampos, Ricci, Stefano, Cenciarelli, Silvia, Candelaresi, Paolo, de Bruijn, Sebastiaan FTM, Pathansali, Rohan, Krishnan, Kailash, Clarke, Brian, Thomalla, Götz, van der Worp, H. Bart, Kwa, Vincent IH, Müller, Susanne, Protogerou, Athanasios D., and the PRECIOUS investigators

Published
2024

8. Intensive Ambulance-Delivered Blood-Pressure Reduction in Hyperacute Stroke

Author

Neurologen, Brain, Circulatory Health, Stroke, Li, Gang, Lin, Yapeng, Yang, Jie, Anderson, Craig S., Chen, Chen, Liu, Feifeng, Billot, Laurent, Li, Qiang, Chen, Xiaoying, Liu, Xiaoqiu, Ren, Xinwen, Zhang, Chunfang, Xu, Ping, Wu, Lijun, Wang, Feng, Qiu, Daijun, Jiang, Mei, Peng, Yiqian, Li, Chaohui, Huang, Yiyang, Zhao, Xiaohui, Liang, Jiye, Wang, Yao, Wu, Xiangjun, Xu, Xiaoyun, Chen, Guofang, Huang, Dongya, Zhang, Yue, Zuo, Lian, Ma, Guozhao, Yang, Yumei, Hao, Junjie, Xu, Xiahong, Xiong, Xinli, Tang, Yueyu, Guo, Yijia, Yu, Jianping, Li, Shuping, He, Song, Mao, Fengkai, Tan, Quandan, Tan, Song, Yu, Nengwei, Xu, Ruxiang, Sun, Mingwei, Li, Binghu, Guo, Jiang, Liu, Leibo, Liu, Hueiming, Van Der Worp, H. Bart, INTERACT4 Investigators, Neurologen, Brain, Circulatory Health, Stroke, Li, Gang, Lin, Yapeng, Yang, Jie, Anderson, Craig S., Chen, Chen, Liu, Feifeng, Billot, Laurent, Li, Qiang, Chen, Xiaoying, Liu, Xiaoqiu, Ren, Xinwen, Zhang, Chunfang, Xu, Ping, Wu, Lijun, Wang, Feng, Qiu, Daijun, Jiang, Mei, Peng, Yiqian, Li, Chaohui, Huang, Yiyang, Zhao, Xiaohui, Liang, Jiye, Wang, Yao, Wu, Xiangjun, Xu, Xiaoyun, Chen, Guofang, Huang, Dongya, Zhang, Yue, Zuo, Lian, Ma, Guozhao, Yang, Yumei, Hao, Junjie, Xu, Xiahong, Xiong, Xinli, Tang, Yueyu, Guo, Yijia, Yu, Jianping, Li, Shuping, He, Song, Mao, Fengkai, Tan, Quandan, Tan, Song, Yu, Nengwei, Xu, Ruxiang, Sun, Mingwei, Li, Binghu, Guo, Jiang, Liu, Leibo, Liu, Hueiming, Van Der Worp, H. Bart, and INTERACT4 Investigators

Published
2024

9. Prevalence and 3-month follow-up of cerebrovascular MRI markers in hospitalized COVID-19 patients: the CORONIS study

Author

Opleiding Neurologie, MS Radiologie, Brain, Cancer, Circulatory Health, Neurologen, Stroke, van Lith, Theresa J., Sluis, Wouter M., Wijers, Naomi T., Meijer, Frederick J.A., Ulzen, Karin Kamphuis van, de Bresser, Jeroen, Dankbaar, Jan Willem, de Mast, Quirijn, Klok, Frederikus A., Cannegieter, Suzanne C., Wermer, Marieke J.H., Huisman, Menno V., Tuladhar, Anil M., van der Worp, H. Bart, de Leeuw, Frank Erik, Opleiding Neurologie, MS Radiologie, Brain, Cancer, Circulatory Health, Neurologen, Stroke, van Lith, Theresa J., Sluis, Wouter M., Wijers, Naomi T., Meijer, Frederick J.A., Ulzen, Karin Kamphuis van, de Bresser, Jeroen, Dankbaar, Jan Willem, de Mast, Quirijn, Klok, Frederikus A., Cannegieter, Suzanne C., Wermer, Marieke J.H., Huisman, Menno V., Tuladhar, Anil M., van der Worp, H. Bart, and de Leeuw, Frank Erik

Published
2024

10. Safety and efficacy of active blood-pressure reduction to the recommended thresholds for intravenous thrombolysis in patients with acute ischaemic stroke in the Netherlands (TRUTH): a prospective, observational, cluster-based, parallel-group study

Author

Communicatie, Cardiovasculaire Epi Team 5, Neurologen, Brain, Circulatory Health, Stroke, Zonneveld, Thomas P., Vermeer, Sarah E., van Zwet, Erik W., Groot, Adrien E.D., Algra, Ale, Aerden, Leo A.M., Alblas, Kees C.L., de Beer, Frank, Brouwers, Paul J.A.M., de Gans, Koen, van Gemert, H. Maarten A., van Ginneken, Bart C.A.M., Grooters, Gerke S., Halkes, Patricia H.A., van der Heijden-Montfroy, Tonny A.M.H.G., Jellema, Korné, de Jong, Sonja W., Lövenich-Ciccarello, Harry, van der Meulen, Willem D.M., Peters, Edwin W., van der Ree, Taco C., Remmers, Michel J.M., Richard, Edo, Rovers, Jörgen M.P., Saxena, Ritu, van Schaik, Sander M., Schonewille, Wouter J., Schreuder, Tobien A.H.C.M.L., de Schryver, Els L.L.M., Schuiling, Wouter J., Spaander, Fianne H., van Tuijl, Julia H., Visser, Marieke C., Zinkstok, Sanne M., Zock, Elles, Dippel, Diederik W.J., Kappelle, L. Jaap, van Oostenbrugge, Robert J., Roos, Yvo B.W.E.M., Vermeij, Frederique H., Wermer, Marieke J.H., van der Worp, H. Bart, Nederkoorn, Paul J., Kruyt, Nyika D., Communicatie, Cardiovasculaire Epi Team 5, Neurologen, Brain, Circulatory Health, Stroke, Zonneveld, Thomas P., Vermeer, Sarah E., van Zwet, Erik W., Groot, Adrien E.D., Algra, Ale, Aerden, Leo A.M., Alblas, Kees C.L., de Beer, Frank, Brouwers, Paul J.A.M., de Gans, Koen, van Gemert, H. Maarten A., van Ginneken, Bart C.A.M., Grooters, Gerke S., Halkes, Patricia H.A., van der Heijden-Montfroy, Tonny A.M.H.G., Jellema, Korné, de Jong, Sonja W., Lövenich-Ciccarello, Harry, van der Meulen, Willem D.M., Peters, Edwin W., van der Ree, Taco C., Remmers, Michel J.M., Richard, Edo, Rovers, Jörgen M.P., Saxena, Ritu, van Schaik, Sander M., Schonewille, Wouter J., Schreuder, Tobien A.H.C.M.L., de Schryver, Els L.L.M., Schuiling, Wouter J., Spaander, Fianne H., van Tuijl, Julia H., Visser, Marieke C., Zinkstok, Sanne M., Zock, Elles, Dippel, Diederik W.J., Kappelle, L. Jaap, van Oostenbrugge, Robert J., Roos, Yvo B.W.E.M., Vermeij, Frederique H., Wermer, Marieke J.H., van der Worp, H. Bart, Nederkoorn, Paul J., and Kruyt, Nyika D.

Published
2024

11. Is NEWS of value for patients with acute stroke?

Author

van Valburg, Mariëlle K, Vernooij, Lisette M, Kalkman, Cornelis J, and van der Worp, H Bart

Abstract

Background: Patients with acute stroke are at risk of respiratory or circulatory compromise resulting in vital instability, which can be captured through the widely used aggregated National Early Warning Score (NEWS). We aimed to assess the relation between vital instability (defined as NEWS of five or higher) and death or dependency at 90 days after stroke.Methods: In this observational cohort study we studied 763 patients with ischaemic stroke (n= 400), intracerebral haemorrhage (ICH) (n= 146) or subarachnoid haemorrhage (SAH) (n= 217), hospitalized to a Dutch tertiary referral hospital from 1 January 2017 to 31 December 2018. We calculated NEWS for each 8 h time span during the first 72 h after hospitalization. We also decomposed NEWS into its three components respiration, circulation and consciousness. The primary outcome was death or dependency (modified Rankin Scale score ⩾3) at 90 days after stroke. The association of vital instability with functional dependency was examined using Poisson regression.Results: Two hundred and twenty-seven (58%) patients with ischaemic stroke, 101 (69%) with ICH and 142 (65%) with SAH had at least one episode of vital instability. In patients with ischaemic stroke or SAH, vital instability was associated after adjustment for confounders with death or dependency (adjusted relative risk 1.55 ((95% CI) 1.25–1.93 and 2.13 (1.35–3.36), respectively)). This was mainly driven by impaired consciousness, which was associated with death or dependency in all types of stroke. Respiratory insufficiency and circulatory instability were associated with death or dependency only in SAH.Conclusion: Vital instability in the first 72 h of hospitalization for ischaemic stroke or SAH is associated with death or dependency at 90 days. Impaired consciousness was the main driver of this relationship. NEWS may not be appropriate for patients with acute stroke, mainly due to the dichotomous manner in which the level of consciousness is classified, and modification of NEWS should be considered for these patients

Published
2024
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12. Statistical Analysis Plan for the INTEnsive Ambulance-Delivered Blood Pressure Reduction in Hyper-ACute Stroke Trial.

Author

Billot, Laurent, Chen, Chen, Song, Lili, Lin, Yapeng, Liu, Feifeng, Chen, Xiaoying, Arima, Hisatomi, Bath, Philip M., Ford, Gary A., Robinson, Thompson G., Sandset, Else Charlotte, Saver, Jeffrey L., Sprigg, Nikola, van der Worp, H. Bart, Yang, Jie, Li, Gang, and Anderson, Craig S.

Abstract

Introduction: Recruitment is complete in the fourth INTEnsive ambulance-delivered blood pressure Reduction in hyper-ACute stroke Trial (INTERACT4), a multicenter, prospective, randomized, open-label, blinded endpoint assessed trial of prehospital blood pressure (BP) lowering initiated in the ambulance for patients with a suspected acute stroke and elevated BP in China. According to the registered and published trial protocol and developed by the blinded trial Steering Committee and Operations team, this manuscript outlines a detailed statistical analysis plan for the trial prior to database lock. Methods: Patients were randomized (1:1) to intensive (target systolic BP 130–140 mm Hg within 30 min) or guideline-recommended BP management (BP lowering only considered if systolic BP >220 mm Hg) group. Primary outcome is an ordinal analysis of the full range of scores on the modified Rankin scale at 90 days. A modified sample size of 2,320 was estimated to provide 90% power to detect a 22% reduction in the odds (common odds ratio of 0.78) of a worse functional outcome using ordinal logistic regression, on the assumption of 5% patients with missing outcome and 6% patients with a stroke mimic. Conclusion: The statistical analysis plan for the trial has been developed to ensure transparent, verifiable, and prespecified analysis and to avoid potential bias in the evaluation of the trial intervention. [ABSTRACT FROM AUTHOR]

Published
2024
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13. Intensive Ambulance-Delivered Blood-Pressure Reduction in Hyperacute Stroke.

Author

Li G, Lin Y, Yang J, Anderson CS, Chen C, Liu F, Billot L, Li Q, Chen X, Liu X, Ren X, Zhang C, Xu P, Wu L, Wang F, Qiu D, Jiang M, Peng Y, Li C, Huang Y, Zhao X, Liang J, Wang Y, Wu X, Xu X, Chen G, Huang D, Zhang Y, Zuo L, Ma G, Yang Y, Hao J, Xu X, Xiong X, Tang Y, Guo Y, Yu J, Li S, He S, Mao F, Tan Q, Tan S, Yu N, Xu R, Sun M, Li B, Guo J, Liu L, Liu H, Ouyang M, Si L, Arima H, Bath PM, Ford GA, Robinson T, Sandset EC, Saver JL, Sprigg N, van der Worp HB, and Song L

Subjects
Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Ambulances, Ischemic Stroke therapy, Time-to-Treatment, Acute Disease, Functional Status, China, Antihypertensive Agents administration & dosage, Antihypertensive Agents adverse effects, Antihypertensive Agents therapeutic use, Blood Pressure drug effects, Emergency Medical Services, Hypertension complications, Hypertension drug therapy, Stroke etiology, Stroke therapy
Abstract

Background: Treatment of acute stroke, before a distinction can be made between ischemic and hemorrhagic types, is challenging. Whether very early blood-pressure control in the ambulance improves outcomes among patients with undifferentiated acute stroke is uncertain., Methods: We randomly assigned patients with suspected acute stroke that caused a motor deficit and with elevated systolic blood pressure (≥150 mm Hg), who were assessed in the ambulance within 2 hours after the onset of symptoms, to receive immediate treatment to lower the systolic blood pressure (target range, 130 to 140 mm Hg) (intervention group) or usual blood-pressure management (usual-care group). The primary efficacy outcome was functional status as assessed by the score on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) at 90 days after randomization. The primary safety outcome was any serious adverse event., Results: A total of 2404 patients (mean age, 70 years) in China underwent randomization and provided consent for the trial: 1205 in the intervention group and 1199 in the usual-care group. The median time between symptom onset and randomization was 61 minutes (interquartile range, 41 to 93), and the mean blood pressure at randomization was 178/98 mm Hg. Stroke was subsequently confirmed by imaging in 2240 patients, of whom 1041 (46.5%) had a hemorrhagic stroke. At the time of patients' arrival at the hospital, the mean systolic blood pressure in the intervention group was 159 mm Hg, as compared with 170 mm Hg in the usual-care group. Overall, there was no difference in functional outcome between the two groups (common odds ratio, 1.00; 95% confidence interval [CI], 0.87 to 1.15), and the incidence of serious adverse events was similar in the two groups. Prehospital reduction of blood pressure was associated with a decrease in the odds of a poor functional outcome among patients with hemorrhagic stroke (common odds ratio, 0.75; 95% CI, 0.60 to 0.92) but an increase among patients with cerebral ischemia (common odds ratio, 1.30; 95% CI, 1.06 to 1.60)., Conclusions: In this trial, prehospital blood-pressure reduction did not improve functional outcomes in a cohort of patients with undifferentiated acute stroke, of whom 46.5% subsequently received a diagnosis of hemorrhagic stroke. (Funded by the National Health and Medical Research Council of Australia and others; INTERACT4 ClinicalTrials.gov number, NCT03790800; Chinese Trial Registry number, ChiCTR1900020534.)., (Copyright © 2024 Massachusetts Medical Society.)

Published
2024
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