243 results on '"Jenniskens, S.F.M."'
Search Results
2. Editor's Choice - Therapeutic Options and Outcomes in Midaortic Syndrome: A Systematic Review and Meta-analysis.
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Cortenbach, K.R.G., Yosofi, B., Rodwell, L., Meek, J.M., Patel, R., Prakash, S.K., Riksen, N.P., Jenniskens, S.F.M., Dirven, M., DeRuiter, M.C., Kimmenade, R.R. van, Cortenbach, K.R.G., Yosofi, B., Rodwell, L., Meek, J.M., Patel, R., Prakash, S.K., Riksen, N.P., Jenniskens, S.F.M., Dirven, M., DeRuiter, M.C., and Kimmenade, R.R. van
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01 januari 2023, Item does not contain fulltext, OBJECTIVE: Midaortic syndrome (MAS) is narrowing of the distal thoracic and or abdominal aorta with congenital, inflammatory, or idiopathic aetiology. If left untreated, the prognosis is poor due to hypertensive complications. Follow up data after treatment are sparse, contrary to aortic coarctation. This study aimed to investigate hypertension during follow up after medical, endovascular, and surgical therapy in juveniles and adults. DATA SOURCES: A meta-analysis of case series and reports was performed, focusing on the incidence of hypertension during the follow up of juvenile (i.e., age 0-17 years) and adult MAS patients after medical, endovascular, or surgical therapy. REVIEW METHODS: Search queries were performed in PubMed, Embase, and Web of Science, and eligible articles underwent quality control. Descriptive statistics were reported based on available data, and individual patient data meta-analyses were performed using a one stage approach, accounting for clustering by case series or decades of reporting for case reports. For the meta-analysis, missing outcome and aetiology data were multiply imputed. RESULTS: The number of juveniles and adults who underwent endovascular therapy (33.7% vs. 27.3%; p = .42) and surgery (52.2% vs. 58.0%; p = .46) was similar. At baseline, 92.4% of juveniles and 87.5% of adults were hypertensive, decreasing to 23.2% and 24.1% during a follow up of 23 months (juveniles) and 18 months (adults), respectively. More hypertension was found compared with surgery in juveniles after endovascular therapy (38.1% vs. 10.8%; p = .020). Meta-analysis also demonstrated a trend for hypertension after endovascular therapy in juveniles, whereas hypertension was more prevalent following surgery in adults compared with endovascular therapy or medication. CONCLUSION: This review and meta-analysis investigated therapeutic options for MAS in juveniles and adults. It found that complications and hypertension during follow up were more common in juvenil
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- 2023
3. Prognostic Value of Thrombus Volume and Interaction With First-Line Endovascular Treatment Device Choice
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Voorst, Henk van, Bruggeman, A.A.E., Andriessen, Jurr W., Hoving, Jan R., Konduri, Praneeta, Yang, Wenjin, Jenniskens, S.F.M., Emmer, B., Majoie, C.B.L.M., Voorst, Henk van, Bruggeman, A.A.E., Andriessen, Jurr W., Hoving, Jan R., Konduri, Praneeta, Yang, Wenjin, Jenniskens, S.F.M., Emmer, B., and Majoie, C.B.L.M.
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Item does not contain fulltext
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- 2023
4. Intratumoral injection therapies for locally advanced pancreatic cancer: systematic review.
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Willink, C.Y., Jenniskens, S.F.M., Klaassen, N.J.M., Stommel, M.W.J., Nijsen, J.F.W., Willink, C.Y., Jenniskens, S.F.M., Klaassen, N.J.M., Stommel, M.W.J., and Nijsen, J.F.W.
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Contains fulltext : 293288.pdf (Publisher’s version ) (Open Access), INTRODUCTION: Pancreatic cancer has one of the worst prognoses of all cancers. Patients with locally advanced pancreatic cancer have a 12.7-20.2 per cent chance of receiving curative surgery after induction systemic chemotherapy. Intratumoral injection therapies have been studied as complementary treatment options for improved local tumour control. The aim of this systematic review was to provide an overview of intratumoral injection therapies, their safety, and oncological outcome in patients with locally advanced pancreatic cancer. METHODS: A literature search was conducted in PubMed, Embase and the Cochrane Library for articles written in English up to 28 November 2022. All study designs involving at least five patients with locally advanced pancreatic cancer who were treated with an intratumoral injection therapy were included. Critical appraisal of the included studies was performed using the Newcastle-Ottawa scale. RESULTS: After evaluation of the 1680 articles yielded by the systematic search, 52 studies treating 1843 patients were included. Included intratumoral injection treatment modalities comprised iodine-125 (125I) seed brachytherapy (32 studies, 1283 patients), phosphorus-32 (32P) microbrachytherapy (5 studies, 133 patients), palladium-103 (103Pd) seed brachytherapy (2 studies, 26 patients), immunotherapy (9 studies, 330 patients), and chemotherapy (4 studies, 71 patients). Overall survival ranged between 7.0 and 16.0 months for 125I, 5.2 and 15.5 months for 32P, 6.9 and 10.0 months for 103Pd, 5.8 and 13.8 months for immunotherapy, and 9.0 and 16.2 months for chemotherapy. Severe complication (greater than or equal to grade III complications using Clavien-Dindo classification) rates were 6.2 per cent for 125I, 49.2 per cent for 32P, 15 per cent for 103Pd, 57.9 per cent for immunotherapy, and 0 per cent for chemotherapy. CONCLUSION: Five intratumoral injection therapies are described and an overview is reported. Some intratumoral injection therapies for
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- 2023
5. Intraoperative MRI-derived volumetric ablation margins and initial correlation with local outcome after MRI-guided cryoablation of renal tumors.
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Jager, N.S. de, Oostenbrugge, T.J. van, Pätz, T., Jenniskens, S.F.M., Fütterer, J.J., Langenhuijsen, J.F., Overduin, C.G., Jager, N.S. de, Oostenbrugge, T.J. van, Pätz, T., Jenniskens, S.F.M., Fütterer, J.J., Langenhuijsen, J.F., and Overduin, C.G.
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Item does not contain fulltext, PURPOSE: To assess volumetric ablation margins derived from intraoperative pre- and post-ablation MRI after magnetic resonance imaging (MRI)-guided percutaneous cryoablation of renal tumors and explore its correlation with local treatment success. METHODS: Retrospective analysis was performed on 30 patients (mean age 69y) who underwent percutaneous MRI-guided cryoablation between May 2014 and May 2020 for 32 renal tumors (size: 1.6-5.1 cm). Tumor and ice-ball volumes were segmented on intraprocedural pre- and post-ablation MR images using Software Assistant for Interventional Radiology (SAFIR) software. After MRI-MRI co-registration, the software automatically quantified the minimal treatment margin (MTM),defined as the smallest 3D distance between the tumor and ice-ball surface. Local tumor progression (LTP) after cryoablation was assessed on follow-up imaging. RESULTS: Median follow-up was 16 months (range: 1-58). Local control after cryoablation was achieved in 26 cases (81%) while LTP occurred in 6 (19%). The intended MTM of ≥5 mm was achieved in 3/32 (9%) cases. Median MTM was significantly smaller for cases with (- 7 mm; IQR:-10 to - 5) vs. without LTP (3 mm; IQR:2 to 4) (P < .001). All cases of LTP had a negative MTM. All negative treatment margins occurred in tumors > 3 cm. CONCLUSIONS: Determination of volumetric ablation margins from intraoperative MRI was feasible and may be useful in predicting local outcome after MRI-guided renal cryoablation. In our preliminary data, an intraoperative MRI-derived minimal margin extending at least 1 mm beyond the MRI-visible tumor led to local control and this was more difficult to achieve in tumors > 3 cm. Ultimately, online margin analysis may be a valuable tool to intraoperatively assess therapy success, but larger prospective studies are needed to establish a reliable threshold for clinical use.
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- 2023
6. Transarterial Chemoembolization With Drug-Eluting Beads Versus Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma: Outcomes From a Multicenter, Randomized, Phase 2 Trial (the TRENDY Trial).
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Méndez Romero, A., Holt, B. van der, Willemssen, F.E.J.A., Man, R.A. de, Heijmen, B.J.M., Habraken, S., Westerveld, H., Delden, O.M. van, Klümpen, H.J., Tjwa, E.T., Braam, P.M., Jenniskens, S.F.M., Vanwolleghem, T., Weytjens, R., d'Archambeau, O., Vos-Geelen, J. de, Buijsen, J., Leij, C. van der, Toom, W. den, Sprengers, D., Ijzermans, J.N.M., Moelker, A., Méndez Romero, A., Holt, B. van der, Willemssen, F.E.J.A., Man, R.A. de, Heijmen, B.J.M., Habraken, S., Westerveld, H., Delden, O.M. van, Klümpen, H.J., Tjwa, E.T., Braam, P.M., Jenniskens, S.F.M., Vanwolleghem, T., Weytjens, R., d'Archambeau, O., Vos-Geelen, J. de, Buijsen, J., Leij, C. van der, Toom, W. den, Sprengers, D., Ijzermans, J.N.M., and Moelker, A.
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Contains fulltext : 296077.pdf (Publisher’s version ) (Open Access), PURPOSE: To compare transarterial chemoembolization delivered with drug eluting beads (TACE-DEB) with stereotactioc body radiation therapy (SBRT) in patients with hepatocellular carcinoma (HCC) in a multicenter randomized trial. METHODS AND MATERIALS: Patients were included if they were eligible for TACE. They could also be recruited if they required treatment prior to liver transplantation. A maximum of four TACE-DEB procedures and ablation after incomplete TACE-DEB were both allowed. SBRT was delivered in six fractions of 8-9Gy. Primary end point was time to progression (TTP). Secondary endpoints were local control (LC), overall survival (OS), response rate (RR), toxicity, and quality of life (QoL). The calculated sample size was 100 patients. RESULTS: Between May 2015 and April 2020, 30 patients were randomized to the study. Due to slow accrual the trial was closed prematurely. Two patients in the SBRT arm were considered ineligible leaving 16 patients in the TACE-DEB arm and 12 in the SBRT arm. Median follow-up was 28.1 months. Median TTP was 12 months for TACEDEB and 19 months for SBRT (p=0.15). Median LC was 12 months for TACE-DEB and >40 months (not reached) for SBRT (p=0.075). Median OS was 36.8 months for TACEDEB and 44.1 months for SBRT (p=0.36). A post-hoc analysis showed 100% for SBRT 1- and 2-year LC, and 54.4% and 43.6% for TACE-DEB (p=0.019). Both treatments resulted in RR>80%. Three episodes of possibly related toxicity grade ≥3 were observed after TACE-DEB. No episodes were observed after SBRT. QoL remained stable after both treatment arms. CONCLUSIONS: In this trial, TTP after TACE-DEB was not significantly improved by SBRT, while SBRT showed higher local antitumoral activity than TACE-DEB, without detrimental effects on OS, toxicity and QoL. To overcome poor accrual in randomized trials that include SBRT, and to generate evidence for including SBRT in treatment guidelines, international cooperation is needed.
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- 2023
7. MRI-Guided Salvage Focal Cryoablation: A 10-Year Single-Center Experience in 114 Patients with Localized Recurrent Prostate Cancer.
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Wimper, Y., Overduin, C.G., Sedelaar, J.P.M., Veltman, J., Jenniskens, S.F.M., Bomers, J.G.R., Fütterer, J.J., Wimper, Y., Overduin, C.G., Sedelaar, J.P.M., Veltman, J., Jenniskens, S.F.M., Bomers, J.G.R., and Fütterer, J.J.
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Contains fulltext : 295903.pdf (Publisher’s version ) (Open Access), Patients with localized recurrent prostate cancer (PCa) are eligible for androgen-deprivation therapy, salvage radical prostatectomy (RP) or radiation therapy. These treatments are associated with serious side-effects, illustrating the need for alternative local treatment options with lower morbidity rates. All patients who underwent magnetic resonance imaging (MRI)-guided salvage focal cryoablation (SFC) with localized recurrent PCa between 2011-2021 (n = 114) were included. Two subgroups were formed: patients without (n = 99) and with prior RP (n = 15). We assessed the recurrence- (RFS) and treatment-free survival (TFS), measured from date of treatment to date of recurrence or initiation of additional salvage treatment, using Kaplan-Meier plots. Complications were reported using the Clavien-Dindo (CD) scale. Overall 1-year and 5-year RFS were 76.0% and 25.1%, and overall 1-year and 5-year TFS were 91.5% and 58.2%, respectively. Patients without prior RP showed a significantly higher 1-year (78.5% vs. 52.5%) and 5-year RFS (28.1% vs. 0.0%; p = 0.03), and a trend towards a higher 1-year (92.6% vs. 79.0%) and 5-year TFS (60.2% vs. 23.0%; p = 0.10) compared to those with prior RP. A total of 46 complications occurred in 37 patients, and the overall complication rate was 32.4% (37/114 patients). The majority (41/46; 89.1%) of complications were minor (CD 1-2). Overall (31.3 vs. 40.0%) and major (3.0 vs. 13.3%) complication rates were lower in patients without compared to those with prior RP, respectively. MRI-guided SFC is an effective and safe therapy for patients with recurrent PCa, and has proved to delay and potentially prevent the initiation of salvage treatments. Patients with locally recurrent PCa after prior RP had an increased risk of recurrence, a shortened time to additional treatment, and more complications compared to those without prior RP, which should be considered when selecting patients for SFC.
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- 2023
8. Inter-rater reliability for assessing intracranial collaterals in patients with acute ischemic stroke: comparing 29 raters and an artificial intelligence-based software
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Wolff, L., Su, J., Loon, D. van, Es, A. van, Doormaal, P.J. van, Majoie, C., Zwam, W. van, Dippel, D., Jenniskens, S.F.M., Lugt, A. van der, Walsum, T. van, Radiology and nuclear medicine, ACS - Atherosclerosis & ischemic syndromes, Radiology & Nuclear Medicine, Neurology, Radiology and Nuclear Medicine, ACS - Microcirculation, Amsterdam Neuroscience - Neurovascular Disorders, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: Carim - B05 Cerebral small vessel disease, and RS: Carim - B06 Imaging
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Reproducibility of results ,OUTCOMES ,Collateral circulation ,Consensus ,Ischemic stroke ,Other Research Radboud Institute for Health Sciences [Radboudumc 0] ,Brain Ischemia ,Cerebral Angiography ,Stroke ,Artificial Intelligence ,PERFUSION ,SCORE ,CT-ANGIOGRAPHY ,Humans ,Radiology, Nuclear Medicine and imaging ,Neurology (clinical) ,BURDEN ,Cardiology and Cardiovascular Medicine ,Software ,Algorithms ,INTRAARTERIAL TREATMENT - Abstract
Purpose Outcome of endovascular treatment in acute ischemic stroke patients is depending on the collateral circulation maintaining blood flow to the ischemic territory. We evaluated the inter-rater reliability and accuracy of raters and an automated algorithm for assessing the collateral score (CS, range: 0–3) in acute ischemic stroke patients. Methods Baseline CTA scans with an intracranial anterior occlusion from the MR CLEAN study (n=500) were used. For each core lab CS, ten CTA scans with sufficient quality were randomly selected. After a training session in collateral scoring, all selected CTA scans were individually evaluated for a visual CS by three groups: 7 radiologists, 13 junior and 9 senior radiology residents. Two additional radiologists scored CS to be used as reference, with a third providing a CS to produce a 2 out of 3 consensus CS in case of disagreement. An automated algorithm was also used to compute CS. Inter-rater agreement was reported with intraclass correlation coefficient (ICC). Accuracy of visual and automated CS were calculated. Results 39 CTA scans were assessed (1 corrupt CTA-scan excluded). All groups showed a moderate ICC (0.689-0.780) in comparison to the reference standard. Overall human accuracy was 65± 7% and increased to 88± 5% for dichotomized CS (0–1, 2–3). Automated CS accuracy was 62%, and 90% for dichotomized CS. No significant difference in accuracy was found between groups with different levels of expertise. Conclusion After training, inter-rater reliability in collateral scoring was not influenced by experience. Automated CS performs similar to residents and radiologists in determining a collateral score.
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- 2022
9. Association of hyperglycemia and computed tomographic perfusion deficits in patients who underwent endovascular treatment for acute ischemic stroke caused by a proximal intracranial occlusion
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Kersten, C., Zandbergen, A.A.M., Berkhemer, O.A., Borst, J., Haalboom, M., Roos, Y., Dippel, D.W., Oostenbrugge, R.J. van, Lugt, A. van der, Zwam, W.H. van, Jenniskens, S.F.M., Majoie, C.B.L.M., Hertog, H.M. den, MUMC+: Hersen en Zenuw Centrum (3), RS: Carim - B05 Cerebral small vessel disease, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, RS: Carim - B06 Imaging, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), Internal Medicine, Neurology, Radiology & Nuclear Medicine, Amsterdam Neuroscience - Cellular & Molecular Mechanisms, ACS - Atherosclerosis & ischemic syndromes, Amsterdam Neuroscience - Neurovascular Disorders, ACS - Microcirculation, and Radiology and nuclear medicine
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THROMBOLYSIS ,OUTCOMES ,Endovascular Procedures ,Other Research Radboud Institute for Health Sciences [Radboudumc 0] ,Acute ischemic stroke ,INSULIN ,GLUCOSE ,Perfusion ,Computed tomographic perfusion ,Neurology ,SDG 3 - Good Health and Well-being ,Infarction ,Hyperglycemia ,Humans ,Neurology (clinical) ,OXIDATIVE STRESS ,Ischemic Stroke - Abstract
Contains fulltext : 287810.pdf (Publisher’s version ) (Closed access) INTRODUCTION: Hyperglycemia is highly prevalent in patients with acute ischemic stroke and is associated with increased risk of symptomatic intracranial hemorrhage, larger infarct size and unfavorable outcome. Furthermore, glucose may modify the effect of endovascular treatment (EVT) in patients with ischemic stroke. Hyperglycemia might lead to accelerated conversion of penumbra into infarct core. However, it remains uncertain whether hyperglycemia on admission is associated with the size of penumbra or infarct core in acute ischemic stroke. In this study, we aimed to assess the association between hyperglycemia and Computed Tomographic Perfusion (CTP) derived parameters in patients who underwent EVT for acute ischemic stroke. METHODS: We used data from the MR CLEAN study (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands). Hyperglycemia was defined as admission serum glucose of >7.8 mmol/L. Dichotomized and quantiles of glucose levels were related to size of core, penumbra and core penumbra ratio. Hypoperfused area is mean transient time 45% higher than that of the contralateral hemisphere. Core is the area with cerebral blood volume of 2 mL/100 g. Core-penumbra ratio is the ischemic core divided by the total volume of hypoperfused tissue (core plus penumbra) multiplied by 100. Adjustments were made for age, sex, NIHSS on admission, onset-imaging time and diabetes mellitus. RESULTS: Hundred seventy-three patients were included. Median glucose level on admission was 6.5 mmol/L (IQR 5.8-7.5 mmol/L) and thirty-five patients (20%) were hyperglycemic. Median core volume was 33.3 mL (IQR 13.6-62.4 mL), median penumbra volume was 80.2 mL (IQR 36.3-123.5 mL) and median core-penumbra ratio was 28.5% (IQR 18.6-45.8%). Patients with hyperglycemia on admission had larger core volumes and core penumbra ratio than normoglycemic patients with a regression coefficient of 15.1 (95% confidence interval (CI), 1.8 to 28.3) and 11.5 (95% confidence interval (CI), 3.4 to 19.7) respectively. CONCLUSION: Hyperglycemia on admission was associated with larger ischemic core volume and larger core-penumbra ratio in patients with acute ischemic stroke who underwent endovascular treatment.
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- 2022
10. Safety and efficacy of aspirin, unfractionated heparin, both, or neither during endovascular stroke treatment (MR CLEAN-MED):an open-label, multicentre, randomised controlled trial
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Steen, W. van der, Graaf, R.A.V. de, Chalos, V., Lingsma, H.F., Doormaal, P.J. van, Coutinho, J.M., Emmer, B.J., Ridder, I. de, Zwam, W. van, Worp, H.B. van der, Schaaf, I. van der, Gons, R.A.R., Yo, L.S.F., Boiten, J., Wijngaard, I. van den, Hofmeijer, J., Martens, J., Schonewille, W., Vos, J.A., Tuladhar, A.M., Laat, K.F. de, Hasselt, B. van, Remmers, M., Vos, D., Rozeman, A., Elgersma, O., Uyttenboogaart, M., Bokkers, R.P.H., Tuijl, J. van, Boukrab, I., Berg, R. van den, Beenen, L.F.M., Roosendaal, S.D., Postma, A.A., Krietemeijer, M., Lycklama, G., Meijer, F.J.A., Hammer, S., Hoorn, A. van der, Yoo, A.J., Gerrits, D., Truijman, M.T.B., Zinkstok, S., Koudstaal, P.J., Manschot, S., Kerkhoff, H., Nieboer, D., Berkhemer, O., Wolff, L., Sluijs, P.M. van der, Voorst, H. van, Tolhuisen, M., Roos, Y.B.W.E.M., Majoie, C.B.L.M., Staals, J., Oostenbrugge, R.J. van, Jenniskens, S.F.M., Dijk, L.C. van, Hertog, H.M. den, Es, A.C.G.M. van, Lugt, A. van der, Dippel, D.W.J., Roozenbeek, B., MR CLEAN-MED Investigators, Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Damage and Repair in Cancer Development and Cancer Treatment (DARE), Neurology, ACS - Atherosclerosis & ischemic syndromes, ANS - Neurovascular Disorders, Radiology and Nuclear Medicine, ACS - Microcirculation, ACS - Pulmonary hypertension & thrombosis, ANS - Cellular & Molecular Mechanisms, Biomedical Engineering and Physics, Graduate School, ANS - Brain Imaging, ANS - Compulsivity, Impulsivity & Attention, Radiology & Nuclear Medicine, Public Health, Pediatric surgery, Radiology and nuclear medicine, RS: Carim - B05 Cerebral small vessel disease, MUMC+: MA Med Staf Spec Neurologie (9), Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: Carim - B06 Imaging, MUMC+: DA BV AIOS Radiologie (9), MUMC+: DA BV AIOS Nucleaire Geneeskunde (9), MUMC+: MA AIOS Neurologie (9), Klinische Neurowetenschappen, and MUMC+: MA Neurologie (3)
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Stroke/etiology ,Adult ,Brain Ischemia/therapy ,Aspirin ,Heparin ,INTRAVENOUS ALTEPLASE ,Other Research Radboud Institute for Health Sciences [Radboudumc 0] ,Vascular damage Radboud Institute for Molecular Life Sciences [Radboudumc 16] ,General Medicine ,THROMBECTOMY ,Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3] ,Magnetic Resonance Imaging ,TIME ,Brain Ischemia ,Stroke ,All institutes and research themes of the Radboud University Medical Center ,Treatment Outcome ,Aspirin/therapeutic use ,REPERFUSION ,Humans ,Heparin/adverse effects ,ACUTE ISCHEMIC-STROKE ,Rare cancers Radboud Institute for Health Sciences [Radboudumc 9] - Abstract
BACKGROUND: Aspirin and unfractionated heparin are often used during endovascular stroke treatment to improve reperfusion and outcomes. However, the effects and risks of anti-thrombotics for this indication are unknown. We therefore aimed to assess the safety and efficacy of intravenous aspirin, unfractionated heparin, both, or neither started during endovascular treatment in patients with ischaemic stroke.METHODS: We did an open-label, multicentre, randomised controlled trial with a 2 × 3 factorial design in 15 centres in the Netherlands. We enrolled adult patients (ie, ≥18 years) with ischaemic stroke due to an intracranial large-vessel occlusion in the anterior circulation in whom endovascular treatment could be initiated within 6 h of symptom onset. Eligible patients had a score of 2 or more on the National Institutes of Health Stroke Scale, and a CT or MRI ruling out intracranial haemorrhage. Randomisation was done using a web-based procedure with permuted blocks and stratified by centre. Patients were randomly assigned (1:1) to receive either periprocedural intravenous aspirin (300 mg bolus) or no aspirin, and randomly assigned (1:1:1) to receive moderate-dose unfractionated heparin (5000 IU bolus followed by 1250 IU/h for 6 h), low-dose unfractionated heparin (5000 IU bolus followed by 500 IU/h for 6 h), or no unfractionated heparin. The primary outcome was the score on the modified Rankin Scale at 90 days. Symptomatic intracranial haemorrhage was the main safety outcome. Analyses were based on intention to treat, and treatment effects were expressed as odds ratios (ORs) or common ORs, with adjustment for baseline prognostic factors. This trial is registered with the International Standard Randomised Controlled Trial Number, ISRCTN76741621.FINDINGS: Between Jan 22, 2018, and Jan 27, 2021, we randomly assigned 663 patients; of whom, 628 (95%) provided deferred consent or died before consent could be asked and were included in the modified intention-to-treat population. On Feb 4, 2021, after unblinding and analysis of the data, the trial steering committee permanently stopped patient recruitment and the trial was stopped for safety concerns. The risk of symptomatic intracranial haemorrhage was higher in patients allocated to receive aspirin than in those not receiving aspirin (43 [14%] of 310 vs 23 [7%] of 318; adjusted OR 1·95 [95% CI 1·13-3·35]) as well as in patients allocated to receive unfractionated heparin than in those not receiving unfractionated heparin (44 [13%] of 332 vs 22 [7%] of 296; 1·98 [1·14-3·46]). Both aspirin (adjusted common OR 0·91 [95% CI 0·69-1·21]) and unfractionated heparin (0·81 [0·61-1·08]) led to a non-significant shift towards worse modified Rankin Scale scores.INTERPRETATION: Periprocedural intravenous aspirin and unfractionated heparin during endovascular stroke treatment are both associated with an increased risk of symptomatic intracranial haemorrhage without evidence for a beneficial effect on functional outcome.FUNDING: The Collaboration for New Treatments of Acute Stroke consortium, the Brain Foundation Netherlands, the Ministry of Economic Affairs, Stryker, Medtronic, Cerenovus, and the Dutch Heart Foundation.
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- 2022
11. Safety and efficacy of aspirin, unfractionated heparin, both, or neither during endovascular stroke treatment (MR CLEAN-MED): an open-label, multicentre, randomised controlled trial
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Steen, Wouter van der, Graaf, Rob A. van de, Chalos, Vicky, Lingsma, Hester F., Doormaal, Pieter Jan van, Coutinho, Jonathan M., Tuladhar, A.M., Meijer, F.J.A., Tuijl, J. van, Jenniskens, S.F.M., Hertog, Heleen den, Dippel, Diederik W.J., Roozenbeek, Bob, Steen, Wouter van der, Graaf, Rob A. van de, Chalos, Vicky, Lingsma, Hester F., Doormaal, Pieter Jan van, Coutinho, Jonathan M., Tuladhar, A.M., Meijer, F.J.A., Tuijl, J. van, Jenniskens, S.F.M., Hertog, Heleen den, Dippel, Diederik W.J., and Roozenbeek, Bob
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- 2022
12. Complications of percutaneous transhepatic cholangiography and biliary drainage, a multicenter observational study
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Turan, A.S., Jenniskens, S.F.M., Martens, J.M., Rutten, M., Yo, L.S., Strijen, M.J. van, Drenth, J.P.H., Siersema, P.D., Geenen, E.J.M. van, Turan, A.S., Jenniskens, S.F.M., Martens, J.M., Rutten, M., Yo, L.S., Strijen, M.J. van, Drenth, J.P.H., Siersema, P.D., and Geenen, E.J.M. van
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Contains fulltext : 283330.pdf (Publisher’s version ) (Open Access), OBJECTIVES: Over 2500 percutaneous transhepatic cholangiography and biliary drainage (PTCD) procedures are yearly performed in the Netherlands. Most interventions are performed for treatment of biliary obstruction following unsuccessful endoscopic biliary cannulation. Our aim was to evaluate complication rates and risk factors for complications in PTCD patients after failed ERCP. METHODS: We performed an observational study collecting data from a cohort that was subjected to PTCD during a 5-year period in one academic and four teaching hospitals. Primary objective was the development of infectious (sepsis, cholangitis, abscess, or cholecystitis) and non-infectious complications (bile leakage, severe hemorrhage, etc.) and mortality within 30 days of the procedure. Subsequently, risk factors for complications and mortality were analyzed with a multilevel logistic regression analysis. RESULTS: A total of 331 patients underwent PTCD of whom 205 (61.9%) developed PTCD-related complications. Of the 224 patients without a pre-existent infection, 91 (40.6%) developed infectious complications, i.e., cholangitis in 26.3%, sepsis in 24.6%, abscess formation in 2.7%, and cholecystitis in 1.3%. Non-infectious complications developed in 114 of 331 patients (34.4%). 30-day mortality was 17.2% (N = 57). Risk factors for infectious complications included internal drainage and drain obstruction, while multiple re-interventions were a risk factor for non-infectious complications. CONCLUSION: Both infectious and non-infectious complications are frequent after PTCD, most often due to biliary drain obstruction.
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- 2022
13. Outcome Prediction Based on Automatically Extracted Infarct Core Image Features in Patients with Acute Ischemic Stroke
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Tolhuisen, M.L., Hoving, J.W., Koopman, M.S., Kappelhof, M., Voorst, H. van, Bruggeman, A.E., Demchuck, A.M., Dippel, D.W., Emmer, B.J., Bracard, S., Guillemin, F., Oostenbrugge, R.J. van, Mitchell, P.J., Zwam, W.H. van, Hill, M.D., Roos, Y., Jovin, T.G., Berkhemer, O.A., Campbell, B.C., Saver, J., White, P., Muir, K.W., Goyal, M., Marquering, H.A., Jenniskens, S.F.M., Majoie, C.B.L.M., Caan, M.W., Tolhuisen, M.L., Hoving, J.W., Koopman, M.S., Kappelhof, M., Voorst, H. van, Bruggeman, A.E., Demchuck, A.M., Dippel, D.W., Emmer, B.J., Bracard, S., Guillemin, F., Oostenbrugge, R.J. van, Mitchell, P.J., Zwam, W.H. van, Hill, M.D., Roos, Y., Jovin, T.G., Berkhemer, O.A., Campbell, B.C., Saver, J., White, P., Muir, K.W., Goyal, M., Marquering, H.A., Jenniskens, S.F.M., Majoie, C.B.L.M., and Caan, M.W.
- Abstract
Item does not contain fulltext, Infarct volume (FIV) on follow-up diffusion-weighted imaging (FU-DWI) is only moderately associated with functional outcome in acute ischemic stroke patients. However, FU-DWI may contain other imaging biomarkers that could aid in improving outcome prediction models for acute ischemic stroke. We included FU-DWI data from the HERMES, ISLES, and MR CLEAN-NO IV databases. Lesions were segmented using a deep learning model trained on the HERMES and ISLES datasets. We assessed the performance of three classifiers in predicting functional independence for the MR CLEAN-NO IV trial cohort based on: (1) FIV alone, (2) the most important features obtained from a trained convolutional autoencoder (CAE), and (3) radiomics. Furthermore, we investigated feature importance in the radiomic-feature-based model. For outcome prediction, we included 206 patients: 144 scans were included in the training set, 21 in the validation set, and 41 in the test set. The classifiers that included the CAE and the radiomic features showed AUC values of 0.88 and 0.81, respectively, while the model based on FIV had an AUC of 0.79. This difference was not found to be statistically significant. Feature importance results showed that lesion intensity heterogeneity received more weight than lesion volume in outcome prediction. This study suggests that predictions of functional outcome should not be based on FIV alone and that FU-DWI images capture additional prognostic information.
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- 2022
14. Added Value of a Blinded Outcome Adjudication Committee in an Open-Label Randomized Stroke Trial
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Ende, N.A.M. van der, Roozenbeek, B., Berkhemer, Olvert A., Koudstaal, Peter J., Boiten, J., Dijk, E.J. van, Jenniskens, S.F.M., Vries, J. de, Lugt, Aad van der, Dippel, D.W., Ende, N.A.M. van der, Roozenbeek, B., Berkhemer, Olvert A., Koudstaal, Peter J., Boiten, J., Dijk, E.J. van, Jenniskens, S.F.M., Vries, J. de, Lugt, Aad van der, and Dippel, D.W.
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Contains fulltext : 242507.pdf (Publisher’s version ) (Open Access)
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- 2022
15. Hospital Variation in Time to Endovascular Treatment for Ischemic Stroke: What Is the Optimal Target for Improvement?
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Hartog, S.J. den, Lingsma, H.F., Doormaal, P.J. van, Hofmeijer, J., Yo, L.S., Majoie, C., Dippel, D.W., Jenniskens, S.F.M., Lugt, A. van der, Roozenbeek, B., Hartog, S.J. den, Lingsma, H.F., Doormaal, P.J. van, Hofmeijer, J., Yo, L.S., Majoie, C., Dippel, D.W., Jenniskens, S.F.M., Lugt, A. van der, and Roozenbeek, B.
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Item does not contain fulltext, Background Time to reperfusion in patients with ischemic stroke is strongly associated with functional outcome and may differ between hospitals and between patients within hospitals. Improvement in time to reperfusion can be guided by between-hospital and within-hospital comparisons and requires insight in specific targets for improvement. We aimed to quantify the variation in door-to-reperfusion time between and within Dutch intervention hospitals and to assess the contribution of different time intervals to this variation. Methods and Results We used data from the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry. The door-to-reperfusion time was subdivided into time intervals, separately for direct patients (door-to-computed tomography, computed tomography-to-computed tomography angiography [CTA], CTA-to-groin, and groin-to-reperfusion times) and for transferred patients (door-to-groin and groin-to-reperfusion times). We used linear mixed models to distinguish the variation in door-to-reperfusion time between hospitals and between patients. The proportional change in variance was used to estimate the amount of variance explained by each time interval. We included 2855 patients of 17 hospitals providing endovascular treatment. Of these patients, 44% arrived directly at an endovascular treatment hospital. The between-hospital variation in door-to-reperfusion time was 9%, and the within-hospital variation was 91%. The contribution of case-mix variables on the variation in door-to-reperfusion time was marginal (2%-7%). Of the between-hospital variation, CTA-to-groin time explained 83%, whereas groin-to-reperfusion time explained 15%. Within-hospital variation was mostly explained by CTA-to-groin time (33%) and groin-to-reperfusion time (42%). Similar results were found for transferred patients. Conclusions Door-to-reperfusion time varies between, but even more within, hospitals providing e
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- 2022
16. Economic Evaluation of Endovascular Treatment for Acute Ischemic Stroke
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Berg, Lauri M.M. van den, Berkhemer, O.A., Fransen, P.S., Beumer, D., Lingsma, H., Majoie, C.B.L.M., Dippel, D.W., Lugt, A. van der, Oostenbrugge, R.J. van, Zwam, W.H. van, Jenniskens, S.F.M., Roos, Y.B.W.E.M., Dijkgraaf, M.G.W., Berg, Lauri M.M. van den, Berkhemer, O.A., Fransen, P.S., Beumer, D., Lingsma, H., Majoie, C.B.L.M., Dippel, D.W., Lugt, A. van der, Oostenbrugge, R.J. van, Zwam, W.H. van, Jenniskens, S.F.M., Roos, Y.B.W.E.M., and Dijkgraaf, M.G.W.
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Item does not contain fulltext, BACKGROUND AND PURPOSE: Endovascular treatment for acute ischemic stroke has been proven clinically effective, but evidence of the cost-effectiveness based on real-world data is scarce. The aim of this study was to assess whether endovascular therapy plus usual care is cost-effective in comparison to usual care alone in acute ischemic stroke patients. METHODS: An economic evaluation was performed from a societal perspective with a 2-year time horizon. Empirical data on health outcomes and the use of resources following endovascular treatment were gathered parallel to the MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) and its 2-year follow-up study. Incremental cost-effectiveness ratios were calculated as the extra costs per additional patient with functional independence (modified Rankin Scale score 0-2) and the extra cost per quality-adjusted life year gained. RESULTS: The mean costs per patient in the intervention group were $126 494 versus $143 331 in the control group (mean difference, -$16 839 [95% CI, -$38 113 to $5456]). Compared with patients in the control group, more patients in the intervention group achieved functional independence, 37.2% versus 23.9% (absolute difference, 13.3% [95% CI, 4.0%-22.0%]) and they generated more quality-adjusted life years, 0.99 versus 0.83 (mean difference of 0.16 [95% CI, 0.04-0.29]). Endovascular treatment dominated standard treatment with $18 233 saved per extra patient with a good outcome and $105 869 saved per additional quality-adjusted life year. CONCLUSIONS: Endovascular treatment added to usual care is clinically effective, and cost saving in comparison to usual care alone in patients with acute ischemic stroke. Registration: URL: https://www.trialregister.nl/trial/695; Unique identifier: NL695. URL: https://www.isrctn.com; Unique identifier: ISRCTN10888758.
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- 2022
17. Endovascular Treatment for Posterior Circulation Stroke in Routine Clinical Practice: Results of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry
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Pirson, F.A.V., Boodt, N., Brouwer, J., Bruggeman, A.A.E., Hartog, S.J. den, Goldhoorn, R.B., Langezaal, L.C.M., Staals, J., Zwam, W.H. van, Leij, C. van der, Brans, R.J.B., Majoie, C.B.L.M., Coutinho, J.M., Emmer, B.J., Dippel, D.W., Lugt, A. van der, Vos, Jan-Albert, Jenniskens, S.F.M., Oostenbrugge, R.J. van, Schonewille, W.J., Pirson, F.A.V., Boodt, N., Brouwer, J., Bruggeman, A.A.E., Hartog, S.J. den, Goldhoorn, R.B., Langezaal, L.C.M., Staals, J., Zwam, W.H. van, Leij, C. van der, Brans, R.J.B., Majoie, C.B.L.M., Coutinho, J.M., Emmer, B.J., Dippel, D.W., Lugt, A. van der, Vos, Jan-Albert, Jenniskens, S.F.M., Oostenbrugge, R.J. van, and Schonewille, W.J.
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Item does not contain fulltext, BACKGROUND AND PURPOSE: The benefit of endovascular treatment (EVT) for posterior circulation stroke (PCS) remains uncertain, and little is known on treatment outcomes in clinical practice. This study evaluates outcomes of a large PCS cohort treated with EVT in clinical practice. Simultaneous to this observational study, several intervention centers participated in the BASICS trial (Basilar Artery International Cooperation Study), which tested the efficacy of EVT for basilar artery occlusion in a randomized setting. We additionally compared characteristics and outcomes of patients treated outside BASICS in trial centers to those from nontrial centers. METHODS: We included patients with PCS from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry: a prospective, multicenter, observational study of patients who underwent EVT in the Netherlands between 2014 and 2018. Primary outcome was a score of 0 to 3 on the modified Rankin Scale at 90 days. Secondary outcomes included reperfusion status and symptomatic intracranial hemorrhage. For outcome comparison between patients treated in trial versus nontrial centers, we used ordinal logistic regression analysis. RESULTS: We included 264 patients of whom 135 (51%) had received intravenous thrombolysis. The basilar artery was most often involved (77%). Favorable outcome (modified Rankin Scale score 0-3) was observed in 115/252 (46%) patients, and 109/252 (43%) patients died. Successful reperfusion was achieved in 178/238 (75%), and symptomatic intracranial hemorrhage occurred in 9/264 (3%). The 154 nontrial patients receiving EVT in BASICS trial centers had similar characteristics and outcomes as the 110 patients treated in nontrial centers (modified Rankin Scale adjusted cOR: 0.77 [95% CI, 0.5-1.2]). CONCLUSIONS: Our study shows that high rates of favorable clinical outcome and successful reperfusion can be achieved with EVT for PCS, despite high mortality.
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- 2022
18. Estimation of treatment effects in observational stroke care data: comparison of statistical approaches
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Amini, M., Leeuwen, N. van, Eijkenaar, F., Graaf, R. de, Samuels, N., Oostenbrugge, R van, Wijngaard, I.R. van den, Doormaal, P.J. van, Roos, Y., Majoie, C., Roozenbeek, B., Dippel, D., Jenniskens, S.F.M., Burke, J., Lingsma, H.F., Amini, M., Leeuwen, N. van, Eijkenaar, F., Graaf, R. de, Samuels, N., Oostenbrugge, R van, Wijngaard, I.R. van den, Doormaal, P.J. van, Roos, Y., Majoie, C., Roozenbeek, B., Dippel, D., Jenniskens, S.F.M., Burke, J., and Lingsma, H.F.
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Contains fulltext : 287821.pdf (Publisher’s version ) (Open Access), INTRODUCTION: Various statistical approaches can be used to deal with unmeasured confounding when estimating treatment effects in observational studies, each with its own pros and cons. This study aimed to compare treatment effects as estimated by different statistical approaches for two interventions in observational stroke care data. PATIENTS AND METHODS: We used prospectively collected data from the MR CLEAN registry including all patients (n = 3279) with ischemic stroke who underwent endovascular treatment (EVT) from 2014 to 2017 in 17 Dutch hospitals. Treatment effects of two interventions - i.e., receiving an intravenous thrombolytic (IVT) and undergoing general anesthesia (GA) before EVT - on good functional outcome (modified Rankin Scale =2) were estimated. We used three statistical regression-based approaches that vary in assumptions regarding the source of unmeasured confounding: individual-level (two subtypes), ecological, and instrumental variable analyses. In the latter, the preference for using the interventions in each hospital was used as an instrument. RESULTS: Use of IVT (range 66-87%) and GA (range 0-93%) varied substantially between hospitals. For IVT, the individual-level (OR ~ 1.33) resulted in significant positive effect estimates whereas in instrumental variable analysis no significant treatment effect was found (OR 1.11; 95% CI 0.58-1.56). The ecological analysis indicated no statistically significant different likelihood (beta = - 0.002%; P = 0.99) of good functional outcome at hospitals using IVT 1% more frequently. For GA, we found non-significant opposite directions of points estimates the treatment effect in the individual-level (ORs ~ 0.60) versus the instrumental variable approach (OR = 1.04). The ecological analysis also resulted in a non-significant negative association (0.03% lower probability). DISCUSSION AND CONCLUSION: Both magnitude and direction of the estimated treatment effects for both interventions depend strongly on the
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- 2022
19. Determinants of Symptomatic Intracranial Hemorrhage After Endovascular Stroke Treatment: A Retrospective Cohort Study
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Steen, W. van der, Ende, N.A.M. van der, Kranendonk, K.R. van, Chalos, V., Oostenbrugge, R.J. van, Zwam, W.H. van, Roos, Y., Doormaal, P.J. van, Es, A. van, Lingsma, H.F., Majoie, C., Lugt, A. van der, Jenniskens, S.F.M., Dippel, D.W., Roozenbeek, B., Steen, W. van der, Ende, N.A.M. van der, Kranendonk, K.R. van, Chalos, V., Oostenbrugge, R.J. van, Zwam, W.H. van, Roos, Y., Doormaal, P.J. van, Es, A. van, Lingsma, H.F., Majoie, C., Lugt, A. van der, Jenniskens, S.F.M., Dippel, D.W., and Roozenbeek, B.
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Item does not contain fulltext, BACKGROUND: Symptomatic intracranial hemorrhage (sICH) is a serious complication after endovascular treatment for ischemic stroke. We aimed to identify determinants of its occurrence and location. METHODS: We retrospectively analyzed data from the Dutch MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) and MR CLEAN registry. We included adult patients with a large vessel occlusion in the anterior circulation who underwent endovascular treatment within 6.5 hours of stroke onset. We used univariable and multivariable logistic regression analyses to identify determinants of overall sICH occurrence, sICH within infarcted brain tissue, and sICH outside infarcted brain tissue. RESULTS: SICH occurred in 203 (6%) of 3313 included patients and was located within infarcted brain tissue in 50 (25%), outside infarcted brain tissue in 23 (11%), and both within and outside infarcted brain tissue in 116 (57%) patients. In 14 patients (7%), data on location were missing. Prior antiplatelet use, baseline systolic blood pressure, baseline plasma glucose levels, post-endovascular treatment modified treatment in cerebral ischemia score, and duration of procedure were associated with all outcome parameters. In addition, determinants of sICH within infarcted brain tissue included history of myocardial infarction (adjusted odds ratio, 1.65 [95% CI, 1.06-2.56]) and poor collateral score (adjusted odds ratio, 1.42 [95% CI, 1.02-1.95]), whereas determinants of sICH outside infarcted brain tissue included level of occlusion on computed tomography angiography (internal carotid artery or internal carotid artery terminus compared with M1: adjusted odds ratio, 1.79 [95% CI, 1.16-2.78]). CONCLUSIONS: Several factors, some potentially modifiable, are associated with sICH occurrence. Further studies should investigate whether modification of baseline systolic blood pressure or plasma glucose level could reduce the risk of sI
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- 2022
20. Improvements in Endovascular Treatment for Acute Ischemic Stroke: A Longitudinal Study in the MR CLEAN Registry
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Compagne, K.C.J., Kappelhof, M., Hinsenveld, W.H., Brouwer, J., Goldhoorn, R.B., Uyttenboogaart, M., Bokkers, R.P., Schonewille, W.J., Martens, J.M., Hofmeijer, J., Worp, H.B. van der, Lo, R.T., Keizer, K., Yo, L.S., Nijeholt, G.J., Hertog, H.M. den, Sturm, E.J.C., Brouwers, P., Walderveen, Marianne A.A. van, Wermer, M.J., Bruijn, S.F. de, Dijk, L.C. van, Boogaarts, H.D., Dijk, E.J. van, Tuijl, J.H. van, Peluso, J.P.P., Kort, P.L. de, Hasselt, B. van, Fransen, P.S., Schreuder, T., Heijboer, R.J., Jenniskens, S.F.M., Sprengers, M.E., Ghariq, E., Wijngaard, I.R. van den, Roosendaal, S.D., Meijer, A., Beenen, L.F., Postma, A.A., Berg, R van den, Yoo, A.J., Doormaal, P.J. van, Proosdij, M.P. van, Krietemeijer, M.G.M., Gerrits, D.G., Hammer, S., Vos, Janet R., Boiten, J., Coutinho, J.M., Emmer, B.J., Es, A. van, Roozenbeek, B., Roos, Y., Zwam, W.H. van, Oostenbrugge, R.J. van, Majoie, C., Dippel, D.W., Lugt, A. van der, Compagne, K.C.J., Kappelhof, M., Hinsenveld, W.H., Brouwer, J., Goldhoorn, R.B., Uyttenboogaart, M., Bokkers, R.P., Schonewille, W.J., Martens, J.M., Hofmeijer, J., Worp, H.B. van der, Lo, R.T., Keizer, K., Yo, L.S., Nijeholt, G.J., Hertog, H.M. den, Sturm, E.J.C., Brouwers, P., Walderveen, Marianne A.A. van, Wermer, M.J., Bruijn, S.F. de, Dijk, L.C. van, Boogaarts, H.D., Dijk, E.J. van, Tuijl, J.H. van, Peluso, J.P.P., Kort, P.L. de, Hasselt, B. van, Fransen, P.S., Schreuder, T., Heijboer, R.J., Jenniskens, S.F.M., Sprengers, M.E., Ghariq, E., Wijngaard, I.R. van den, Roosendaal, S.D., Meijer, A., Beenen, L.F., Postma, A.A., Berg, R van den, Yoo, A.J., Doormaal, P.J. van, Proosdij, M.P. van, Krietemeijer, M.G.M., Gerrits, D.G., Hammer, S., Vos, Janet R., Boiten, J., Coutinho, J.M., Emmer, B.J., Es, A. van, Roozenbeek, B., Roos, Y., Zwam, W.H. van, Oostenbrugge, R.J. van, Majoie, C., Dippel, D.W., and Lugt, A. van der
- Abstract
Contains fulltext : 251533.pdf (Publisher’s version ) (Open Access), BACKGROUND: We evaluated data from all patients in the Netherlands who underwent endovascular treatment for acute ischemic stroke in the past 3.5 years, to identify nationwide trends in time to treatment and procedural success, and assess their effect on clinical outcomes. METHODS: We included patients with proximal occlusions of the anterior circulation from the second and first cohorts of the MR CLEAN (Multicenter Randomized Clinical trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry (March 2014 to June 2016; June 2016 to November 2017, respectively). We compared workflow times and rates of successful reperfusion (defined as an extended Thrombolysis in Cerebral Infarction score of 2B-3) between cohorts and chronological quartiles (all included patients stratified in chronological quartiles of intervention dates to create equally sized groups over the study period). Multivariable ordinal logistic regression was used to assess differences in the primary outcome (ordinal modified Rankin Scale at 90 days). RESULTS: Baseline characteristics were similar between cohorts (second cohort n=1692, first cohort n=1488) except for higher age, poorer collaterals, and less signs of early ischemia on computed tomography in the second cohort. Time from stroke onset to groin puncture and reperfusion were shorter in the second cohort (median 185 versus 210 minutes; P<0.001 and 236 versus 270 minutes; P<0.001, respectively). Successful reperfusion was achieved more often in the second than in the first cohort (72% versus 66%; P<0.001). Functional outcome significantly improved (adjusted common odds ratio 1.23 [95% CI, 1.07-1.40]). This effect was attenuated by adjustment for time from onset to reperfusion (adjusted common odds ratio, 1.12 [95% CI, 0.98-1.28]) and successful reperfusion (adjusted common odds ratio, 1.13 [95% CI, 0.99-1.30]). Outcomes were consistent in the analysis per chronological quartile. CONCLUSIONS: Clinical outcomes after end
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- 2022
21. Clinical Outcome After Endovascular Treatment in Patients With Active Cancer and Ischemic Stroke: A MR CLEAN Registry Substudy
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Verschoof, M.A., Groot, A.E., Bruijn, S. de, Roozenbeek, B., Worp, H.B. van der, Dippel, D.W., Emmer, B.J., Roosendaal, S.D., Majoie, C., Jenniskens, S.F.M., Roos, Y., Coutinho, J.M., Verschoof, M.A., Groot, A.E., Bruijn, S. de, Roozenbeek, B., Worp, H.B. van der, Dippel, D.W., Emmer, B.J., Roosendaal, S.D., Majoie, C., Jenniskens, S.F.M., Roos, Y., and Coutinho, J.M.
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Item does not contain fulltext, BACKGROUND AND OBJECTIVES: To explore clinical and safety outcomes of patients with acute ischemic stroke (AIS) and active cancer after endovascular treatment (EVT). METHODS: Using data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry, we compared patients with active cancer (defined as cancer diagnosed within 12 months before stroke, metastatic disease, or current cancer treatment) to patients without cancer. Outcomes were 90-day modified Rankin Scale (mRS) score, mortality, successful reperfusion (expanded Treatment in Cerebral Infarction score >/=2b), symptomatic intracranial hemorrhage (sICH), and recurrent stroke. Subgroup analyses were performed in patients with a prestroke mRS score of 0 or 1 and according to treatment setting (curative or palliative). Analyses were adjusted for prognostic variables. RESULTS: Of 2,583 patients who underwent EVT, 124 (4.8%) had active cancer. They more often had prestroke disability (mRS score >/=2: 34.1% vs 16.6%). The treatment setting was palliative in 25.3% of the patients. There was a shift toward worse functional outcome at 90 days in patients with active cancer (adjusted common odds ratio [acOR] 2.2, 95% confidence interval [CI] 1.5-3.2). At 90 days, patients with active cancer were less often independent (mRS score 0-2: 22.6% vs 42.0%, adjusted OR [aOR] 0.5, 95% CI 0.3-0.8) and more often dead (52.2% vs 26.5%, aOR 3.2, 95% CI 2.1-4.9). Successful reperfusion (67.8% vs 60.5%, aOR 1.4, 95% CI 1.0-2.1) and sICH rates (6.5% vs 5.9%, aOR 1.1, 95% CI 0.5-2.3) did not differ. Recurrent stroke within 90 days was more common in patients with active cancer (4.0% vs 1.3%, aOR 3.1, 95% CI 1.2-8.1). The sensitivity analysis of patients with a prestroke mRS score of 0 or 1 showed that patients with active cancer still had a worse outcome at 90 days (acOR 1.9, 95% CI 1.2-3.0). Patients with active cancer in a palliative treatment setting regained
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- 2022
22. Etiology of Large Vessel Occlusion Posterior Circulation Stroke: Results of the MR CLEAN Registry
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Pirson, F., Boodt, N., Brouwer, J., Bruggeman, A.A.E., Hinsenveld, W.H., Staals, J., Zwam, W.H. van, Leij, C. van der, Brans, R.J.B., Majoie, C., Dippel, D.W., Lugt, A. van der, Jenniskens, S.F.M., Schonewille, W.J., Oostenbrugge, R.J. van, Pirson, F., Boodt, N., Brouwer, J., Bruggeman, A.A.E., Hinsenveld, W.H., Staals, J., Zwam, W.H. van, Leij, C. van der, Brans, R.J.B., Majoie, C., Dippel, D.W., Lugt, A. van der, Jenniskens, S.F.M., Schonewille, W.J., and Oostenbrugge, R.J. van
- Abstract
Item does not contain fulltext, BACKGROUND: In patients with large vessel occlusion stroke of the anterior circulation, underlying cause is a determinant of outcome. Whether this is the case for posterior circulation large vessel occlusion stroke has yet to be determined. We aimed to report on cause in patients with posterior circulation stroke treated with endovascular thrombectomy and to analyze the association with functional outcome. METHODS: We used data of patients with posterior circulation stroke included in the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) registry, a prospective multicenter observational study, between 2014 and 2018. Stroke cause was categorized into large artery atherosclerosis (LAA), cardioembolism, arterial dissection, embolic stroke of undetermined source (ESUS), other determined cause, or undetermined cause. For primary analysis on the association between cause and outcome, we used multivariable ordinal logistic regression analysis to estimate the adjusted common odds ratio for a shift towards a better functional outcome on the modified Rankin Scale at 90 days with LAA as a reference group. Secondary outcomes included favorable functional outcome (modified Rankin Scale score 0-3), National Institutes of Health Stroke Scale score at 24 to 48 hours, reperfusion on digital subtraction angiography, and stroke progression. RESULTS: Of 264 patients with posterior circulation stroke, 84 (32%) had LAA, 48 (18%) cardioembolism, 31 (12%) dissection, and 14 (5%) ESUS. Patients with a dissection were younger (48 [interquartile range, 43-60] years) and had a lower National Institutes of Health Stroke Scale at baseline (12 [interquartile range, 6-31]) than patients with other cause. Functional outcome was better for patients with cardioembolism and ESUS compared to LAA (modified Rankin Scale adjusted common odds ratio, 2.4 [95% CI, 1.1-5.2], respectively adjusted common odds ratio, 3.1 [95% CI, 1.0-9.3]).
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- 2022
23. Association of hyperglycemia and computed tomographic perfusion deficits in patients who underwent endovascular treatment for acute ischemic stroke caused by a proximal intracranial occlusion: A subgroup analysis of a randomized phase 3 trial (MR CLEAN)
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Kersten, C., Zandbergen, A.A.M., Berkhemer, O.A., Borst, J., Haalboom, M., Roos, Y., Dippel, D.W., Oostenbrugge, R.J. van, Lugt, A. van der, Zwam, W.H. van, Jenniskens, S.F.M., Majoie, C.B.L.M., Hertog, H.M. den, Kersten, C., Zandbergen, A.A.M., Berkhemer, O.A., Borst, J., Haalboom, M., Roos, Y., Dippel, D.W., Oostenbrugge, R.J. van, Lugt, A. van der, Zwam, W.H. van, Jenniskens, S.F.M., Majoie, C.B.L.M., and Hertog, H.M. den
- Abstract
Item does not contain fulltext, INTRODUCTION: Hyperglycemia is highly prevalent in patients with acute ischemic stroke and is associated with increased risk of symptomatic intracranial hemorrhage, larger infarct size and unfavorable outcome. Furthermore, glucose may modify the effect of endovascular treatment (EVT) in patients with ischemic stroke. Hyperglycemia might lead to accelerated conversion of penumbra into infarct core. However, it remains uncertain whether hyperglycemia on admission is associated with the size of penumbra or infarct core in acute ischemic stroke. In this study, we aimed to assess the association between hyperglycemia and Computed Tomographic Perfusion (CTP) derived parameters in patients who underwent EVT for acute ischemic stroke. METHODS: We used data from the MR CLEAN study (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands). Hyperglycemia was defined as admission serum glucose of >7.8 mmol/L. Dichotomized and quantiles of glucose levels were related to size of core, penumbra and core penumbra ratio. Hypoperfused area is mean transient time 45% higher than that of the contralateral hemisphere. Core is the area with cerebral blood volume of <2 mL/100 g and penumbra is the area with cerebral blood volume > 2 mL/100 g. Core-penumbra ratio is the ischemic core divided by the total volume of hypoperfused tissue (core plus penumbra) multiplied by 100. Adjustments were made for age, sex, NIHSS on admission, onset-imaging time and diabetes mellitus. RESULTS: Hundred seventy-three patients were included. Median glucose level on admission was 6.5 mmol/L (IQR 5.8-7.5 mmol/L) and thirty-five patients (20%) were hyperglycemic. Median core volume was 33.3 mL (IQR 13.6-62.4 mL), median penumbra volume was 80.2 mL (IQR 36.3-123.5 mL) and median core-penumbra ratio was 28.5% (IQR 18.6-45.8%). Patients with hyperglycemia on admission had larger core volumes and core penumbra ratio than normoglycemic patients with a regression c
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- 2022
24. Interhospital transfer vs. direct presentation of patients with a large vessel occlusion not eligible for IV thrombolysis
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Meenen, L.C.C. van, Groot, A.E., Venema, E., Emmer, B.J., Smeekes, M.D., Kommer, G.J., Majoie, C., Roos, Y., Schonewille, W.J., Dijk, E.J. van, Boogaarts, H.D., Jenniskens, S.F.M., Meijer, A., Roozenbeek, B., Coutinho, J.M., Radiology and nuclear medicine, Amsterdam Neuroscience - Neurovascular Disorders, Clinical Neurophysiology, Damage and Repair in Cancer Development and Cancer Treatment (DARE), Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Graduate School, Neurology, Radiology and Nuclear Medicine, ACS - Microcirculation, ACS - Atherosclerosis & ischemic syndromes, ACS - Pulmonary hypertension & thrombosis, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam Reproduction & Development (AR&D), Biomedical Engineering and Physics, APH - Methodology, Amsterdam Movement Sciences, RS: Carim - B06 Imaging, RS: Carim - B05 Cerebral small vessel disease, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), MUMC+: Hersen en Zenuw Centrum (3), MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, Public Health, Radiology & Nuclear Medicine, and Neurosciences
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Male ,Time Factors ,Iv thrombolysis ,medicine.medical_treatment ,UT-Hybrid-D ,Severity of Illness Index ,Patient Admission ,Modified Rankin Scale ,REPERFUSION ,Medicine ,Registries ,ACUTE ISCHEMIC-STROKE ,Patient transfer ,Stroke ,Thrombectomy ,Aged, 80 and over ,Original Communication ,Endovascular Procedures ,Confounding ,Thrombolysis ,Middle Aged ,Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3] ,TIME ,Outcome and Process Assessment, Health Care ,Neurology ,Cardiology ,Female ,Presentation (obstetrics) ,ACCESS ,Rare cancers Radboud Institute for Health Sciences [Radboudumc 9] ,medicine.medical_specialty ,CIRCULATION ,Arterial Occlusive Diseases ,Time-to-Treatment ,Internal medicine ,Humans ,Contraindication ,Aged ,Ischemic Stroke ,business.industry ,Other Research Radboud Institute for Health Sciences [Radboudumc 0] ,CARE ,medicine.disease ,ENDOVASCULAR THROMBECTOMY ,Intracranial Arterial Diseases ,Neurology (clinical) ,business ,Large vessel occlusion - Abstract
Background and purpose Direct presentation of patients with acute ischemic stroke to a comprehensive stroke center (CSC) reduces time to endovascular treatment (EVT), but may increase time to treatment for intravenous thrombolysis (IVT). This dilemma, however, is not applicable to patients who have a contraindication for IVT. We examined the effect of direct presentation to a CSC on outcomes after EVT in patients not eligible for IVT. Methods We used data from the MR CLEAN Registry (2014–2017). We included patients who were not treated with IVT and compared patients directly presented to a CSC to patients transferred from a primary stroke center. Outcomes included treatment times and 90-day modified Rankin Scale scores (mRS) adjusted for potential confounders. Results Of the 3637 patients, 680 (19%) did not receive IVT and were included in the analyses. Of these, 389 (57%) were directly presented to a CSC. The most common contraindications for IVT were anticoagulation use (49%) and presentation > 4.5 h after onset (26%). Directly presented patients had lower baseline NIHSS scores (median 16 vs. 17, p = 0.015), higher onset-to-first-door times (median 105 vs. 66 min, p β = − 51.6, 95% CI: − 64.0 to − 39.2) and lower onset-to-groin times (median 220 vs. 230 min; adjusted β = − 44.0, 95% CI: − 65.5 to − 22.4). The 90-day mRS score did not differ between groups (adjusted OR: 1.23, 95% CI: 0.73–2.08). Conclusions In patients who were not eligible for IVT, treatment times for EVT were better for patients directly presented to a CSC, but without a statistically significant effect on clinical outcome.
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- 2020
25. MRI-guided percutaneous cryoablation of small renal tumors: 3D treatment margin assessment and correlation with local outcome
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Van Oostenbrugge, T.J., primary, De Jager, N.S., additional, Pätz, T., additional, Jenniskens, S.F.M., additional, Fütterer, J.J., additional, Langenhuijsen, J.F., additional, and Overduin, C.G., additional
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- 2021
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26. Assessment of Recurrent Stroke Risk in Patients With a Carotid Web
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Guglielmi, V., Compagne, K.C.J., Sarrami, A.H., Sluis, W.M., Berg, L.A. van den, Sluijs, P.M. van der, Mandell, D.M., Lugt, A. van der, Roos, Y., Majoie, C., Dippel, D.W., Emmer, B.J., Jenniskens, S.F.M., Boogaarts, H.D., Meijer, A., Pegge, S.A.H., Vinke, R.S., Geerlings, A.L., Romviel, Sharon, Kanselaar, K.J.L., Straaten, T. van, Es, A. van, Coutinho, J.M., MUMC+: Hersen en Zenuw Centrum (3), RS: Carim - B05 Cerebral small vessel disease, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, RS: Carim - B06 Imaging, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), MUMC+: MA Med Staf Spec Neurologie (9), MUMC+: MA AIOS Neurologie (9), MUMC+: MA Niet Med Staf Neurologie (9), Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Damage and Repair in Cancer Development and Cancer Treatment (DARE), Graduate School, 05 Neurology and psychiatry, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, ACS - Pulmonary hypertension & thrombosis, Amsterdam Neuroscience - Neurovascular Disorders, Neurology, Radiology and Nuclear Medicine, and Radiology & Nuclear Medicine
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Male ,medicine.medical_specialty ,AFRO-CARIBBEAN PATIENTS ,Computed Tomography Angiography ,FIBROMUSCULAR DYSPLASIA ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Arterial Occlusive Diseases ,Lesion ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Recurrent stroke ,Interquartile range ,Recurrence ,medicine.artery ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Registries ,Stroke ,Aged ,Netherlands ,Original Investigation ,ARTERY ,medicine.diagnostic_test ,business.industry ,Hazard ratio ,Other Research Radboud Institute for Health Sciences [Radboudumc 0] ,Middle Aged ,medicine.disease ,Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3] ,ISCHEMIC-STROKE ,Angiography ,Cardiology ,Female ,Neurology (clinical) ,Internal carotid artery ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Carotid Artery, Internal ,Cohort study ,Rare cancers Radboud Institute for Health Sciences [Radboudumc 9] - Abstract
Importance: A carotid web (CW) is a shelf-like lesion along the posterior wall of the internal carotid artery bulb and an underrecognized cause of young stroke. Several studies suggest that patients with symptomatic CW have a high risk of recurrent stroke, but high-quality data are lacking.Objective: To assess the 2-year risk of recurrent stroke in patients with a symptomatic CW.Design, Setting, and Participants: A comparative cohort study used data from the MR CLEAN trial (from 2010-2014) and MR CLEAN Registry (from 2014-2017). Data were analyzed in September 2020. The MR CLEAN trial and MR CLEAN Registry were nationwide prospective multicenter studies on endovascular treatment (EVT) of large vessel occlusion (LVO) stroke in the Netherlands. Baseline data were from 3439 consecutive adult patients with anterior circulation LVO stroke and available computed tomography (CT)-angiography of the carotid bulb. Two neuroradiologists reevaluated CT-angiography images for presence or absence of CW and identified 30 patients with CW ipsilateral to the index stroke. For these 30 eligible CW participants, detailed follow-up data regarding stroke recurrence within 2 years were acquired. These 30 patients with CW ipsilateral to the index stroke were compared with 168 patients without CW who participated in the MR CLEAN extended follow-up trial and who were randomized to the EVT arm.Main Outcomes and Measures: The primary outcome was recurrent stroke occurring within 2 years after the index stroke. Cox proportional hazards regression models were used to compare recurrent stroke rates within 2 years for patients with and without CW, adjusted for age and sex. The research question was formulated prior to data collection.Results: Of 3439 patients with baseline CT-angiography assessed, the median age was 72 years (interquartile range, 61-80 years) and 1813 (53%) were men. Patients with CW were younger (median age, 57 [interquartile range, 46-66] years vs 66 [interquartile range, 56-77] years; P = .02 and more often women (22 of 30 [73%] vs 67 of 168 [40%]; P = .001) than patients without CW. Twenty-eight of 30 patients (93%) received medical management after the index stroke (23 with antiplatelet therapy and 5 with anticoagulant therapy). During 2 years of follow-up, 5 of 30 patients (17%) with CW had a recurrent stroke compared with 5 of 168 patients (3%) without CW (adjusted hazard ratio, 4.9; 95% CI, 1.4-18.1).Conclusions and Relevance: In this study, 1 of 6 patients with a symptomatic CW had a recurrent stroke within 2 years, suggesting that medical management alone may not provide sufficient protection for patients with CW.
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- 2021
27. Clinical and Imaging Markers Associated With Hemorrhagic Transformation in Patients With Acute Ischemic Stroke
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Kranendonk, K.R. van, Treumiet, K.M., Boers, A.M.M., Berkhemer, O.A., Berg, L.A. van den, Chalos, V., Lingsma, H.F., Zwam, W.H. van, Lugt, A. van der, Oostenbrugge, R.J. van, Dippel, D.W.J., Roos, Y.B.W.E.M., Marquering, H.A., Majoie, C.B.L.M., Fransen, P.S.S., Beumer, D., Yoo, A.J., Schonewille, W.J., Vos, J.A., Nederkoorn, P.J., Wenner, M.J.H., Walderveen, M.A.A. van, Staals, J., Hofmeijer, J., Oostayen, J.A. van, Nijeholt, G.J.L.A., Boiten, J., Brouwer, P.A., Emmet, B.J., Bruijn, S.F. de, Dijk, L.C. van, Kappelle, L.J., R.H. lo, Dijk, E.J. van, Vries, J. de, Kort, P.L.M. de, Rooij, W.J.J. van, Berg, J.S.P. van den, Hassell, B.A.A.M. van, Aerden, L.A.M., Dallinga, R.J., Visser, M.C., Bot, J.C.J., Vroomen, P.C., Eshghi, O., Schreuder, T.H.C.M.L., Heijboer, R.J.J., Keizer, K., Tielbeek, A.V., Hertog, H.M. den, Gerrits, D.G., Berg-Vos, R.M. van den, Karas, G.B., Steyerberg, E.W., Flach, H.Z., Sprengers, M.E.S., Jenniskens, S.F.M., Beenen, L.F.M., Berg, R. van den, Koudstaal, P.J., MR CLEAN Investigators, RS: Carim - B05 Cerebral small vessel disease, RS: CARIM - R3.03 - Cerebral small vessel disease, RS: Carim - B06 Imaging, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: CARIM - R3.11 - Imaging, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, MUMC+: MA AIOS Neurologie (9), MUMC+: MA Med Staf Spec Neurologie (9), Graduate School, Radiology and Nuclear Medicine, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, ANS - Neurovascular Disorders, Neurology, Radiology and nuclear medicine, VU University medical center, Amsterdam Neuroscience - Neurovascular Disorders, Radiology & Nuclear Medicine, Orthopedics and Sports Medicine, and Public Health
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medicine.medical_specialty ,Population ,infarction ,intracranial hemorrhages ,Infarction ,BLOOD-PRESSURE ,Tissue plasminogen activator ,All institutes and research themes of the Radboud University Medical Center ,Hematoma ,Internal medicine ,medicine ,risk factors ,atrial fibrillation ,education ,Stroke ,TISSUE-PLASMINOGEN ACTIVATOR ,Advanced and Specialized Nursing ,HEALTH-CARE PROFESSIONALS ,education.field_of_study ,business.industry ,INTRAVENOUS ALTEPLASE ,Other Research Radboud Institute for Health Sciences [Radboudumc 0] ,blood pressure ,Atrial fibrillation ,SYMPTOMATIC INTRACRANIAL HEMORRHAGE ,Odds ratio ,Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3] ,medicine.disease ,stroke ,n/a OA procedure ,reperfusion ,Blood pressure ,THROMBOLYTIC THERAPY ,ENDOVASCULAR TREATMENT ,Cardiology ,RISK-FACTORS ,TRIAL ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug ,INTRAARTERIAL TREATMENT - Abstract
Background and Purpose— Hemorrhagic transformation (HT) after acute ischemic stroke may cause severe neurological deterioration and affects functional outcome. Identifying patients most likely to suffer from this complication could potentially be used for future treatment selection. Reperfusion after endovascular therapy could be associated with different risk factors for HT than intravenous thrombolytics as these treatments largely differ. In this study, we aimed to identify clinical and imaging markers that are associated with HT subtypes in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) population. Methods— In this post hoc analysis, all patients with follow-up imaging were included. HT was classified according to ECASS II (European Cooperative Acute Stroke Study). Variables with an association of P Results— Of the 478 out of 500 included patients in this subanalysis, 46% had HT (n=222). Of these, 66% had hemorrhagic infarction (n=147) and 34% PH (n=75). Symptomatic intracranial hemorrhage was observed in 7.3% (n=35) of all patients. Baseline National Institutes of Health Stroke Scale (odds ratio [OR], 1.05,95% CI, 1.01–1.09 per point) and absent/poor collaterals (OR, 1.90; 95% CI, 1.05–3.42) were significantly associated with hemorrhagic infarction. Increased systolic blood pressure (OR, 1.17; 95% CI, 1.05–1.31 per 10 mm Hg) and atrial fibrillation (OR, 1.94; 95% CI, 1.08–3.48) were associated with PH. Increased systolic blood pressure (OR, 1.28; 95% CI, 1.12–1.48) and antiplatelet use (OR, 2.6; 95% CI, 1.08–6.3) were associated with symptomatic intracranial hemorrhage. Conclusions— Clinical and imaging stroke severity parameters were associated with HT, both in hemorrhagic infarction and PH, whereas baseline patients characteristics like systolic blood pressure, atrial fibrillation, and antiplatelet use were only associated with PH or symptomatic intracranial hemorrhage. Clinical Trial Registration— URL: http://www.controlled-trials.com . Unique identifier: ISRCTN10888758.
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- 2019
28. Multiparametric magnetic resonance imaging and follow-up to avoid prostate biopsy in 4259 men
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Venderink, W., Luijtelaar, A. van, Leest, M.M. van der, Barentsz, J.O., Jenniskens, S.F.M., Sedelaar, M., Hulsbergen-van de Kaa, C.A., Overduin, C.G., and Futterer, J.J.
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Urological cancers Radboud Institute for Health Sciences [Radboudumc 15] ,Other Research Radboud Institute for Health Sciences [Radboudumc 0] ,Urological cancers Radboud Institute for Molecular Life Sciences [Radboudumc 15] ,Rare cancers Radboud Institute for Health Sciences [Radboudumc 9] - Abstract
Contains fulltext : 215678.pdf (Publisher’s version ) (Closed access) OBJECTIVE: To determine the proportion of men avoiding biopsy because of negative multiparametric magnetic resonance imaging (mpMRI) findings in a prostate MRI expert centre, and to assess the number of clinically significant prostate cancers (csPCa) detected during follow-up. PATIENTS AND METHODS: Retrospective study of 4259 consecutive men having mpMRI of the prostate between January 2012 and December 2017, with either a history of previous negative transrectal ultrasonography-guided biopsy or biopsy naive. Patients underwent mpMRI in a referral centre. Lesions were classified according to Prostate Imaging Reporting And Data System (PI-RADS) versions 1 and 2. Negative mpMRI was defined as an index lesion PI-RADS /=3 + 4 was considered csPCa. Kaplan-Meier analysis and univariable logistic regression models were used in the cohort of patients with negative mpMRI and follow-up. RESULTS: Overall, in 53.6% (2281/4259) of patients had a lesion classified as PI-RADS
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- 2019
29. Collateral Circulation and Outcome in Atherosclerotic Versus Cardioembolic Cerebral Large Vessel Occlusion
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Guglielmi, V., LeCouffe, N.E., Zinkstok, S.M., Compagne, K.C.J., Eker, R., Treurniet, K.M., Tolhuisen, M.L., Worp, H.B. van der, Jansen, I.G.H., Oostenbrugge, R.J. van, Marquering, H.A., Dippel, D.W.J., Emmer, B.J., Majoie, C.B.L.M., Roos, Y.B.W.E.M., Coutinho, J.M., Lugt, A. van der, Zwam, W.H. van, Boiten, J., Vos, J.A., Mulder, M.J.H.L., Goldhoorn, R.J.B., Kappelhof, M., Schonewille, W.J., Wermer, M.J.H., Walderveen, M.A.A. van, Staals, J., Hofmeijer, J., Martens, J.M., Nijeholt, G.J.L.A., Roozenbeek, B., Bruijn, S.F. de, Dijk, L.C. van, R.H. lo, Dijk, E.J. van, Boogaarts, H.D., Kort, P.L.M. de, Peluso, J.P., Berg, J.S.P. van den, Hasselt, B.A.A.M. van, Aerden, L.A.M., Dallinga, R.J., Uyttenboogaart, M., Eshghi, O., Schreuder, T.H.C.M.L., Heijboer, R.J.J., Keizer, K., Yo, L.S.F., Hertog, H.M. den, Sturm, E.J.C., Sprengers, M.E.S., Jenniskens, S.F.M., Berg, R. van den, Yoo, A.J., Beenen, L.F.M., Postma, A.A., Roosendaal, S.D., Kallen, B.F.W. van der, Wijngaard, I.R. van den, Es, A.C.G.M. van, Bot, J., Doormaal, P.J. van, Flach, H.Z., Lingsma, H.F., Ghannouti, N. el, Sterrenberg, M., Puppels, C., Pellikaan, W., Sprengers, R., Elfrink, M., Meris, J. de, Vermeulen, T., Geerlings, A., Vemde, G. van, Simons, T., Rijswijk, C. van, Messchendorp, G., Bongenaar, H., Bodde, K., Kleijn, S., Lodico, J., Droste, H., Wollaert, M., Jeurrissen, D., Bos, E., Drabbe, Y., Aaldering, N., Zweedijk, B., Khalilzada, M., Venema, E., Chalos, V., Geuskens, R.R., Straaten, T. van, Ergezen, S., Harmsma, R.R.M., Muijres, D., Jong, A. de, Hinsenveld, W., Berkhemer, O.A., Boers, A.M.M., Huguet, J., Groot, P.F.C., Mens, M.A., Kranendonk, K.R. van, Tolhuijsen, M.L., Alves, H., MR-CLEAN Registry Investigators, Neurology, Radiology and nuclear medicine, VU University medical center, Pediatric surgery, ACS - Atherosclerosis & ischemic syndromes, Radiology & Nuclear Medicine, Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Graduate School, ACS - Microcirculation, ACS - Pulmonary hypertension & thrombosis, ANS - Neurovascular Disorders, Radiology and Nuclear Medicine, AGEM - Re-generation and cancer of the digestive system, AGEM - Digestive immunity, CCA - Imaging and biomarkers, ARD - Amsterdam Reproduction and Development, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, RS: Carim - B05 Cerebral small vessel disease, RS: CARIM - R3.03 - Cerebral small vessel disease, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: Carim - B06 Imaging, RS: CARIM - R3.11 - Imaging, Promovendi CD, MUMC+: MA AIOS Neurologie (9), MUMC+: MA Med Staf Spec Neurologie (9), MUMC+: DA BV AIOS Nucleaire Geneeskunde (9), MUMC+: DA BV AIOS Radiologie (9), and MUMC+: MA Niet Med Staf Neurologie (9)
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Carotid Artery Diseases ,Male ,endovascular treatment ,Original Contributions ,FEATURES ,EMBOLIC STROKES ,Brain Ischemia ,Modified Rankin Scale ,Occlusion ,Medicine ,Advanced and Specialised Nursing ,Registries ,collateral circulation ,ACUTE ISCHEMIC-STROKE ,Stroke ,HYPOPERFUSION ,Aged, 80 and over ,education.field_of_study ,Brain ,Atrial fibrillation ,Middle Aged ,THROMBECTOMY ,Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3] ,Collateral circulation ,ETIOLOGY ,Intracranial Embolism ,Cardiology ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,Female ,Internal carotid artery ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,atherothrombotic stroke ,Population ,Clinical Sciences ,Clinical Neurology ,UNDETERMINED SOURCE ,CLASSIFICATION ,All institutes and research themes of the Radboud University Medical Center ,medicine.artery ,Internal medicine ,ischemic stroke ,Humans ,cardiovascular diseases ,education ,cardiac emboli ,Aged ,Advanced and Specialized Nursing ,business.industry ,Other Research Radboud Institute for Health Sciences [Radboudumc 0] ,medicine.disease ,CT ANGIOGRAPHY ,Stenosis ,ATRIAL-FIBRILLATION ,Neurology (clinical) ,business - Abstract
Supplemental Digital Content is available in the text., Background and Purpose— Due to chronic hypoperfusion, cervical atherosclerosis may promote cerebral collateral circulation. We hypothesized that patients with ischemic stroke due to cervical carotid atherosclerosis have a more extensive collateral circulation and better outcomes than patients with cardioembolism. We tested this hypothesis in a population of patients who underwent endovascular treatment for large vessel occlusion. Methods— From the MR-CLEAN Registry (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), we selected consecutive adult endovascular treatment patients (March 2014 to June 2016) with acute ischemic stroke due to anterior circulation large vessel occlusion and compared patients with cervical carotid artery stenosis >50% to those with cardioembolic etiology. The primary outcome was collateral score, graded on a 4-point scale. Secondary outcomes included the modified Rankin Scale (mRS) score and mortality at 90 days. We performed multivariable regression analyses and adjusted for potential confounders. Results— Of 1627 patients in the Registry, 190 patients with cervical carotid atherosclerosis and 476 with cardioembolism were included. Patients with cervical carotid atherosclerosis were younger (median 69 versus 76 years, P
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- 2019
30. Blood pressure during endovascular treatment under conscious sedation or local anesthesia
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Samuels, N., Graaf, R.A. van de, Berg, C.A.T. van den, Nieboer, D., Eralp, I., Treurniet, K.M., Emmer, B.J., Immink, R.V., Majoie, C., Zwam, W.H. van, Bokkers, R.P., Uyttenboogaart, M., Hasselt, B. van, Muhling, J., Burke, J.F., Roozenbeek, B., Lugt, A. van der, Dippel, D.W., Jenniskens, S.F.M., Boogaarts, H.D., Dijk, E.J. van, Lingsma, H.F., Es, A. van, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, Radiology and Nuclear Medicine, ACS - Diabetes & metabolism, Anesthesiology, Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: Carim - B05 Cerebral small vessel disease, RS: Carim - B06 Imaging, Neurology, Radiology & Nuclear Medicine, and Public Health
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Intraoperative Neurophysiological Monitoring ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Conscious Sedation ,Blood Pressure ,THERAPY ,Brain Ischemia ,0302 clinical medicine ,Modified Rankin Scale ,Local anesthesia ,Prospective Studies ,Registries ,ACUTE ISCHEMIC-STROKE ,030212 general & internal medicine ,Prospective cohort study ,Netherlands ,OUTCOMES ,STATEMENT ,Endovascular Procedures ,THROMBECTOMY ,Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3] ,3. Good health ,Anesthesia ,medicine.symptom ,Mean arterial pressure ,Sedation ,Clinical Neurology ,Article ,Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] ,EVENTS ,GENERAL-ANESTHESIA ,03 medical and health sciences ,MANAGEMENT ,medicine ,Humans ,Endovascular treatment ,Ischemic Stroke ,INTRAOPERATIVE HYPOTENSION ,business.industry ,Other Research Radboud Institute for Health Sciences [Radboudumc 0] ,Odds ratio ,CARE ,Confidence interval ,Blood pressure ,Anesthetic ,Ischemic stroke ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Anesthesia, Local - Abstract
ObjectiveTo evaluate the role of blood pressure as mediator of the effect of conscious sedation (CS) compared to local anesthesia (LA) on functional outcome after EVT.MethodsPatients treated in MR CLEAN Registry centers with CS or LA as preferred anesthetic approach during EVT for ischemic stroke were analyzed. First, we evaluated the effect of CS on area under the threshold (AUT), relative difference between baseline and lowest procedural mean arterial pressure (∆LMAP) and procedural blood pressure trend, compared to LA. Second, we assessed the association between blood pressure and functional outcome (modified Rankin Scale, mRS) with multivariable regression. Lastly, we evaluated whether blood pressure explained the effect of CS on mRS.ResultsIn 440 patients with available blood pressure data, patients treated under CS (n = 262) had larger AUTs (median 228 vs 23 mm Hg*min), larger ∆LMAP (median 16% vs 6%) and a more negative blood pressure trend (−0.22 vs −0.08 mm Hg/min) compared to LA (n = 178). Larger ∆LMAP and AUTs were associated with worse mRS (adjusted common OR (acOR) per 10%-drop 0.87, 95%CI 0.78–0.97, and acOR per 300 mm Hg*min 0.89, 95%CI 0.82–0.97). Patients treated under CS had worse mRS compared to LA (acOR 0.59, 95%CI 0.40–0.87) and this association remained when adjusting for ∆LMAP and AUT (acOR 0.62, 95%CI0.42–0.92).ConclusionsLarge blood pressure drops are associated with worse functional outcome. However, blood pressure drops do not explain the worse outcomes in the CS group.
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- 2021
31. Quantified health and cost effects of faster endovascular treatment for large vessel ischemic stroke patients in the Netherlands
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Voorst, Henk van, Kunz, Wolfgang G., Berg, Lucie A. van den, Kappelhof, M., Pinckaers, Floor M.E., Goyal, Mayank, Boogaarts, H.D., Jenniskens, S.F.M., Dijkgraaf, Marcel G.W., Majoie, C.B., Voorst, Henk van, Kunz, Wolfgang G., Berg, Lucie A. van den, Kappelhof, M., Pinckaers, Floor M.E., Goyal, Mayank, Boogaarts, H.D., Jenniskens, S.F.M., Dijkgraaf, Marcel G.W., and Majoie, C.B.
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Item does not contain fulltext
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- 2021
32. Prediction of Outcome and Endovascular Treatment Benefit: Validation and Update of the MR PREDICTS Decision Tool
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Venema, E., Roozenbeek, B., Mulder, Maxim, Brown, S., Majoie, C., Steyerberg, Ewout W., Demchuk, A.M., Muir, K.W., Davalos, A., Mitchell, P.J., Bracard, S., Berkhemer, O.A., Lycklama, A.N.G.J., Oostenbrugge, R.J. van, Roos, Y., Zwam, W.H. van, Lugt, A. van der, Hill, M.D., White, P., Campbell, B.C., Guillemin, F., Saver, J.L., Jovin, T.G., Goyal, M., Dijk, E.J. van, Boogaarts, H.D., Jenniskens, S.F.M., Meijer, A., Dippel, D.W., Lingsma, H.F., Venema, E., Roozenbeek, B., Mulder, Maxim, Brown, S., Majoie, C., Steyerberg, Ewout W., Demchuk, A.M., Muir, K.W., Davalos, A., Mitchell, P.J., Bracard, S., Berkhemer, O.A., Lycklama, A.N.G.J., Oostenbrugge, R.J. van, Roos, Y., Zwam, W.H. van, Lugt, A. van der, Hill, M.D., White, P., Campbell, B.C., Guillemin, F., Saver, J.L., Jovin, T.G., Goyal, M., Dijk, E.J. van, Boogaarts, H.D., Jenniskens, S.F.M., Meijer, A., Dippel, D.W., and Lingsma, H.F.
- Abstract
Item does not contain fulltext, [Figure: see text].
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- 2021
33. Importance of Occlusion Site for Thrombectomy Technique in Stroke: Comparison Between Aspiration and Stent Retriever
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Bernsen, M.L.E., Goldhoorn, R.B., Lingsma, H.F., Oostenbrugge, R.J. van, Zwam, W.H. van, Uyttenboogaart, M., Roos, Y., Dijk, E.J. van, Boogaarts, H.D., Vinke, R.S., Jenniskens, S.F.M., Pegge, S.A.H., Meijer, A., Martens, J.M., Hofmeijer, J., Bernsen, M.L.E., Goldhoorn, R.B., Lingsma, H.F., Oostenbrugge, R.J. van, Zwam, W.H. van, Uyttenboogaart, M., Roos, Y., Dijk, E.J. van, Boogaarts, H.D., Vinke, R.S., Jenniskens, S.F.M., Pegge, S.A.H., Meijer, A., Martens, J.M., and Hofmeijer, J.
- Abstract
Item does not contain fulltext, BACKGROUND AND PURPOSE: Thrombectomy with stent retriever and direct aspiration are equally effective in the endovascular treatment of anterior circulation acute ischemic stroke. We report efficacy and safety of initial treatment technique per occlusion segment. METHODS: For this study, we analyzed data from the MR CLEAN Registry, a prospective, observational study in all centers that perform endovascular therapy in the Netherlands. We used ordinal logistic regression analysis to compare clinical and technical results of first line direct aspiration treatment with that of stent retriever thrombectomy stratified for occlusion segment. Primary outcome measure was functional outcome at 3 months. Secondary outcome measures included reperfusion grade expressed as the extended Thrombolysis in Cerebral Infarction score, periprocedural complication risk, time to reperfusion, and mortality. RESULTS: Of the 2282 included patients, 1658 (73%) were initially treated with stent retriever and 624 (27%) with aspiration. Four hundred sixty-two patients had an occlusion of the intracranial part of the carotid artery, 1349 of the proximal middle cerebral artery, and 471 of the distal parts of the middle cerebral artery. There was no difference in functional outcome between aspiration and stent retriever thrombectomy (odds ratio, 1.0 [95% CI, 0.9-1.2]) in any of the occlusion segments (P value for interaction=0.2). Reperfusion rate was higher in the aspiration group (odds ratio, 1.4 [95% CI, 1.1-1.6]) and did not differ between occlusion segments (P value for interaction=0.6). Procedure times were shorter in the aspiration group (minutes 50 versus 65 minutes; P<0.0001). There was no difference in periprocedural complications or mortality. CONCLUSIONS: In unselected patients with anterior circulation infarcts, we observed equal functional outcome of aspiration and stent retriever thrombectomy in all occlusion segments. When aspiration was the first line treatment modality, reperfusion
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- 2021
34. Software-based planning of ultrasound and CT-guided percutaneous radiofrequency ablation in hepatic tumors
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Amerongen, M.J. van, Mariappan, P., Voglreiter, P., Flanagan, R., Jenniskens, S.F.M., Pollari, M., Kolesnik, M., Moche, M., Futterer, J.J., Amerongen, M.J. van, Mariappan, P., Voglreiter, P., Flanagan, R., Jenniskens, S.F.M., Pollari, M., Kolesnik, M., Moche, M., and Futterer, J.J.
- Abstract
Item does not contain fulltext, OBJECTIVES: Radiofrequency ablation (RFA) can be associated with local recurrences in the treatment of liver tumors. Data obtained at our center for an earlier multinational multicenter trial regarding an in-house developed simulation software were re-evaluated in order to analyze whether the software was able to predict local recurrences. METHODS: Twenty-seven RFA ablations for either primary or secondary hepatic tumors were included. Colorectal liver metastases were shown in 14 patients and hepatocellular carcinoma in 13 patients. Overlap of the simulated volume and the tumor volume was automatically generated and defined as positive predictive value (PPV) and additionally visually assessed. Local recurrence during follow-up was defined as gold standard. Sensitivity and specificity were calculated using the visual assessment and gold standard. RESULTS: Mean tumor size was 18 mm (95% CI 15-21 mm). Local recurrence occurred in 5 patients. The PPV of the simulation showed a mean of 0.89 (0.84-0.93 95% CI). After visual assessment, 9 incomplete ablations were observed, of which 4 true positives and 5 false positives for the detection of an incomplete ablation. The sensitivity and specificity were, respectively, 80% and 77% with a correct prediction in 78% of cases. No significant correlation was found between size of the tumor and PPV (Pearson Correlation 0.10; p = 0.62) or between PPV and recurrence rates (Pearson Correlation 0.28; p = 0.16). CONCLUSIONS: The simulation software shows promise in estimating the completeness of liver RFA treatment and predicting local recurrence rates, but could not be performed real-time. Future improvements in the field of registration could improve results and provide a possibility for real-time implementation.
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- 2021
35. Effect of First-Pass Reperfusion on Outcome After Endovascular Treatment for Ischemic Stroke
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Hartog, S.J. den, Zaidat, O., Roozenbeek, B., Es, A. van, Bruggeman, A.A.E., Emmer, B.J., Majoie, C., Zwam, W.H. van, Wijngaard, I.R. van den, Doormaal, P.J. van, Lingsma, H.F., Dijk, E.J. van, Boogaarts, H.D., Vries, J. de, Pegge, S.A.H., Meijer, A., Straaten, T. van, Geerlings, A.L., Jenniskens, S.F.M., Burke, J.F., Dippel, D.W., Hartog, S.J. den, Zaidat, O., Roozenbeek, B., Es, A. van, Bruggeman, A.A.E., Emmer, B.J., Majoie, C., Zwam, W.H. van, Wijngaard, I.R. van den, Doormaal, P.J. van, Lingsma, H.F., Dijk, E.J. van, Boogaarts, H.D., Vries, J. de, Pegge, S.A.H., Meijer, A., Straaten, T. van, Geerlings, A.L., Jenniskens, S.F.M., Burke, J.F., and Dippel, D.W.
- Abstract
Contains fulltext : 235752.pdf (Publisher’s version ) (Open Access), Background First-pass reperfusion (FPR) is associated with favorable outcome after endovascular treatment. It is unknown whether this effect is independent of patient characteristics and whether FPR has better outcomes compared with excellent reperfusion (Expanded Thrombolysis in Cerebral Infarction [eTICI] 2C-3) after multiple-passes reperfusion. We aimed to evaluate the association between FPR and outcome with adjustment for patient, imaging, and treatment characteristics to single out the contribution of FPR. Methods and Results FPR was defined as eTICI 2C-3 after 1 pass. Multivariable regression models were used to investigate characteristics associated with FPR and to investigate the effect of FPR on outcomes. We included 2686 patients of the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry. Factors associated with FPR were as follows: history of hyperlipidemia (adjusted odds ratio [OR], 1.05; 95% CI, 1.01-1.10), middle cerebral artery versus intracranial carotid artery occlusion (adjusted OR, 1.11; 95% CI, 1.06-1.16), and aspiration versus stent thrombectomy (adjusted OR, 1.07; 95% CI, 1.03-1.11). Interventionist experience increased the likelihood of FPR (adjusted OR, 1.03 per 50 patients previously treated; 95% CI, 1.01-1.06). Adjusted for patient, imaging, and treatment characteristics, FPR remained associated with a better 24-hour National Institutes of Health Stroke Scale (NIHSS) score (-37%; 95% CI, -43% to -31%) and a better modified Rankin Scale (mRS) score at 3 months (adjusted common OR, 2.16; 95% CI, 1.83-2.54) compared with no FPR (multiple-passes reperfusion+no excellent reperfusion), and compared with multiple-passes reperfusion alone (24-hour NIHSS score, (-23%; 95% CI, -31% to -14%), and mRS score (adjusted common OR, 1.45; 95% CI, 1.19-1.78)). Conclusions FPR compared with multiple-passes reperfusion is associated with favorable outcome, independently of patient, i
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- 2021
36. Healthy Life-Year Costs of Treatment Speed From Arrival to Endovascular Thrombectomy in Patients With Ischemic Stroke: A Meta-analysis of Individual Patient Data From 7 Randomized Clinical Trials
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Almekhlafi, M.A., Goyal, M., Dippel, D.W., Majoie, C., Campbell, B.C., Muir, K.W., Demchuk, A.M., Bracard, S., Guillemin, F., Jovin, T.G., Mitchell, P., White, P., Hill, M.D., Dijk, E.J. van, Jenniskens, S.F.M., Brown, S., Saver, J.L., Almekhlafi, M.A., Goyal, M., Dippel, D.W., Majoie, C., Campbell, B.C., Muir, K.W., Demchuk, A.M., Bracard, S., Guillemin, F., Jovin, T.G., Mitchell, P., White, P., Hill, M.D., Dijk, E.J. van, Jenniskens, S.F.M., Brown, S., and Saver, J.L.
- Abstract
Contains fulltext : 238537.pdf (Publisher’s version ) (Closed access), IMPORTANCE: The benefits of endovascular thrombectomy (EVT) are time dependent. Prior studies may have underestimated the time-benefit association because time of onset is imprecisely known. OBJECTIVE: To assess the lifetime outcomes associated with speed of endovascular thrombectomy in patients with acute ischemic stroke due to large-vessel occlusion (LVO). DATA SOURCES: PubMed was searched for randomized clinical trials of stent retriever thrombectomy devices vs medical therapy in patients with anterior circulation LVO within 12 hours of last known well time, and for which a peer-reviewed, complete primary results article was published by August 1, 2020. STUDY SELECTION: All randomized clinical trials of stent retriever thrombectomy devices vs medical therapy in patients with anterior circulation LVO within 12 hours of last known well time were included. DATA EXTRACTION/SYNTHESIS: Patient-level data regarding presenting clinical and imaging features and functional outcomes were pooled from the 7 retrieved randomized clinical trials of stent retriever thrombectomy devices (entirely or predominantly) vs medical therapy. All 7 identified trials published in a peer-reviewed journal (by August 1, 2020) contributed data. Detailed time metrics were collected including last known well-to-door (LKWTD) time; last known well/onset-to-puncture (LKWTP) time; last known well-to-reperfusion (LKWR) time; door-to-puncture (DTP) time; and door-to-reperfusion (DTR) time. MAIN OUTCOMES AND MEASURES: Change in healthy life-years measured as disability-adjusted life-years (DALYs). DALYs were calculated as the sum of years of life lost (YLL) owing to premature mortality and years of healthy life lost because of disability (YLD). Disability weights were assigned using the utility-weighted modified Rankin Scale. Age-specific life expectancies without stroke were calculated from 2017 US National Vital Statistics. RESULTS: Among the 781 EVT-treated patients, 406 (52.0%) were early-treated (
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- 2021
37. White Matter Lesions and Outcomes After Endovascular Treatment for Acute Ischemic Stroke: MR CLEAN Registry Results
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Venema, S.M. Uniken, Postma, A.A., Wijngaard, I.R. van den, Vos, J.A., Lingsma, H.F., Bokkers, R.P., Hofmeijer, J., Dippel, D.W., Dijk, E.J. van, Boogaarts, H.D., Jenniskens, S.F.M., Straaten, T. van, Majoie, C.B., Worp, H.B. van der, Venema, S.M. Uniken, Postma, A.A., Wijngaard, I.R. van den, Vos, J.A., Lingsma, H.F., Bokkers, R.P., Hofmeijer, J., Dippel, D.W., Dijk, E.J. van, Boogaarts, H.D., Jenniskens, S.F.M., Straaten, T. van, Majoie, C.B., and Worp, H.B. van der
- Abstract
Item does not contain fulltext, [Figure: see text].
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- 2021
38. Endovascular treatment in anterior circulation stroke beyond 6.5 hours after onset or time last seen well: results from the MR CLEAN Registry.
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Dekker, L., Venema, E., Pirson, F.A.V., Majoie, C.B.L.M., Emmer, B.J., Jansen, I.G., Mulder, M.J.H.L., Lemmens, R., Goldhoorn, R.B., Wermer, M.J., Boiten, J., ycklama À Nijeholt, G.J. L, Roos, Y.B.W.E.M., Es, A.C. van, Lingsma, H.F., Dippel, D.W., Zwam, W.H. van, Jenniskens, S.F.M., Oostenbrugge, R.J. van, Wijngaard, I.R. van den, Dekker, L., Venema, E., Pirson, F.A.V., Majoie, C.B.L.M., Emmer, B.J., Jansen, I.G., Mulder, M.J.H.L., Lemmens, R., Goldhoorn, R.B., Wermer, M.J., Boiten, J., ycklama À Nijeholt, G.J. L, Roos, Y.B.W.E.M., Es, A.C. van, Lingsma, H.F., Dippel, D.W., Zwam, W.H. van, Jenniskens, S.F.M., Oostenbrugge, R.J. van, and Wijngaard, I.R. van den
- Abstract
01 december 2021, Contains fulltext : 246130.pdf (Publisher’s version ) (Open Access), BACKGROUND: Randomised controlled trials with perfusion selection have shown benefit of endovascular treatment (EVT) for ischaemic stroke between 6 and 24 hours after symptom onset or time last seen well. However, outcomes after EVT in these late window patients without perfusion imaging are largely unknown. We assessed their characteristics and outcomes in routine clinical practice. METHODS: The Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry, a prospective, multicentre study in the Netherlands, included patients with an anterior circulation occlusion who underwent EVT between 2014 and 2017. CT perfusion was no standard imaging modality. We used adjusted ordinal logistic regression analysis to compare patients treated within versus beyond 6.5 hours after propensity score matching on age, prestroke modified Rankin Scale (mRS), National Institutes of Health Stroke Scale, Alberta Stroke Programme Early CT Score (ASPECTS), collateral status, location of occlusion and treatment with intravenous thrombolysis. Outcomes included 3-month mRS score, functional independence (defined as mRS 0-2), and death. RESULTS: Of 3264 patients who underwent EVT, 106 (3.2%) were treated beyond 6.5 hours (median 8.5, IQR 6.9-10.6), of whom 93 (87.7%) had unknown time of stroke onset. CT perfusion was not performed in 87/106 (80.2%) late window patients. Late window patients were younger (mean 67 vs 70 years, p<0.04) and had slightly lower ASPECTS (median 8 vs 9, p<0.01), but better collateral status (collateral score 2-3: 68.3% vs 57.7%, p=0.03). No differences were observed in proportions of functional independence (43.3% vs 40.5%, p=0.57) or death (24.0% vs 28.9%, p=0.28). After matching, outcomes remained similar (adjusted common OR for 1 point improvement in mRS 1.04, 95% CI 0.56 to 1.93). CONCLUSIONS: Without the use of CT perfusion selection criteria, EVT in the 6.5-24-hour time window was not associated with poore
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- 2021
39. Association of White Matter Lesions and Outcome After Endovascular Stroke Treatment
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Luijten, S.P.R., Bos, D., Compagne, K.C.J., Wolff, L., Majoie, C., Roos, Y., Zwam, W.H. van, Oostenbrugge, R.J. van, Dippel, D.W., Jenniskens, S.F.M., Lugt, A. van der, Es, A. van, Luijten, S.P.R., Bos, D., Compagne, K.C.J., Wolff, L., Majoie, C., Roos, Y., Zwam, W.H. van, Oostenbrugge, R.J. van, Dippel, D.W., Jenniskens, S.F.M., Lugt, A. van der, and Es, A. van
- Abstract
Item does not contain fulltext, OBJECTIVE: To investigate the association between white matter lesions (WML) and functional outcome in patients with acute ischemic stroke (AIS) and the modification of the effect of endovascular treatment (EVT) by WML. METHODS: We used data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) trial and assessed severity of WML on baseline noncontrast CT imaging (NCCT; n = 473) according to the Van Swieten Scale. Poststroke functional outcome was assessed with the modified Rankin Scale. We investigated the association of WML with functional outcome using ordinal logistic regression models adjusted for age, sex, and other relevant cardiovascular and prognostic risk factors. In addition, an interaction term between treatment allocation and WML severity was used to assess treatment effect modification by WML. RESULTS: We found an independent negative association between more severe WML and functional outcome (adjusted common odds ratio [acOR] 0.77 [95% confidence interval (CI) 0.66-0.90]). Patients with absent to moderate WML had similar benefit of EVT on functional outcome (acOR 1.93 [95% CI 1.31-2.84]) as patients with severe WML (acOR 1.95 [95% CI 0.90-4.20]). No treatment effect modification of WML was found (p for interaction = 0.85). CONCLUSIONS: WML are associated with poor functional outcome after AIS, but do not modify the effect of EVT. CLASSIFICATION OF EVIDENCE: Prognostic accuracy. This study provides Class II evidence that for patients with AIS, the presence of WML on baseline NCCT is associated with worse functional outcomes.
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- 2021
40. A Randomized Trial of Intravenous Alteplase before Endovascular Treatment for Stroke
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LeCouffe, N.E., Kappelhof, M., Treurniet, K.M., Rinkel, L.A., Bruggeman, A.E., Berkhemer, O.A., Martens, J.M., Tuladhar, A.M., Boogaarts, H.D., Laat, K.F. de, Jenniskens, S.F.M., Majoie, C.B.L.M., Roos, Y.B.W.E.M., LeCouffe, N.E., Kappelhof, M., Treurniet, K.M., Rinkel, L.A., Bruggeman, A.E., Berkhemer, O.A., Martens, J.M., Tuladhar, A.M., Boogaarts, H.D., Laat, K.F. de, Jenniskens, S.F.M., Majoie, C.B.L.M., and Roos, Y.B.W.E.M.
- Abstract
Item does not contain fulltext
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- 2021
41. Association of Ischemic Core Imaging Biomarkers With Post-Thrombectomy Clinical Outcomes in the MR CLEAN Registry
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Koopman, M.S., Hoving, J.W., Kappelhof, M., Berkhemer, O.A., Beenen, L.F., Zwam, W.H. van, Jong, H.W.A.M. de, Dankbaar, J.W., Dippel, D.W., Coutinho, J.M., Marquering, H.A., Jenniskens, S.F.M., Emmer, B.J., Majoie, C., Koopman, M.S., Hoving, J.W., Kappelhof, M., Berkhemer, O.A., Beenen, L.F., Zwam, W.H. van, Jong, H.W.A.M. de, Dankbaar, J.W., Dippel, D.W., Coutinho, J.M., Marquering, H.A., Jenniskens, S.F.M., Emmer, B.J., and Majoie, C.
- Abstract
Contains fulltext : 287811.pdf (Publisher’s version ) (Open Access), Background: A considerable proportion of acute ischemic stroke patients treated with endovascular thrombectomy (EVT) are dead or severely disabled at 3 months despite successful reperfusion. Ischemic core imaging biomarkers may help to identify patients who are more likely to have a poor outcome after endovascular thrombectomy (EVT) despite successful reperfusion. We studied the association of CT perfusion-(CTP), CT angiography-(CTA), and non-contrast CT-(NCCT) based imaging markers with poor outcome in patients who underwent EVT in daily clinical practice. Methods: We included EVT-treated patients (July 2016-November 2017) with an anterior circulation occlusion from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry with available baseline CTP, CTA, and NCCT. We used multivariable binary and ordinal logistic regression to analyze the association of CTP ischemic core volume, CTA-Collateral Score (CTA-CS), and Alberta Stroke Program Early CT Score (ASPECTS) with poor outcome (modified Rankin Scale score (mRS) 5-6) and likelihood of having a lower score on the mRS at 90 days. Results: In 201 patients, median core volume was 13 (IQR 5-41) mL. Median ASPECTS was 9 (IQR 8-10). Most patients had grade 2 (83/201; 42%) or grade 3 (28/201; 14%) collaterals. CTP ischemic core volume was associated with poor outcome [aOR per 10 mL 1.02 (95%CI 1.01-1.04)] and lower likelihood of having a lower score on the mRS at 90 days [aOR per 10 mL 0.85 (95% CI 0.78-0.93)]. In multivariable analysis, neither CTA-CS nor ASPECTS were significantly associated with poor outcome or the likelihood of having a lower mRS. Conclusion: In our population of patients treated with EVT in daily clinical practice, CTP ischemic core volume is associated with poor outcome and lower likelihood of shift toward better outcome in contrast to either CTA-CS or ASPECTS.
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- 2021
42. Endovascular treatment in older adults with acute ischemic stroke in the MR CLEAN Registry
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Groot, A.E., Treurniet, K.M., Jansen, I.G., Lingsma, H.F., Hinsenveld, W., Graaf, R.A. van de, Roozenbeek, B., Willems, H.C., Schonewille, W.J., Marquering, H.A., Berg, R van den, Dippel, D.W., Majoie, C., Roos, Y., Dijk, E.J. van, Boogaarts, H.D., Jenniskens, S.F.M., Coutinho, J.M., Groot, A.E., Treurniet, K.M., Jansen, I.G., Lingsma, H.F., Hinsenveld, W., Graaf, R.A. van de, Roozenbeek, B., Willems, H.C., Schonewille, W.J., Marquering, H.A., Berg, R van den, Dippel, D.W., Majoie, C., Roos, Y., Dijk, E.J. van, Boogaarts, H.D., Jenniskens, S.F.M., and Coutinho, J.M.
- Abstract
Item does not contain fulltext, OBJECTIVE: To explore clinical outcomes in older adults with acute ischemic stroke treated with endovascular thrombectomy (EVT). METHODS: We included consecutive patients (2014-2016) with an anterior circulation occlusion undergoing EVT from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry. We assessed the effect of age (dichotomized at >/=80 years and as continuous variable) on the modified Rankin Scale (mRS) score at 90 days, symptomatic intracranial hemorrhage (sICH), and reperfusion rate. The association between age and mRS was assessed with multivariable ordinal logistic regression, and a multiplicative interaction term was added to the model to assess modification of reperfusion by age on outcome. RESULTS: Of the 1,526 patients, 380 (25%) were >/=80 years of age (referred to here as older adults). Older adults had a worse functional outcome than younger patients (adjusted common odds ratio [acOR] for an mRS score shift toward better outcome 0.31, 95% confidence interval [CI] 0.24-0.39). Mortality was also higher in older adults (51% vs 22%, adjusted odds ratio 3.12, 95% CI 2.33-4.19). There were no differences in proportion of patients with mRS scores of 4 to 5, sICH, or reperfusion rates. Successful reperfusion was more strongly associated with a shift toward good functional outcome in older adults than in younger patients (acOR 3.22, 95% CI 2.04-5.10 vs 2.00, 95% CI 1.56-2.57, p interaction = 0.026). CONCLUSION: Older age is associated with an increased absolute risk of poor clinical outcome, while the relative benefit of successful reperfusion seems to be higher in these patients. These results should be taken into consideration in the selection of older adults for EVT.
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- 2020
43. Focal Salvage MR Imaging-Guided Cryoablation for Localized Prostate Cancer Recurrence after Radiotherapy: 12-Month Follow-up
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Bomers, J.G.R., Overduin, C.G., Jenniskens, S.F.M., Cornel, E.B., Lin, E. van, Sedelaar, M., Fütterer, J.J., Bomers, J.G.R., Overduin, C.G., Jenniskens, S.F.M., Cornel, E.B., Lin, E. van, Sedelaar, M., and Fütterer, J.J.
- Abstract
Contains fulltext : 219698.pdf (Publisher’s version ) (Closed access), PURPOSE: To evaluate safety, quality of life (QoL), and local cancer control after focal salvage MR imaging-guided cryoablation in patients with local recurrence of prostate cancer (PCa) after radiotherapy. MATERIALS AND METHODS: A retrospective, single-center study was performed in 62 patients with radiorecurrent PCa who underwent MR imaging-guided cryoablation since May 2011 with a follow-up >/=12 months in December 2017. Rates and descriptions of adverse events were reported. Ablation complications were classified according to the Clavien and SIR systems. Validated questionnaires were used to observe functional outcomes and QoL before therapy and 6 and 12 months after therapy. Cancer control was defined as no biochemical failure according to Phoenix criteria and no other clinical evidence for local or metastatic disease. RESULTS: All procedures were technically feasible. The number of complications requiring major therapy (Clavien grade 3b/4 or SIR grade D/E/F) was low (2 [3.2%] and 1 [1.6%], respectively). After 12 months, the International Consultation of Incontinence Questionnaire-Short Form (P < .001) and 5-item International Index of Erectile Function (P = .001) scores became significantly worse, indicating increased symptoms of incontinence and diminished erectile function, without compromising QoL. Six patients developed metastases within 6 months. After 12 months, 36 patients (63%) were disease-free. CONCLUSIONS: Focal salvage MR imaging-guided cryoablation is safe and is associated with a high technical success rate, preservation of QoL, and local PCa control. This treatment can be a reasonable alternative to salvage radical prostatectomy in properly selected patients with low morbidity and preservation of QoL; however, longer follow-up is needed.
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- 2020
44. Anesthetic management during endovascular treatment of acute ischemic stroke in the MR CLEAN Registry
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Goldhoorn, R.B., Bernsen, M.L.E., Hofmeijer, J., Martens, J.M., Lingsma, H.F., Dippel, D.W., Lugt, A. van der, Buhre, W., Roos, Y., Majoie, C., Vos, J.A, Boiten, J., Emmer, B., Boogaarts, H.D., Dijk, E.J. van, Jenniskens, S.F.M., Geerlings, A.L., Straaten, T. van, Oostenbrugge, R.J. van, Zwam, W.H. van, Goldhoorn, R.B., Bernsen, M.L.E., Hofmeijer, J., Martens, J.M., Lingsma, H.F., Dippel, D.W., Lugt, A. van der, Buhre, W., Roos, Y., Majoie, C., Vos, J.A, Boiten, J., Emmer, B., Boogaarts, H.D., Dijk, E.J. van, Jenniskens, S.F.M., Geerlings, A.L., Straaten, T. van, Oostenbrugge, R.J. van, and Zwam, W.H. van
- Abstract
Item does not contain fulltext, OBJECTIVE: To compare outcomes after endovascular treatment (EVT) for acute ischemic stroke with 3 different types of anesthetic management in clinical practice, as anesthetic management may influence functional outcome. METHODS: Data of patients with an anterior circulation occlusion, included in the Dutch nationwide, prospective Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry between March 2014 and June 2016, were analyzed. Patients were divided into 3 groups defined by anesthetic technique performed during EVT: local anesthesia only (LA), general anesthesia (GA), or conscious sedation (CS). Primary outcome was the modified Rankin Scale score at 90 days. To compare functional outcome between groups, we estimated a common odds ratio (OR) with ordinal logistic regression, adjusted for age, sex, prestroke modified Rankin Scale score, baseline NIH Stroke Scale score, collaterals, and time from onset to arrival at intervention center. RESULTS: A total of 1,376 patients were included. Performed anesthetic technique was LA in 821 (60%), GA in 381 (28%), and CS in 174 (13%) patients. Compared to LA, both GA and CS were associated with worse functional outcome on the modified Rankin Scale score at 90 days (GA cORadj 0.75; 95% confidence interval [CI] 0.58-0.97; CS cORadj 0.45; 95% CI 0.33-0.62). CS was associated with worse functional outcome than GA (cORadj 0.60; 95% CI 0.42-0.87). CONCLUSIONS: LA is associated with better functional outcome than systemic sedation in patients undergoing EVT for acute ischemic stroke. Whereas LA had a clear advantage over CS, this was less prominent compared to GA. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients with acute ischemic stroke undergoing EVT, LA improves functional outcome compared to GA or CS.
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- 2020
45. National Institutes of Health Stroke Scale: An Alternative Primary Outcome Measure for Trials of Acute Treatment for Ischemic Stroke
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Chalos, V., Ende, N.A.M. van der, Lingsma, H.F., Mulder, M., Venema, E., Dijkland, S.A., Berkhemer, O.A., Yoo, A.J., Broderick, J.P., Palesch, Y.Y., Yeatts, S.D., Roos, Y., Oostenbrugge, R.J. van, Zwam, W.H. van, Majoie, C., Lugt, A. van der, Roozenbeek, B., Dippel, D.W., Dijk, E.J. van, Vries, J. de, Jenniskens, S.F.M., Berg, R van den, Koudstaal, P.J., Chalos, V., Ende, N.A.M. van der, Lingsma, H.F., Mulder, M., Venema, E., Dijkland, S.A., Berkhemer, O.A., Yoo, A.J., Broderick, J.P., Palesch, Y.Y., Yeatts, S.D., Roos, Y., Oostenbrugge, R.J. van, Zwam, W.H. van, Majoie, C., Lugt, A. van der, Roozenbeek, B., Dippel, D.W., Dijk, E.J. van, Vries, J. de, Jenniskens, S.F.M., Berg, R van den, and Koudstaal, P.J.
- Abstract
Contains fulltext : 219673.pdf (Publisher’s version ) (Open Access), Background and Purpose- The modified Rankin Scale (mRS) at 3 months is the most commonly used primary outcome measure in stroke treatment trials, but it lacks specificity and requires long-term follow-up interviews, which consume time and resources. An alternative may be the National Institutes of Health Stroke Scale (NIHSS), early after stroke. Our aim was to evaluate whether the NIHSS assessed within 1 week after treatment could serve as a primary outcome measure for trials of acute treatment for ischemic stroke. Methods- We used data from 2 randomized controlled trials of endovascular treatment for ischemic stroke: the positive MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands; N=500) and the neutral IMS (Interventional Management of Stroke) III trial (N=656). We used a causal mediation model, with linear and ordinal logistic regression adjusted for confounders, to evaluate the NIHSS 24 hours and 5 to 7 days after endovascular treatment as primary outcome measures (instead of the mRS at 3 months) in both trials. Patients who had died before the NIHSS was assessed received the maximum score of 42. NIHSS+1 was then log10-transformed. Results- In both trials, there was a significant correlation between the NIHSS at 24 hours and 5 to 7 days and the mRS. In MR CLEAN, we found a significant effect of endovascular treatment on the mRS and on the NIHSS at 24 hours and 5 to 7 days. After adjustment for NIHSS at 24 hours and 5 to 7 days, the effect of endovascular treatment on the mRS decreased from common odds ratio 1.68 (95% CI, 1.22-2.32) to respectively 1.36 (95% CI, 0.97-1.91) and 1.24 (95% CI, 0.87-1.79), indicating that treatment effect on the mRS is in large part mediated by the NIHSS. In the IMS III trial there was no treatment effect on the NIHSS at 24 hours and 5 to 7 days, corresponding with the absence of a treatment effect on the mRS. Conclusions- The NIHSS within 1 week satisfies the requir
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- 2020
46. Magnetic Resonance Imaging Assessment After Therapy in Prostate Cancer
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Koopman, A., Jenniskens, S.F.M., Futterer, J.J., Koopman, A., Jenniskens, S.F.M., and Futterer, J.J.
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Contains fulltext : 219669.pdf (Publisher’s version ) (Closed access), Prostate cancer is the fifth leading cause of death worldwide. A variety of treatment options is available for localized prostate cancer and may range from active surveillance to focal therapy or whole gland treatment, that is, surgery or radiotherapy. Serum prostate-specific antigen levels are an important tool to monitor treatment success after whole gland treatment, unfortunately prostate-specific antigen is unreliable after focal therapy. Multiparametric magnetic resonance imaging of the prostate is rapidly gaining field in the management of prostate cancer and may play a crucial role in the evaluation of recurrent prostate cancer. This article will focus on postprocedural magnetic resonance imaging after different forms of local therapy in patients with prostate cancer.
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- 2020
47. Stroke Etiology and Thrombus Computed Tomography Characteristics in Patients With Acute Ischemic Stroke: A MR CLEAN Registry Substudy
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Boodt, N., Compagne, K.C.J., Dutra, B.G., Samuels, N., Tolhuisen, M.L., Alves, H., Kappelhof, M., Lycklama, A.N.G.J., Marquering, H.A., Majoie, C., Lingsma, H.F., Dijk, E.J. van, Boogaarts, H.D., Jenniskens, S.F.M., Dippel, D.W., Lugt, A. van der, Boodt, N., Compagne, K.C.J., Dutra, B.G., Samuels, N., Tolhuisen, M.L., Alves, H., Kappelhof, M., Lycklama, A.N.G.J., Marquering, H.A., Majoie, C., Lingsma, H.F., Dijk, E.J. van, Boogaarts, H.D., Jenniskens, S.F.M., Dippel, D.W., and Lugt, A. van der
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Contains fulltext : 220836.pdf (Publisher’s version ) (Open Access), Background and Purpose- If a relationship between stroke etiology and thrombus computed tomography characteristics exists, assessing these characteristics in clinical practice could serve as a useful additional diagnostic tool for the identification of stroke subtype. Our purpose was to study the association of stroke etiology and thrombus computed tomography characteristics in patients with acute ischemic stroke due to a large vessel occlusion. Methods- For 1429 consecutive patients enrolled in the MR CLEAN Registry, we determined stroke cause as defined by the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria. The association of stroke etiology with the hyperdense artery sign, clot burden score, and thrombus location was estimated with univariable and multivariable binary and ordinal logistic regression. Additionally, for 367 patients with available thin-section imaging, we assessed the association of stroke etiology with absolute and relative thrombus attenuation, distance from internal carotid artery-terminus to thrombus, thrombus length, and thrombus attenuation increase with univariable and multivariable linear regression. Results- Compared with cardioembolic strokes, noncardioembolic strokes were associated with presence of hyperdense artery sign (odds ratio, 2.2 [95% CI, 1.6-3.0]), lower clot burden score (common odds ratio, 0.4 [95% CI, 0.3-0.6]), shift towards a more proximal thrombus location (common odds ratio, 0.2 [95% CI, 0.2-0.3]), higher absolute thrombus attenuation (beta, 3.6 [95% CI, 0.9-6.4]), decrease in distance from the ICA-terminus (beta, -5.7 [95% CI, -8.3 to -3.0]), and longer thrombi (beta, 8.6 [95% CI, 6.5-10.7]), based on univariable analysis. Thrombus characteristics of strokes with undetermined cause were similar to those of cardioembolic strokes. Conclusions- Thrombus computed tomography characteristics of cardioembolic stroke are distinct from those of noncardioembolic stroke. Additionally, our study supports the general
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- 2020
48. Combined Effect of Age and Baseline Alberta Stroke Program Early Computed Tomography Score on Post-Thrombectomy Clinical Outcomes in the MR CLEAN Registry
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Ospel, J., Kappelhof, M., Groot, A.E., LeCouffe, N.E., Coutinho, J.M., Yoo, A.J., Yo, L.S., Beenen, L.F., Zwam, W.H. van, Lugt, A. van der, Postma, A.A., Roos, Y., Jenniskens, S.F.M., Boogaarts, H.D., Dijk, E.J. van, Goyal, M., Majoie, C., Ospel, J., Kappelhof, M., Groot, A.E., LeCouffe, N.E., Coutinho, J.M., Yoo, A.J., Yo, L.S., Beenen, L.F., Zwam, W.H. van, Lugt, A. van der, Postma, A.A., Roos, Y., Jenniskens, S.F.M., Boogaarts, H.D., Dijk, E.J. van, Goyal, M., and Majoie, C.
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Contains fulltext : 229573.pdf (Publisher’s version ) (Closed access), BACKGROUND AND PURPOSE: Ischemic brain tissue damage in patients with acute ischemic stroke, as measured by the Alberta Stroke Program Early CT Score (ASPECTS) may be more impactful in older than in younger patients, although this has not been studied. We aimed to investigate a possible interaction effect between age and ASPECTS on functional outcome in acute ischemic stroke patients undergoing endovascular treatment, and compared reperfusion benefit across age and ASPECTS subgroups. METHODS: Patients with ischemic stroke from the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands; March 2014-November 2017) were included. Multivariable ordinal logistic regression was performed to obtain effect size estimates (adjusted common odds ratio) on functional outcome (modified Rankin Scale score) for continuous age and granular ASPECTS, with a 2-way multiplicative interaction term (agexASPECTS). Outcomes in four patient subgroups based on age (< versus >/= median age [71.8 years]) and baseline ASPECTS (6-10 versus 0-5) were assessed. RESULTS: We included 3279 patients. There was no interaction between age and ASPECTS on modified Rankin Scale (P=0.925). The highest proportion of modified Rankin Scale 5 to 6 was observed in patients >71.8 years with baseline ASPECTS 0 to 5 (68/107, 63.6%). There was benefit of reperfusion in all age-ASPECTS subgroups. Although the adjusted common odds ratio was lower in patients >71.8 years with ASPECTS 0 to 5 (adjusted common odds ratio, 1.60 [95% CI, 0.66-3.88], n=110), there was no significant difference from the main effect (P=0.299). CONCLUSIONS: Although the proportion of poor outcomes following endovascular treatment was highest in older patients with low baseline ASPECTS, outcomes did not significantly differ from the main effect. These results do not support withholding endovascular treatment based n a combination of high age and low ASPECTS.
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- 2020
49. Admission Blood Pressure in Relation to Clinical Outcomes and Successful Reperfusion After Endovascular Stroke Treatment
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Berg, S.A. van den, Venema, S.M. Uniken, Mulder, M., Treurniet, K.M., Samuels, N., Lingsma, H.F., Goldhoorn, R.B., Jansen, I.G., Coutinho, J.M., Roozenbeek, B., Dippel, D.W., Roos, Y., Dijk, E.J. van, Boogaarts, H.D., Jenniskens, S.F.M., Meijer, A., Worp, H.B. van der, Nederkoorn, P.J., Berg, S.A. van den, Venema, S.M. Uniken, Mulder, M., Treurniet, K.M., Samuels, N., Lingsma, H.F., Goldhoorn, R.B., Jansen, I.G., Coutinho, J.M., Roozenbeek, B., Dippel, D.W., Roos, Y., Dijk, E.J. van, Boogaarts, H.D., Jenniskens, S.F.M., Meijer, A., Worp, H.B. van der, and Nederkoorn, P.J.
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Contains fulltext : 229554.pdf (Publisher’s version ) (Open Access), BACKGROUND AND PURPOSE: Optimal blood pressure (BP) targets before endovascular treatment (EVT) for acute ischemic stroke are unknown. We aimed to assess the relation between admission BP and clinical outcomes and successful reperfusion after EVT. METHODS: We used data from the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry, an observational, prospective, nationwide cohort study of patients with ischemic stroke treated with EVT in routine clinical practice in the Netherlands. Baseline systolic BP (SBP) and diastolic BP (DBP) were recorded on admission. The primary outcome was the score on the modified Rankin Scale at 90 days. Secondary outcomes included successful reperfusion (extended Thrombolysis in Cerebral Infarction score 2B-3), symptomatic intracranial hemorrhage, and 90-day mortality. Multivariable logistic and linear regression were used to assess the associations of SBP and DBP with outcomes. The relations between BPs and outcomes were tested for nonlinearity. Parameter estimates were calculated per 10 mm Hg increase or decrease in BP. RESULTS: We included 3180 patients treated with EVT between March 2014 and November 2017. The relations between admission SBP and DBP with 90-day modified Rankin Scale scores and mortality were J-shaped, with inflection points around 150 and 81 mm Hg, respectively. An increase in SBP above 150 mm Hg was associated with poor functional outcome (adjusted common odds ratio, 1.09 [95% CI, 1.04-1.15]) and mortality at 90 days (adjusted odds ratio, 1.09 [95% CI, 1.03-1.16]). Following linear relationships, higher SBP was associated with a lower probability of successful reperfusion (adjusted odds ratio, 0.97 [95% CI, 0.94-0.99]) and with the occurrence of symptomatic intracranial hemorrhage (adjusted odds ratio, 1.06 [95% CI, 0.99-1.13]). Results for DBP were largely similar. CONCLUSIONS: In patients with acute ischemic stroke treated with EVT, high
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- 2020
50. Improving quality of stroke care through benchmarking center performance: why focusing on outcomes is not enough
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Amini, Marzyeh, Leeuwen, Nikki van, Eijkenaar, Frank, Mulder, Maxim J.H.L., Schonewille, W., Lycklama a Nijeholt, G.L.A., Jenniskens, S.F.M., Roozenbeek, B., Lingsma, Hester F., Amini, Marzyeh, Leeuwen, Nikki van, Eijkenaar, Frank, Mulder, Maxim J.H.L., Schonewille, W., Lycklama a Nijeholt, G.L.A., Jenniskens, S.F.M., Roozenbeek, B., and Lingsma, Hester F.
- Abstract
Contains fulltext : 226775.pdf (publisher's version ) (Open Access)
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- 2020
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