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1. Clinical and Imaging Markers Associated With Hemorrhagic Transformation in Patients With Acute Ischemic Stroke

Author: 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
Subjects: 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.
Published: 2019
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2. Collateral Circulation and Outcome in Atherosclerotic Versus Cardioembolic Cerebral Large Vessel Occlusion

Author: 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)
Subjects: 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
Published: 2019
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3. MR CLEAN-NO IV: intravenous treatment followed by endovascular treatment versus direct endovascular treatment for acute ischemic stroke caused by a proximal intracranial occlusion—study protocol for a randomized clinical trial

Author: Treurniet, K.M., LeCouffe, N.E., Kappelhof, M., Emmer, B.J., Es, A.C.G.M. van, Boiten, J., Lycklama, G.J., Keizer, K., Yo, L.S.F., Lingsma, H.F., Zwam, W.H. van, Ridder, I. de, Oostenbrugge, R.J. van, Lugt, A. van der, Dippel, D.W.J., Coutinho, J.M., Roos, Y.B.W.E.M., Majoie, C.B.L.M., MR CLEAN-NO IV Investigators, Public Health, Radiology & Nuclear Medicine, Neurology, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: Carim - B05 Cerebral small vessel disease, RS: Carim - B06 Imaging, MUMC+: MA Med Staf Spec Neurologie (9), MUMC+: MA Neurologie (3), RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, Klinische Neurowetenschappen, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, ANS - Cellular & Molecular Mechanisms, ANS - Compulsivity, Impulsivity & Attention, ANS - Neurovascular Disorders, Graduate School, and Radiology and Nuclear Medicine
Subjects: medicine.medical_specialty, Prognostic variable, Medicine (miscellaneous), ADJUSTMENT, Intravenous alteplase, law.invention, Brain Ischemia, Study Protocol, Randomized controlled trial, ALTEPLASE, Fibrinolytic Agents, Modified Rankin Scale, law, Internal medicine, Occlusion, medicine, Humans, Multicenter Studies as Topic, Pharmacology (medical), Endovascular treatment, Thrombolytic Therapy, Adverse effect, TISSUE-PLASMINOGEN ACTIVATOR, Randomized Controlled Trials as Topic, Thrombectomy, THROMBOLYSIS, lcsh:R5-920, OUTCOMES, Ischemic stroke, medicine.diagnostic_test, INFORMED-CONSENT, business.industry, MECHANICAL THROMBECTOMY, Endovascular Procedures, Clinical trial, Stroke, Clinical equipoise, Treatment Outcome, DEFERRED CONSENT, Angiography, Cardiology, EXPERIENCE, lcsh:Medicine (General), business, ARTERY RECANALIZATION
Abstract: BackgroundEndovascular treatment (EVT) has greatly improved the prognosis of acute ischemic stroke (AIS) patients with a proximal intracranial large vessel occlusion (LVO) of the anterior circulation. Currently, there is clinical equipoise concerning the added benefit of intravenous alteplase administration (IVT) prior to EVT. The aim of this study is to assess the efficacy and safety of omitting IVT before EVT in patients with AIS caused by an anterior circulation LVO.MethodsMR CLEAN-NO IV is a multicenter randomized open-label clinical trial with blinded outcome assessment (PROBE design). Patients ≥ 18 years of age with a pre-stroke mRS DiscussionIVT prior to EVT might facilitate early reperfusion before EVT or improved reperfusion rates during EVT. Conversely, among other potential adverse effects, the increased risk of bleeding could nullify the beneficial effects of IVT. MR CLEAN-NO IV will provide insight into whether IVT is still of added value in patients eligible for EVT.Trial registrationwww.isrctn.com:ISRCTN80619088. Registered on 31 October 2017.
Published: 2021

4. Workflow Intervals of Endovascular Acute Stroke Therapy During On- Versus Off-Hours The MR CLEAN Registry

Author: Hinsenveld, W.H., Ridder, I.R. de, Oostenbrugge, R.J. van, Vos, J.A., Groot, A.E., Coutinho, J.M., Nijeholt, G.J.L.A., Boiten, J., Schonewille, W.J., Dippel, D.W.J., Lugt, A. van der, Majoie, C.B.L.M., Roos, Y.B.W.E.M., Zwam, W.H. van, Jansen, I.G.H., Mulder, M.J.H.L., Goldhoorn, R.J.B., Compagne, K.C.J., Kappelhof, M., Wermer, M.J.H., Walderveen, M.A.A. van, Staals, J., Hofmeijer, J., Martens, J.M., Roozenbeek, B., Emmer, B.J., Bruijn, S.F. de, Dijk, L.C. van, Worp, H.B. van der, R.H. lo, Dijk, E.J. van, Boogaarts, H.D., Kort, P.L.M. de, Peluso, J.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., Boersc, A.M.M., Huguet, J., Groot, P.F.C., Mens, M.A., Kranendonk, K.R. van, Treurniet, K.M., Tolhuijsen, M.L., Alves, H., MR CLEAN Registry Investigators, RS: Carim - B05 Cerebral small vessel disease, RS: CARIM - R3.03 - Cerebral small vessel disease, MUMC+: MA Niet Med Staf Neurologie (9), Promovendi CD, MUMC+: MA Med Staf Spec Neurologie (9), MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, RS: Carim - B06 Imaging, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: CARIM - R3.11 - Imaging, MUMC+: MA AIOS Neurologie (9), MUMC+: DA BV AIOS Nucleaire Geneeskunde (9), MUMC+: DA BV AIOS Radiologie (9), Psychiatrie & Neuropsychologie, Radiology and nuclear medicine, VU University medical center, Pediatric surgery, ACS - Atherosclerosis & ischemic syndromes, Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Graduate School, Neurology, ANS - Neurovascular Disorders, Radiology and Nuclear Medicine, ACS - Microcirculation, ACS - Pulmonary hypertension & thrombosis, AGEM - Digestive immunity, AGEM - Re-generation and cancer of the digestive system, ARD - Amsterdam Reproduction and Development, Radiology & Nuclear Medicine, and Public Health
Subjects: Male, medicine.medical_specialty, Time Factors, workflow, medicine.medical_treatment, DOOR, endovascular procedures, DELAYS, Time-to-Treatment, All institutes and research themes of the Radboud University Medical Center, Modified Rankin Scale, medicine, Clinical endpoint, Humans, QUALITY, Registries, Lead (electronics), Stroke, Aged, Retrospective Studies, Aged, 80 and over, Advanced and Specialized Nursing, OUTCOMES, Groin, business.industry, delivery of health care, holidays, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Odds ratio, Middle Aged, THROMBECTOMY, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], medicine.disease, ADMISSION, stroke, Surgery, TIME, Observational Studies as Topic, medicine.anatomical_structure, ISCHEMIC-STROKE, Intravenous therapy, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, Complication, business
Abstract: Background and Purpose— Endovascular treatment (EVT) of patients with acute ischemic stroke because of large vessel occlusion involves complicated logistics, which may cause a delay in treatment initiation during off-hours. This might lead to a worse functional outcome. We compared workflow intervals between endovascular treatment–treated patients presenting during off- and on-hours. Methods— We retrospectively analyzed data from the MR CLEAN Registry, a prospective, multicenter, observational study in the Netherlands and included patients with an anterior circulation large vessel occlusion who presented between March 2014 and June 2016. Off-hours were defined as presentation on Monday to Friday between 17:00 and 08:00 hours, weekends (Friday 17:00 to Monday 8:00) and national holidays. Primary end point was first door to groin time. Secondary end points were functional outcome at 90 days (modified Rankin Scale) and workflow time intervals. We stratified for transfer status, adjusted for prognostic factors, and used linear and ordinal regression models. Results— We included 1488 patients of which 936 (62.9%) presented during off-hours. Median first door to groin time was 140 minutes (95% CI, 110–182) during off-hours and 121 minutes (95% CI, 85–157) during on-hours. Adjusted first door to groin time was 14.6 minutes (95% CI, 9.3–20.0) longer during off-hours. Door to needle times for intravenous therapy were slightly longer (3.5 minutes, 95% CI, 0.7–6.3) during off-hours. Groin puncture to reperfusion times did not differ between groups. For transferred patients, the delay within the intervention center was 5.0 minutes (95% CI, 0.5–9.6) longer. There was no significant difference in functional outcome between patients presenting during off- and on-hours (adjusted odds ratio, 0.92; 95% CI, 0.74–1.14). Reperfusion rates and complication rates were similar. Conclusions— Presentation during off-hours is associated with a slight delay in start of endovascular treatment in patients with acute ischemic stroke. This treatment delay did not translate into worse functional outcome or increased complication rates.
Published: 2019
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5. Impact of single phase CT angiography collateral status on functional outcome over time: results from the MR CLEAN Registry

Author: Jansen, I.G.H., Mulder, M.J.H.L., Goldhoorn, R.J.B., Boers, A.M.M., Es, A.C.G.M. van, Yo, L.S.F., Hofmeijer, J., Martens, J.M., Walderveen, M.A.A. van, Kallen, B.F.W. van der, Jenniskens, S.F.M., Treurniet, K.M., Marqueriny, H.A., Sprengers, M.E.S., Schonewille, W.J., Bot, J.C.J., Nijeholt, G.J.L.A., Lingsma, H.F., Liebeskind, D.S., Boiten, J., Vos, J.A., Roos, Y.B.W.E.M., Oostenbrugge, R.J. van, Lugt, A. van der, Zwam, W.H. van, Dippel, D.W.J., Wijngaard, I.R. van den, Majoie, C.B.L.M., Coutinho, J.M., Wermern, M.J.H., Staals, J., Roozenbeek, B., Emmer, B.J., Bruijn, S.F. de, Dijk, L.C. van, Worp, H.B. van der, R.H. lo, Dijk, E.J. van, Boogaarts, H.D., Kort, P.L.M. de, Peluso, J.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., Hertog, H.M. den, Sturm, E.J.C., Berg, R. van den, Yoo, A.J., Beenen, L.F.M., Roosendaal, S.D., Es, A. van, Emmer, B., Bot, J., Doormaal, P.J. van, Flach, H.Z., 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., Zweedijk, B., Khalilzada, M., Venema, E., Chalos, V., Compagne, K.J., Geuskens, R.R., Straaten, T. van, Ergezen, S., Harmsma, R.R.M., Muijres, D., Jong, A. de, Hinseveld, W., Berkhemer, O.A., Huguet, J., Groot, P.F.C., Mens, M.A., Kranendonk, K.R. van, Kappelhof, M., Tolhuijsen, M.L., Alves, H., MR CLEAN Registry Investigators, Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Clinical Neurophysiology, Neurology, Radiology & Nuclear Medicine, Public Health, MUMC+: MA AIOS Neurologie (9), Klinische Neurowetenschappen, RS: Carim - B05 Cerebral small vessel disease, RS: CARIM - R3.03 - Cerebral small vessel disease, Promovendi CD, MUMC+: MA Neurologie (3), RS: Carim - B06 Imaging, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: CARIM - R3.11 - Imaging, MUMC+: MA Med Staf Spec Neurologie (9), Radiology and nuclear medicine, Amsterdam Neuroscience - Neurovascular Disorders, ACS - Atherosclerosis & ischemic syndromes, ANS - Neurovascular Disorders, ACS - Microcirculation, Graduate School, and Radiology and Nuclear Medicine
Subjects: Male, PREDICTOR, Computed Tomography Angiography, THERAPY, 030218 nuclear medicine & medical imaging, law.invention, Brain Ischemia, 0302 clinical medicine, Randomized controlled trial, Modified Rankin Scale, Time windows, law, ct angiography, REPERFUSION, Prospective Studies, Registries, Single phase, Stroke, intervention, Netherlands, Aged, 80 and over, medicine.diagnostic_test, Endovascular Procedures, General Medicine, Middle Aged, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], Treatment Outcome, Cardiology, Female, LEPTOMENINGEAL COLLATERALS, STROKE, Adult, medicine.medical_specialty, Adolescent, Time to treatment, Collateral Circulation, 03 medical and health sciences, Young Adult, Internal medicine, SCORE, medicine, MANAGEMENT, Humans, Endovascular treatment, Aged, business.industry, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Recovery of Function, medicine.disease, n/a OA procedure, ENDOVASCULAR TREATMENT, Angiography, Surgery, Neurology (clinical), business, COMPUTED TOMOGRAPHIC ANGIOGRAPHY, 030217 neurology & neurosurgery
Abstract: BackgroundCollateral status modified the effect of endovascular treatment (EVT) for stroke in several randomized trials. We assessed the association between collaterals and functional outcome in EVT treated patients and investigated if this association is time dependent.MethodsWe included consecutive patients from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands (MR CLEAN) Registry (March 2014–June 2016) with an anterior circulation large vessel occlusion undergoing EVT. Functional outcome was measured on the modified Rankin Scale (mRS) at 90 days. We investigated the association between collaterals and mRS in the MR CLEAN Registry with ordinal logistic regression and if this association was time dependent with an interaction term. Additionally, we determined modification of EVT effect by collaterals compared with MR CLEAN controls, and also investigated if this was time dependent with multiplicative interaction terms.Results1412 patients were analyzed. Functional independence (mRS score of 0–2) was achieved in 13% of patients with grade 0 collaterals, in 27% with grade 1, in 46% with grade 2, and in 53% with grade 3. Collaterals were significantly associated with mRS (adjusted common OR 1.5 (95% CI 1.4 to 1.7)) and significantly modified EVT benefit (P=0.04). None of the effects were time dependent. Better collaterals corresponded to lower mortality (PConclusionIn routine clinical practice, better collateral status is associated with better functional outcome and greater treatment benefit in EVT treated acute ischemic stroke patients, independent of time to treatment. Within the 6 hour time window, a substantial proportion of patients with absent and poor collaterals can still achieve functional independence.
Published: 2019
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6. Endovascular Treatment With or Without Prior Intravenous Alteplase for Acute Ischemic Stroke

Author: Chalos, V., LeCouffe, N.E., Uyttenboogaart, M., Lingsma, H.F., Mulder, M.J.H.L., Venema, E., Treurniet, K.M., Eshghi, O., Worp, H.B. van der, Lugt, A. van der, Roos, Y.B.W.E.M., Majoie, C.B.L.M., Dippel, D.W.J., Roozenbeek, B., Coutinho, J.M., Oostenbrugge, R.J. van, Zwam, W.H. van, Boiten, J., Vos, J.A., Jansen, I.G.H., Goldhoorn, R.J.B., Schonewille, W.J., Wermer, M.J.H., Walderveen, M.A.A. van, Staals, J., Hofmeijer, J., Martens, J.M., Nijeholt, G.J.L.A., Emmer, B.J., 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.J.P., Berg, J.S.P. van den, Hasselt, B.A.A.M. van, Aerden, L.A.M., Dallinga, R.J., 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., Roosendaal, S.D., Kallen, B.F.W. van der, Wijngaard, I.R. van den, Es, A.C.G.M. van, Bot, J.C.J., Doormaal, P.J. van, Flach, H.Z., 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., Zweedijk, B., Khalilzada, M., Compagne, K.C.J., Geuskens, R.R., Straaten, T. van, Ergezen, S., Harmsma, R.R.M., Jong, A. de, Hinsenveld, W., Berkhemer, O.A., Boers, A.M.M., Groot, P.F.C., Mens, M.A., Kranendonk, K.R. van, Kappelhof, M., Tolhuijsen, M.L., Alves, H., MR CLEAN Registry Investigators, Neurology, Public Health, Radiology & Nuclear Medicine, Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Radiology and nuclear medicine, ACS - Atherosclerosis & ischemic syndromes, Graduate School, ACS - Microcirculation, ANS - Neurovascular Disorders, Radiology and Nuclear Medicine, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, 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 Niet Med Staf Neurologie (9), Promovendi CD, MUMC+: MA Med Staf Spec Neurologie (9), and Clinical Neurophysiology
Subjects: Male, endovascular treatment, Time Factors, medicine.medical_treatment, RECANALIZATION, ANTERIOR CIRCULATION STROKE, THERAPY, law.invention, Brain Ischemia, Workflow, Disability Evaluation, Randomized controlled trial, Modified Rankin Scale, law, Risk Factors, REPERFUSION, Thrombolytic Therapy, Prospective Studies, Registries, Stroke, DIRECT MECHANICAL THROMBECTOMY, Netherlands, Original Research, Aged, 80 and over, OUTCOMES, Confounding, Endovascular Procedures, Atrial fibrillation, Thrombolysis, Middle Aged, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], Combined Modality Therapy, stroke, Treatment Outcome, thrombectomy, Tissue Plasminogen Activator, Cardiology, Female, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, thrombolysis, Cerebrovascular Procedures, All institutes and research themes of the Radboud University Medical Center, Fibrinolytic Agents, Internal medicine, large vessel occlusion, medicine, Humans, Aged, Ischemic Stroke, business.industry, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Odds ratio, Recovery of Function, medicine.disease, Cerebrovascular Disease/Stroke, Observational study, business
Abstract: Background It is unclear whether intravenous thrombolysis ( IVT ) with alteplase before endovascular treatment ( EVT ) is beneficial for patients with acute ischemic stroke caused by a large vessel occlusion. We compared clinical and procedural outcomes, safety, and workflow between patients treated with both IVT and EVT and those treated with EVT alone in routine clinical practice. Methods and Results Using multivariable regression, we evaluated the association of IVT + EVT with 90‐day functional outcome (modified Rankin Scale), mortality, reperfusion, first‐pass effect, and symptomatic intracranial hemorrhage in the MR CLEAN (Multicenter Randomised Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands) Registry. Of 1485 patients, 1161 (78%) were treated with IVT + EVT , and 324 (22%) with EVT alone. Patients treated with IVT + EVT had atrial fibrillation less often (16% versus 44%) and had better pre‐stroke modified Rankin Scale scores (pre‐stroke modified Rankin Scale 0: 73% versus 52%) than those treated with EVT alone. Procedure time was shorter in the IVT + EVT group (median 62 versus 68 minutes). Nontransferred IVT + EVT patients had longer door‐to‐groin‐puncture times (median 105 versus 94 minutes). IVT + EVT was associated with better functional outcome (adjusted common odds ratio 1.47; 95% CI : 1.10–1.96) and lower mortality (adjusted odds ratio 0.58; 95% CI : 0.40–0.82). Successful reperfusion, first‐pass effect, and symptomatic intracranial hemorrhage did not differ between groups. Conclusions In this observational study, patients treated with IVT + EVT had better clinical outcomes than patients who received EVT alone. This finding may demonstrate a true benefit of IVT before EVT , but its interpretation is hampered by the possibility of residual confounding and selection bias. Randomized trials are required to properly assess the effect of IVT before EVT .
Published: 2019
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7. Circle of Willis variations in migraine patients with ischemic stroke

Author: Hamming, A.M., Walderveen, M.A.A. van, Mulder, I.A., Schaaf, I.C. van der, Kappelle, L.J., Velthuis, B.K., Ferrari, M.D., Terwindt, G.M., Visser, M.C., Schonewille, W., Algra, A., Wermer, M.J.H., Majoie, C.B., Roos, Y.B., Duijm, L.E., Keizer, K., Lugt, A. van der, Dippel, D.W., Droogh-de Greeve, K.E., Bienfait, H.P., Nijeholt, G.J.L.A., Boiten, J., Duyndam, D., Kwa, V.I., Meijer, F.J., Dijk, E.J. van, Kesselring, F.O., Hofmeijer, J., Vos, J.A., Rooij, W.J. van, Kort, P.L. de, Pleiter, C.C., Bakker, S.L., Bot, J., Dankbaar, J.W., Mali, W.P., Seeters, T. van, Horsch, A.D., Niesten, J.M., Biessels, G.J., Luitse, M.J., Graaf, Y. van der, Dutch Acute Stroke Study, Amsterdam Neuroscience - Neurovascular Disorders, and Neurology
Subjects: Male, Computed Tomography Angiography, Brain Ischemia, Behavioral Neuroscience, 0302 clinical medicine, Risk Factors, Prevalence, Medicine, migraine, Prospective Studies, Non-U.S. Gov't, Circle of Willis/diagnostic imaging, circle of Willis, humans, Stroke, Original Research, Computed Tomography Angiography/methods, neuroimaging, Research Support, Non-U.S. Gov't, 05 social sciences, Brain, Middle Aged, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], Brain Ischemia/diagnosis, Female, Rare cancers Radboud Institute for Health Sciences [Radboudumc 9], Adult, medicine.medical_specialty, Migraine Disorders, Research Support, Brain/blood supply, 050105 experimental psychology, 03 medical and health sciences, All institutes and research themes of the Radboud University Medical Center, medicine.artery, Internal medicine, Journal Article, Anterior cerebral artery, Humans, 0501 psychology and cognitive sciences, Migraine Disorders/complications, Posterior communicating artery, Risk factor, Aged, Analysis of Variance, business.industry, computed tomography, Odds ratio, medicine.disease, Migraine, International Classification of Headache Disorders, strokes, business, 030217 neurology & neurosurgery, Stroke/complications, Circle of Willis
Abstract: Objectives: Migraine is a risk factor for stroke, which might be explained by a higher prevalence in anatomical variants in the circle of Willis (CoW). Here, we compared the presence of CoW variants in patients with stroke with and without migraine. Materials and Methods: Participants were recruited from the prospective Dutch acute Stroke Study. All participants underwent CT angiography on admission. Lifetime migraine history was assessed with a screening questionnaire and confirmed by an interview based on International Classification of Headache Disorders criteria. The CoW was assessed for incompleteness/hypoplasia (any segment 1/3), and for posterior communicating artery (Pcom) dominance (Pcom–P1 difference > 1/3). Odds ratios with adjustments for age and sex (aOR) were calculated with logistic regression. Results: We included 646 participants with stroke, of whom 52 had a history of migraine. Of these, 45 (87%) had an incomplete or hypoplastic CoW versus 506 (85%) of the 594 participants without migraine (aOR: 1.47; 95% CI: 0.63–3.44). There were no differences between participants with and without migraine in variations of the anterior or posterior CoW, anterior cerebral artery asymmetry (aOR: 0.86; 95% CI: 0.43–1.74), or Pcom dominance (aOR: 0.64; 95% CI: 0.32–1.30). There were no differences in CoW variations between migraine patients with or without aura. Conclusion: We found no significant difference in the completeness of the CoW in acute stroke patients with migraine compared to those without.
Published: 2019
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8. Safety and Outcome of Endovascular Treatment for Minor Ischemic Stroke: Results From the Multicenter Clinical Registry of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands

Author: Goldhoorn, R.B., Mulder, M.J.H.L., Jansen, I.G.H., Zwam, W.H. van, Staals, J., Lugt, A. van der, Dippel, D.W.J., Lingsma, H.F., Vos, J.A., Boiten, J., Wijngaard, I.R. van den, Majoie, C.B.L.M., Roos, Y.B.W.E.M., Oostenbrugge, R.J. van, Goldhoorn, R.J.B., Schonewille, W.J., Coutinho, J.M., Wermer, M.J.H., Walderveen, M.A.A. van, Hofmeijer, J., Martens, J.M., Nijeholt, G.J.L.A., Roozenbeek, B., Emmer, B.J., Bruijn, S.F. de, Dijk, L.C. van, Worp, H.B. van der, R.H. lo, Dijk, E.J. van, Boogaarts, H.D., Kort, P.L.M. de, Peluso, J.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., Roosendaal, S.D., Kallen, B.F.W. van der, Es, A. van, Emmer, B., Bot, J., Doormaal, P.J. van, Postma, A., Flach, H.Z., 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., Zweedijk, B., Khalilzada, M., Venema, E., Chalos, V., Compagne, K.J., 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, Treurniet, K.M., Kappelhof, M., Tolhuijsen, M.L., Alves, H., MR CLEAN Registry Investigators, Neurology, Radiology & Nuclear Medicine, Public Health, Klinische Neurowetenschappen, RS: Carim - B05 Cerebral small vessel disease, RS: CARIM - R3.03 - Cerebral small vessel disease, MUMC+: MA Niet Med Staf Neurologie (9), Promovendi CD, RS: Carim - B06 Imaging, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: CARIM - R3.11 - Imaging, MUMC+: MA Med Staf Spec Neurologie (9), MUMC+: MA Neurologie (3), MUMC+: DA BV AIOS Nucleaire Geneeskunde (9), RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, MUMC+: DA BV AIOS Radiologie (9), Amsterdam Neuroscience - Neurovascular Disorders, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, Radiology and Nuclear Medicine, Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), and Radiology and nuclear medicine
Subjects: Male, endovascular treatment, Time Factors, Severity of Illness Index, THERAPY, ANGIOGRAPHY, law.invention, Brain Ischemia, Disability Evaluation, 0302 clinical medicine, Randomized controlled trial, Modified Rankin Scale, law, Risk Factors, Occlusion, Prospective Studies, Registries, Stroke, Netherlands, Ischemic stroke, medicine.diagnostic_test, LARGE VESSEL OCCLUSION, Rehabilitation, Endovascular Procedures, minor symptoms, Middle Aged, THROMBECTOMY, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], Treatment Outcome, Cerebrovascular Circulation, Cardiology, ANTERIOR CIRCULATION, Female, TRIAL, SCALE SCORE, Cardiology and Cardiovascular Medicine, Intracranial Hemorrhages, medicine.medical_specialty, Clinical Decision-Making, 03 medical and health sciences, large vessel oclusion, All institutes and research themes of the Radboud University Medical Center, Internal medicine, medicine, Humans, Artery occlusion, cardiovascular diseases, Aged, business.industry, Patient Selection, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Recovery of Function, MILD, medicine.disease, Arterial occlusion, Angiography, Surgery, Observational study, Neurology (clinical), business, 030217 neurology & neurosurgery, INTRAARTERIAL TREATMENT
Abstract: Goal: Insufficient data is available about safety and efficacy of endovascular treatment (EVT) in patients with minor stroke symptoms because these patients were excluded from most randomized trials. We aimed to compare characteristics, functional outcome, and complications in patients with minor ischemic stroke National Institutes of Health Stroke Scale score ≤5 (NIHSS score ≤5) and moderate to severe ischemic stroke (NIHSS score ≥6) due to intracranial proximal artery occlusion of the anterior circulation who underwent EVT. Materials and Methods: We report patients with an anterior circulation occlusion who were included between March 2014 and June 2016 in the multicenter randomized clinical trial of EVT of acute ischemic stroke in the Netherlands Registry, a prospective, multicenter, observational study for stroke centers that perform EVT in the Netherlands. Minor ischemic stroke was defined as baseline NIHSS score of 5 or less. Primary outcome is the modified Rankin Scale (mRS) score at 90 days. Secondary outcomes include symptomatic intracranial hemorrhage (sICH) and mortality. Findings: Seventy-one (5.5%) patients had a NIHSS score of 5 or less. Functional independence (mRS 0-2 at 90 days) was reached in 75% of these patients, compared to 40% of patients with NIHSS score of 6 or more. sICH occurred in 4% of patients, of which 1% occurred peri-interventionally. Death occurred in 6% of patients. Conclusions: Patients with minor ischemic stroke with an intracranial proximal arterial occlusion of the anterior circulation who underwent EVT have a high chance of favorable outcome and appear to have low occurrence of treatment-related sICH. Therefore, our results encourage the use of EVT for minor ischemic stroke in the absence of effect estimates from controlled studies.
Published: 2019
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9. Intracranial Cerebrospinal Fluid Volume as a Predictor of Malignant Middle Cerebral Artery Infarction

Author: Kauw, Frans, Bennink, Edwin, de Jong, Hugo W. A. M., Kappelle, L. Jaap, Horsch, Alexander D., Velthuis, Birgitta K., Dankbaar, Jan W., Majoie, C. B., Roos, Y. B., Duijm, L. E., Keizer, K., van der Lugt, A., Dippel, D. W., Droogh-de Greve, K. E., Bienfait, H. P., van Walderveen, M. A., Wermer, M. J., Nijeholt, Lycklama A. G. J., Boiten, J., Duyndam, D., Kwa, V., I, Meijer, F. J., van Dijk, E. J., Kesselring, F. O., Hofmeijer, J., Vos, J. A., Schonewille, W. J., van Rooij, W. J., de Kort, P. L., Pleiter, C. C., Bakker, S. L., Bot, J., Visser, M. C., Velthuis, B. K., van der Schaaf, I. C., Dankbaar, J. W., Mali, W. P., van Seeters, T., Horsch, A. D., Niesten, J. M., Biessels, G. J., Kappelle, L. J., Luitse, M. J., van der Graaf, Y., Radiology & Nuclear Medicine, Neurology, Physics and medical technology, Radiology and nuclear medicine, VU University medical center, Dermatology, Surgery, Public and occupational health, Human genetics, Radiation Oncology, Amsterdam Neuroscience - Neurovascular Disorders, and ACS - Atherosclerosis & ischemic syndromes
Subjects: medicine.medical_specialty, Original Contributions, infarction, Clinical Sciences, Clinical Neurology, Infarction, Perfusion scanning, All institutes and research themes of the Radboud University Medical Center, Midline shift, Internal medicine, medicine.artery, Journal Article, Medicine, odds ratio, cardiovascular diseases, Advanced and Specialised Nursing, humans, Stroke, Advanced and Specialized Nursing, brain edema, middle cerebral artery, infarction, middle cerebral artery, Receiver operating characteristic, medicine.diagnostic_test, business.industry, Odds ratio, medicine.disease, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], Angiography, Middle cerebral artery, Cardiology, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, Neurology (clinical), prognosis, business, Cardiology and Cardiovascular Medicine, Rare cancers Radboud Institute for Health Sciences [Radboudumc 9]
Abstract: Supplemental Digital Content is available in the text., Background and Purpose— Predicting malignant middle cerebral artery (MCA) infarction can help to identify patients who may benefit from preventive decompressive surgery. We aimed to investigate the association between the ratio of intracranial cerebrospinal fluid (CSF) volume to intracranial volume (ICV) and malignant MCA infarction. Methods— Patients with an occlusion proximal to the M3 segment of the MCA were selected from the DUST (Dutch Acute Stroke Study). Admission imaging included noncontrast computed tomography (CT), CT perfusion, and CT angiography. Patient characteristics and CT findings were collected. The ratio of intracranial CSF volume to ICV (CSF/ICV) was quantified on admission thin-slice noncontrast CT. Malignant MCA infarction was defined as a midline shift of >5 mm on follow-up noncontrast CT, which was performed 3 days after the stroke or in case of clinical deterioration. To test the association between CSF/ICV and malignant MCA infarction, odds ratios and 95% CIs were calculated for 3 multivariable models by using binary logistic regression. Model performances were compared by using the likelihood ratio test. Results— Of the 286 included patients, 35 (12%) developed malignant MCA infarction. CSF/ICV was independently associated with malignant MCA infarction in 3 multivariable models: (1) with age and admission National Institutes of Health Stroke Scale (odds ratio, 3.3; 95% CI, 1.1–11.1), (2) with admission National Institutes of Health Stroke Scale and poor collateral score (odds ratio, 7.0; 95% CI, 2.6–21.3), and (3) with terminal internal carotid artery or proximal M1 occlusion and poor collateral score (odds ratio, 7.7; 95% CI, 2.8–23.9). The performance of model 1 (areas under the receiver operating characteristic curves, 0.795 versus 0.824; P=0.033), model 2 (areas under the receiver operating characteristic curves, 0.813 versus 0.850; P
Published: 2019
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10. Determinants of extended door-to-needle time in acute ischemic stroke and its influence on in-hospital mortality: Results of a nationwide Dutch clinical audit

Author: Kuhrij, Laurien S., Marang-van de Mheen, Perla J., van den Berg-Vos, Renske M., de Leeuw, Frank-Erik, Nederkoorn, Paul J., Lingsma, H. F., de Borst, G. J., van Norden, A. G. W., Eysink Smeets, M. M., Aerden, L. A. M., Alblas, C. L., de Beer, F., Bienfait, H. P., Boon, A. E., Bor, S., Boreas, A. M. H. P., Bronner, I., Brouns, R., Brouwers, P. J. A. M., Brugman, F., Dane, M. L., Fransen, P. S. S., van Gemert, H. M. A., van Golde, A. E. L., de Graaf, M. T., Hani, L., van der Heijden, A. M. H. G., Hilkens, P. H., ten Holter, J. B. M., de Jong, S. W., Kapelle, L. J., Keizer, K., Keunen, R., Kloppenborg, R. P., Kok, A. J. M., Koops, L., Kruyt, N. D., de Leeuw, F. E., Lövenich, H., Luijckx, G. J., Maasland, E., Miedema, I., Nederkoorn, P. J., Persoon, S., Peters, E. W., van der Ree, T. C., Rozeman, A. D., Saxena, R., van Schaik, S., de Schryver, E. L. L. M., Schuiling, W. J., Schut, E. S., Staals, J. E. A., Stalpers, X., Tjeerdsma, H., van Tuijl, J. H., Vermeer, S. E., Visser, M. C., van den Wijngaard, I., van Zagten, M. S. G., Zylicz, S. A., Graduate School, ACS - Atherosclerosis & ischemic syndromes, Amsterdam Neuroscience - Neurovascular Disorders, Neurology, RS: Carim - B05 Cerebral small vessel disease, Klinische Neurowetenschappen, MUMC+: MA Med Staf Spec Neurologie (9), and RS: CARIM - R3.03 - Cerebral small vessel disease
Subjects: Clinical audit, Male, medicine.medical_specialty, Percentile, Neurology, medicine.medical_treatment, 030204 cardiovascular system & hematology, Logistic regression, lcsh:RC346-429, Time-to-Treatment, 03 medical and health sciences, 0302 clinical medicine, All institutes and research themes of the Radboud University Medical Center, Internal medicine, medicine, Humans, Neurochemistry, Thrombolytic Therapy, Quality improvement, Stroke, lcsh:Neurology. Diseases of the nervous system, Aged, Netherlands, Aged, 80 and over, business.industry, General Medicine, Thrombolysis, Middle Aged, medicine.disease, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], 3. Good health, Female, Neurology (clinical), Neurosurgery, INTRAVENOUS THROMBOLYSIS, business, 030217 neurology & neurosurgery, Research Article
Abstract: Background Intravenous thrombolysis (IVT) plays a prominent role in the treatment of acute ischemic stroke (AIS). The sooner IVT is administered, the higher the odds of a good outcome. Therefore, registering the in-hospital time to treatment with IVT, i.e. the door-to-needle time (DNT), is a powerful way to measure quality improvement. The aim of this study was to identify determinants that are associated with extended DNT. Methods Patients receiving IVT in 2015 and 2016 registered in the Dutch Acute Stroke Audit were included. DNT and onset-to-door time (ODT) were dichotomized using the median (i.e. extended DNT) and the 90th percentile (i.e. severely extended DNT). Logistic regression was performed to identify determinants associated with (severely) extended DNT/ODT and its effect on in-hospital mortality. A linear model with natural spline was used to investigate the association between ODT and DNT. Results Included were 9518 IVT treated patients from 75 hospitals. Median DNT was 26 min (IQR 20–37). Determinants associated with a higher likelihood of extended DNT were female sex (OR 1.17, 95% CI 1.05–1.31) and admission during off-hours (OR 1.12, 95% CI 1.01–1.25). Short ODT correlated with longer DNT, whereas longer ODT correlated with shorter DNT. Young age (OR 1.38, 95% CI 1.07–1.76) and admission to a comprehensive stroke center (OR 1.26, 1.10–1.45) were associated with severely extended DNT, which was associated with in-hospital mortality (OR 1.54, 95%CI 1.19–1.98). Conclusions Even though DNT in the Netherlands is short compared to other countries, lowering the DNT may be achievable by focusing on specific subgroups.
Published: 2019

11. Acute endovascular treatment of patients with ischemic stroke from intracranial large vessel occlusion and extracranial carotid dissection

Author: Compagne, K.C.J., Goldhoorn, R.B., Uyttenboogaart, M., Oostenbrugge, R.J. van, Zwam, W.H. van, Doormaal, P.J. van, Dippel, D.W.J., Lugt, A. van der, Emmer, B.J., Es, A.C.G.M. van, Majoie, C.B.L.M., Roos, Y.B.W.E.M., Boiten, J., Vos, J.A., Jansen, I.G.H., Mulder, M.J.H.L., Kappelhof, M., Schonewille, W.J., Coutinho, J.M., Wermer, M.J.H., Walderveen, M.A.A. van, Staals, J., Hofmeijer, J., Martens, J.M., Nijeholt, G.J.L., Roozenbeek, B., Bruijn, S.F. de, Dijk, L.C. van, Worp, H.B. van der, R.H. lo, Dijk, E.J. van, Boogaarts, H.D., Kort, P.L.M. de, Peluso, J.J.P., Berg, J.S.P. van den, Hasselt, B.A.A.M. van, Aerden, L.A.M., Dallinga, R.J., 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, Bot, J., Boiten, G.J., 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, Hinseveld, W., Berkhemer, O.A., Boers, A.M.M., Huguet, J., Groot, P.F.C., Mens, M.A., Kranendonk, K.R. van, Treurniet, K.M., Tolhuijsen, M.L., Alves, H., MR CLEAN Investigators, Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Radiology and Nuclear Medicine, ANS - Neurovascular Disorders, Radiology and nuclear medicine, VU University medical center, Pediatric surgery, ACS - Atherosclerosis & ischemic syndromes, Klinische Neurowetenschappen, RS: Carim - B05 Cerebral small vessel disease, RS: CARIM - R3.03 - Cerebral small vessel disease, MUMC+: MA Niet Med Staf Neurologie (9), Promovendi CD, MUMC+: MA Neurologie (3), RS: Carim - B06 Imaging, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: CARIM - R3.11 - Imaging, MUMC+: MA Med Staf Spec Neurologie (9), MUMC+: DA BV AIOS Nucleaire Geneeskunde (9), RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, MUMC+: DA BV AIOS Radiologie (9), Radiology & Nuclear Medicine, Neurology, and Public Health
Subjects: endovascular treatment, medicine.medical_specialty, carotid dissection, CAD, 030204 cardiovascular system & hematology, lcsh:RC346-429, Carotid artery dissection, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Occlusion, SCORE, medicine, ischemic stroke, MANAGEMENT, REPERFUSION, ACUTE ISCHEMIC-STROKE, cardiovascular diseases, Endovascular treatment, Contraindication, lcsh:Neurology. Diseases of the nervous system, Original Research, tandem lesion, business.industry, MECHANICAL THROMBECTOMY, ARTERY DISSECTION, medicine.disease, Neurology, thrombectomy, Carotid artery occlusion, Cardiology, Neurology (clinical), Carotid dissection, business, 030217 neurology & neurosurgery, Large vessel occlusion, INTRAARTERIAL TREATMENT
Abstract: Introduction: Carotid artery dissection (CAD) and atherosclerotic carotid artery occlusion (ACAO) are major causes of a tandem occlusion in patients with intracranial large vessel occlusion (LVO). Presence of tandem occlusions may hamper intracranial access and potentially increases the risk of procedural complications of endovascular treatment (EVT). Our aim was to assess neurological, functional and technical outcome and complications of EVT for intracranial LVO in patients with CAD in comparison to patients with ACAO and to patients without CAD or ACAO.Methods: We analyzed data of the MR CLEAN trial intervention arm and MR CLEAN Registry, acquired in 16 Dutch EVT-centers. Primary outcome was the change in stroke severity by comparing the National Institute of Health Stroke Scale (NIHSS) score at 24-48 h after treatment vs. baseline. Secondary outcomes included reperfusion rate and symptomatic intracranial hemorrhage (sICH). We compared outcomes and complications between patients with CAD vs. patients with ACAO and patients without CAD or ACAO.Results: In total, we identified 74 (4.7%) patients with CAD, 92 (5.9%) patients with ACAO and 1398 (89.4%) patients without CAD or ACAO. Neurological improvement at short-term after EVT in patients with CAD was significantly better compared to ACAO (raw mean -5 vs. mean -1 NIHSS point; p = 0.03) and did not differ compared to patients without CAD or ACAO (-4 NIHSS points; p = 0.62). Rates of successful reperfusion in patients with CAD (47%) was comparable to patients with ACAO (47%; p = 1.00), but was less often achieved compared to patients without CAD or ACAO (58%; p = 0.08). Occurrence of sICH did not differ significantly between CAD patients (5%) and ACAO (11%; p = 0.33) or without CAD/ACAO (6%; p = 1.00).Conclusion: EVT in patients with intracranial LVO due to CAD results in neurological improvement comparable to patients without tandem occlusions. Therefore, carotid artery dissection by itself should not be a contraindication for endovascular treatment in stroke patients with intracranial large vessel occlusion. Although more challenging endovascular procedures are to be suspected in both patients with CAD or ACAO, accurate distinction between CAD and ACAO might influence clinical decision making as better clinical outcome can be expected in patients with CAD.
Published: 2019
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12. CT angiography and CT perfusion improve prediction of infarct volume in patients with anterior circulation stroke

Author: Seeters, T. van, Biessels, G.J., Kappelle, L.J., Schaaf, I.C. van der, Dankbaar, J.W., Horsch, A.D., Niesten, J.M., Luitse, M.J., Majoie, C.B., Vos, J.A., Schonewille, W.J., Walderveen, M.A. van, Wermer, M.J., Duijm, L.E.M., Keizer, K., Bot, J.C., Visser, M.C, Lugt, A. van der, Dippel, D.W., Kesselring, F.O., Hofmeijer, J., Lycklama a Nijeholt, G.J., Boiten, J., Rooij, W.J. van, Kort, P.L. de, Roos, Y.B., Meijer, F.J.A., Pleiter, C.C., Mali, W.P., Graaf, Y. van der, Velthuis, B.K., Dijk, E.J. van, Radiology and nuclear medicine, ICaR - Ischemia and repair, ANS - Neurovascular Disorders, Radiology and Nuclear Medicine, ACS - Amsterdam Cardiovascular Sciences, Neurology, Clinical Neurophysiology, Faculty of Behavioural, Management and Social Sciences, Faculty of Science and Technology, and Radiology & Nuclear Medicine
Subjects: Male, Neurology, Computed Tomography Angiography, Perfusion scanning, 030204 cardiovascular system & hematology, 0302 clinical medicine, Prospective Studies, Non-U.S. Gov't, Stroke, Netherlands, Computed tomography angiography, Neuroradiology, Aged, 80 and over, Ischemic stroke, medicine.diagnostic_test, Research Support, Non-U.S. Gov't, Middle Aged, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], Multicenter Study, CT angiography, Radiology Nuclear Medicine and imaging, Cerebrovascular Circulation, Predictive value of tests, cardiovascular system, Female, Neurosurgery, Radiology, Cardiology and Cardiovascular Medicine, Rare cancers Radboud Institute for Health Sciences [Radboudumc 9], Brain Infarction, medicine.medical_specialty, Clinical Neurology, Observational Study, Research Support, METIS-320852, IR-103002, 03 medical and health sciences, Predictive Value of Tests, medicine, Journal Article, Humans, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Diagnostic Neuroradiology, Aged, business.industry, medicine.disease, Logistic Models, Infarct volume, Angiography, CT perfusion, Neurology (clinical), business, Prediction, 030217 neurology & neurosurgery, Follow-Up Studies
Abstract: Introduction We investigated whether baseline CT angiography (CTA) and CT perfusion (CTP) in acute ischemic stroke could improve prediction of infarct presence and infarct volume on follow-up imaging. Methods We analyzed 906 patients with suspected anterior circulation stroke from the prospective multicenter Dutch acute stroke study (DUST). All patients underwent baseline non-contrast CT, CTA, and CTP and follow-up non-contrast CT/MRI after 3 days. Multivariable regression models were developed including patient characteristics and non-contrast CT, and subsequently, CTA and CTP measures were added. The increase in area under the curve (AUC) and R2 was assessed to determine the additional value of CTA and CTP. Results At follow-up, 612 patients (67.5 %) had a detectable infarct on CT/MRI; median infarct volume was 14.8 mL (interquartile range (IQR) 2.8–69.6). Regarding infarct presence, the AUC of 0.82 (95 % confidence interval (CI) 0.79–0.85) for patient characteristics and non-contrast CT was improved with addition of CTA measures (AUC 0.85 (95 % CI 0.82–0.87); p
Published: 2016
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13. Reader response: Comparative safety and efficacy of combined IVT and MT with direct MT in large vessel occlusion

Author: LeCouffe, N.E., Treurniet, K.M., Majoie, C.B.L.M., Roos, Y.B.W.E.M., Coutinho, J.M., Emmer, B.J., Dippel, D.W.J., Es, A.C.G.M. van, Boiten, J., Nijeholt, G.J.L.A., Keizer, K., Yo, L.S.F., Zwam, W.H. van, Lugt, A. van der, Roozenbeek, B., Worp, H.B. van der, R.H. lo, Wijngaard, I.R. van den, Ridder, I. de, Costala, V., Lemmens, R., Hofmeijer, J., Martens, J.M., Schonewille, W.J., Vos, J.A., Uyttenboogaart, M., Bokkers, R.P.H., Peluso, J.J.P., Tuijl, J.H. van, Schreuder, F.H.B.M., Boogaarts, H.D., Dijk, L.C. van, Laat, K.F. de, Fransen, P.S.S., Hasselt, B.A.A.M. van, Brouwers, P.J., Sturm, E.J.C., Remmers, M.J.M., Jong, T.E.A.M. de, Rozeman, A.D., Elgersma, O.E.H., Wermer, M.J.H., Walderveen, M.A.A. van, MR CLEAN-NO IV Investigators, Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Radiology and nuclear medicine, Amsterdam Neuroscience - Neurovascular Disorders, and ACS - Atherosclerosis & ischemic syndromes
Subjects: medicine.medical_specialty, medicine.medical_treatment, Clinical Neurology, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Mechanical Thrombolysis, law, Internal medicine, Medicine, 030212 general & internal medicine, Science & Technology, business.industry, Confounding, Thrombolysis, Blood pressure, Hemostasis, Propensity score matching, Cardiology, Observational study, Neurosciences & Neurology, Neurology (clinical), business, Life Sciences & Biomedicine, 030217 neurology & neurosurgery
Abstract: In their article, Goyal et al.1 questioned the added benefit of IV thrombolysis (IVT) prior to mechanical thrombectomy (MT) in patients with ischemic stroke and a large vessel occlusion. As we await the results of ongoing randomized trials (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands [MR CLEAN–NO IV], [ISRCTN80619088][1]; Bridging Thrombolysis Versus Direct Mechanical Thrombectomy in Acute Ischemic Stroke [SWIFT DIRECT], [NCT03192332][2]; Direct Intra-arterial Thrombectomy in Order to Revascularize AIS Patients With Large Vessel Occlusion Efficiently in Chinese Tertiary Hospitals [DIRECT-MT], [NCT03469206][3]), we must rely on observational data with adequate adjustment for potential confounding variables to estimate the value of IVT in MT-eligible patients.2 Goyal et al.1 rightfully stated that no statistical method can completely adjust for allocation bias. However, current American Heart Association guidelines state that a blood pressure above 185/110 mm Hg and impaired hemostasis (direct oral anticoagulant use or international normalized ratio >1.7) are contraindications for IVT.3 These variables have also been associated with worse outcomes4 and, therefore, are true confounders. Much to our surprise, data on baseline blood pressure and hemostasis were not reported in by Goyal et al.,1 and it does not appear that these variables were used in the propensity score matching. We invite the authors to comment on why information on baseline blood pressure and hemostasis was not reported and how this may have affected their results. [1]: /external-ref?link_type=ISRCTN&access_num=ISRCTN80619088 [2]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03192332&atom=%2Fneurology%2F91%2F24%2F1115.atom [3]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03469206&atom=%2Fneurology%2F91%2F24%2F1115.atom
Published: 2018
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14. Intracranial Carotid Artery Calcification and Effect of Endovascular Stroke Treatment MR CLEAN Subgroup Analysis

Author: Compagne, K.C.J., Clephas, P.R.D., Majoie, C.B.L.M., Roos, Y.B.W.E.M., Berkhemer, O.A., Oostenbrugge, R.J. van, Zwam, W.H. van, Es, A.C.G.M. van, Dippel, D.W.J., Lugt, A. van der, Bos, D., Fransen, P.S.S., Beumer, D., Berg, L.A. van den, Schonewille, W.J., Vos, J.A., Nederkoorn, P.J., Wermer, M.J.H., Walderveen, M.A.A. van, Staals, J., Hofmeijer, E., Oostayen, J.A. van, Nijeholt, G.J.L.A., Boiten, J., Brouwer, P.A., Emmer, 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, Berg, J.S.P. van den, Rooij, W.J.J. van, Hasselt, 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., Marquering, H.A., Beenen, L.F., Sprengers, M.E.S., Jenniskens, S.F.M., Berg, R. van den, Yoo, A.J., Koudstaal, P.J., Flach, H.Z., Steyerberg, E.W., Lingsma, H.F., MR CLEAN Investigators, Radiology and nuclear medicine, VU University medical center, Neurology, Amsterdam Neuroscience - Neurovascular Disorders, ACS - Atherosclerosis & ischemic syndromes, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, RS: CARIM - R3.03 - Cerebral small vessel disease, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: CARIM - R3.11 - Imaging, Beeldvorming, MUMC+: MA AIOS Neurologie (9), and MUMC+: MA Med Staf Spec Neurologie (9)
Subjects: Tunica media, medicine.medical_specialty, IMPACT, medicine.medical_treatment, RECANALIZATION, Subgroup analysis, 030204 cardiovascular system & hematology, tomography, Revascularization, DISEASE, 03 medical and health sciences, 0302 clinical medicine, carotid arteries, Modified Rankin Scale, Internal medicine, medicine, ACUTE ISCHEMIC-STROKE, Stroke, Advanced and Specialized Nursing, business.industry, MECHANICAL THROMBECTOMY, Odds ratio, medicine.disease, Tunica intima, stroke, medicine.anatomical_structure, thrombectomy, tunica media, Cardiology, REVASCULARIZATION, TRIAL, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery, Calcification
Abstract: Background and Purpose— Previous studies suggest that intracranial carotid artery calcification (ICAC) volume might influence the clinical outcome of patients after endovascular treatment (EVT) for acute ischemic stroke. Importantly, ICAC can be subtyped into a medial or intimal pattern that may differentially influence the effect of EVT in patients with acute ischemic stroke. Methods— All 500 patients included in the MR CLEAN (Multicenter Randomized Clinical trial of Endovascular treatment for acute ischemic stroke in the Netherlands) were evaluated. Volume (mm 3 ) and location pattern (tunica intima or tunica media) of ICAC could be determined on baseline noncontrast computed tomography in 344 patients. Functional outcome at 90 days was assessed with the modified Rankin Scale. Next, we investigated the association of ICAC volume and pattern with functional outcome using adjusted ordinal logistic regression models. Effect modification by EVT was assessed with an interaction term between treatment allocation and ICAC aspect. Results— We found evidence for treatment effect modification by ICAC pattern ( P interaction=0.04). Patients with predominantly medial calcification had better functional outcome with EVT than without this treatment (adjusted common odds ratio, 2.32; 95% CI, 1.23–4.39), but we observed no effect of EVT in patients with predominantly intimal calcifications (adjusted common odds ratio, 0.82; 95% CI, 0.40–1.68). We did not find an association of ICAC volume with functional outcome (adjusted common odds ratio per unit increase ICAC volume 1.01 (95% CI, 0.89–1.13). Moreover, we found no evidence for effect modification by ICAC volume ( P interaction=0.61). Conclusions— The benefit of EVT in acute ischemic stroke patients with a medial calcification pattern is larger than the benefit in patients with an intimal calcification pattern. Clinical Trial Registration— URL: http://www.trialregister.nl . Unique identifier: NTR1804. URL: http://www.isrctn.com . Unique identifier: ISRCTN10888758.
Published: 2018
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15. Endovascular treatment for acute ischaemic stroke in routine clinical practice: prospective, observational cohort study (MR CLEAN Registry)

Author: Jansen, I.G.H., Mulder, M.J.H.L., Goldhoorn, R.J.B., Emmer, B.J., Es, A.C.G.M. van, Roozenbeek, B., Schonewille, W.J., Berg, R. van den, Coutinho, J.M., Staals, J., Postma, A.A., Lycklama, G.J., Hofmeijer, J., Martens, J.M., Hertog, H.M. den, Sturm, F.J.C., Worp, H.B. van der, R.H. lo, Heijboer, R.J.J., Keizer, K., Uyttenboogaart, M., Eshghi, O., Wermer, M.J.H., Walderveen, M.A.A. van, Dijk, E.J. van, Boogaarts, H.D., Bruijn, S.F. de, Dijk, L.C. van, Berg, J.S.P. van den, Hasselt, B.A.A.M. van, Kort, P.L.M. de, Peluso, J.P.P., Schreuder, T.H.C.M.L., Aerden, L.A.M., Dallinga, R.J., Sprengers, M.E.S., Yo, L.S.F., Jenniskens, S.F.M., Roosendaal, S.D., Kallen, B.F.W. van der, Wijngaard, I.R. van den, Bot, J.C.J., Doormaal, P.J. van, Flach, H.Z., Venema, E., Lingsma, H.F., Beenen, L.F.M., Yoo, A.J., Boiten, J., Vos, J.A., Roos, Y.B.W.E.M., Oostenbrugge, R.J. van, Lugt, A. van der, Zwam, W.H. van, Dippel, D.W.J., Majoie, C.B.L.M., R Clean Registry Investigators m, Amsterdam Neuroscience - Neurovascular Disorders, Radiology and nuclear medicine, Promovendi CD, Klinische Neurowetenschappen, MUMC+: MA Niet Med Staf Neurologie (9), RS: CARIM - R3.03 - Cerebral small vessel disease, MUMC+: MA Med Staf Spec Neurologie (9), Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), MUMC+: MA Neurologie (3), RS: CARIM - R3.11 - Imaging, Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Neurology, Graduate School, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, and ANS - Neurovascular Disorders
Subjects: Male, medicine.medical_specialty, RANDOMIZED CONTROLLED-TRIALS, medicine.medical_treatment, 030204 cardiovascular system & hematology, CLOT BURDEN SCORE, Brain Ischemia, Time-to-Treatment, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Modified Rankin Scale, law, medicine, Humans, Registries, VALIDITY, METAANALYSIS, Aged, Netherlands, Thrombectomy, business.industry, Cerebral infarction, Research, MECHANICAL THROMBECTOMY, Endovascular Procedures, General Medicine, Thrombolysis, Odds ratio, Middle Aged, medicine.disease, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], Confidence interval, Surgery, Stroke, Outcome and Process Assessment, Health Care, THROMBOLYTIC THERAPY, INFARCT, Female, Observational study, business, Intracranial Hemorrhages, 030217 neurology & neurosurgery, Cohort study
Abstract: Contains fulltext : 193545.pdf (Publisher’s version ) (Open Access) OBJECTIVE: To determine outcomes and safety of endovascular treatment for acute ischaemic stroke, due to proximal intracranial vessel occlusion in the anterior circulation, in routine clinical practice. DESIGN: Ongoing, prospective, observational cohort study. SETTING: 16 centres that perform endovascular treatment in the Netherlands. PARTICIPANTS: 1488 patients included in the Multicentre Randomised Controlled Trial of Endovascular Treatment for Acute Ischaemic Stroke in the Netherlands (MR CLEAN) Registry who had received endovascular treatment, including stent retriever thrombectomy, aspiration, and all alternative methods for acute ischaemic stroke within 6.5 hours from onset of symptoms between March 2014 and June 2016. MAIN OUTCOME MEASURES: The primary outcome was the modified Rankin Scale (mRS) score, ranging from 0 (no symptoms) to 6 (death) at 90 days after the onset of symptoms. Secondary outcomes were excellent functional outcome (mRS score 0-1), good functional outcome (mRS score 0-2), and favourable functional outcome (mRS score 0-3) at 90 days; score on the extended thrombolysis in cerebral infarction scale at the end of the intervention procedure; National Institutes of Health Stroke Scale score 24-48 hours after intervention; and complications that occurred during intervention, hospital admission, or three months' follow up period. Outcomes and safety variables in the MR CLEAN Registry were compared with the MR CLEAN trial intervention and control arms. RESULTS: A statistically significant shift was observed towards better functional outcome in patients in the MR CLEAN Registry compared with the MR CLEAN trial intervention arm (adjusted common odds ratio 1.30, 95% confidence interval 1.02 to 1.67) and the MR CLEAN trial control arm (1.85, 1.46 to 2.34). The reperfusion rate, with successful reperfusion defined as a score of 2B-3 on the extended thrombolysis in cerebral infarction score, was 58.7%, the same as for patients in the MR CLEAN trial. Duration from onset of stroke to start of endovascular treatment and from onset of stroke to successful reperfusion or last contrast bolus was one hour shorter for patients in the MR CLEAN Registry. Symptomatic intracranial haemorrhage occurred in 5.8% of patients in the MR CLEAN Registry compared with 7.7% in the MR CLEAN trial intervention arm and 6.4% in the MR CLEAN trial control arm. CONCLUSION: In routine clinical practice, endovascular treatment for patients with acute ischaemic stroke is at least as effective and safe as in the setting of a randomised controlled trial.
Published: 2018
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16. A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke

Author: Berkhemer, O.A., Fransen, P.S.S., Beumer, D., Berg, L.A. van den, Lingsma, H.F., Yoo, A.J., Schonewille, W.J., Vos, J.A., Nederkoorn, P.J., Wermer, 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., Emmer, 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, Hasselt, 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., Marquering, H.A., Sprengers, M.E.S., Jenniskens, S.F.M., Beenen, L.F.M., Berg, R. van den, Koudstaal, P.J., Zwam, W.H. van, Roos, Y.B.W.E.M., Lugt, A. van der, Oostenbrugge, R.J. van, Majoie, C.B.L.M., Dippel, D.W.J., MR CLEAN Investigators, Clinical Neurophysiology, Faculty of Science and Technology, ACS - Amsterdam Cardiovascular Sciences, ANS - Amsterdam Neuroscience, Radiology and Nuclear Medicine, Graduate School, Neurology, Biomedical Engineering and Physics, Other Research, Other departments, Radiology and nuclear medicine, NCA - neurodegeneration, Public Health, Radiology & Nuclear Medicine, RS: CARIM - R3 - Vascular biology, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, MUMC+: MA AIOS Neurologie (9), Interne Geneeskunde, Klinische Neurowetenschappen, MUMC+: MA Med Staf Spec Neurologie (9), MUMC+: MA Arts Assistenten Obstetrie Gynaecologie (9), Huisartsgeneeskunde, NUTRIM, and MUMC+: DA BV Medisch Specialisten Radiologie (9)
Subjects: medicine.medical_specialty, Solitaire Cryptographic Algorithm, Randomization, RECANALIZATION, THERAPY, law.invention, Randomized controlled trial, Modified Rankin Scale, law, SCORE, medicine, OCCLUSIONS, IR-98132, Intracerebral hemorrhage, business.industry, Other Research Radboud Institute for Health Sciences [Radboudumc 0], General Medicine, Odds ratio, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], medicine.disease, Confidence interval, Surgery, Clinical trial, Anesthesia, ENDOVASCULAR TREATMENT, METIS-313119, CEREBRAL INFARCT, business
Abstract: Contains fulltext : 153000.pdf (Publisher’s version ) (Open Access) BACKGROUND: In patients with acute ischemic stroke caused by a proximal intracranial arterial occlusion, intraarterial treatment is highly effective for emergency revascularization. However, proof of a beneficial effect on functional outcome is lacking. METHODS: We randomly assigned eligible patients to either intraarterial treatment plus usual care or usual care alone. Eligible patients had a proximal arterial occlusion in the anterior cerebral circulation that was confirmed on vessel imaging and that could be treated intraarterially within 6 hours after symptom onset. The primary outcome was the modified Rankin scale score at 90 days; this categorical scale measures functional outcome, with scores ranging from 0 (no symptoms) to 6 (death). The treatment effect was estimated with ordinal logistic regression as a common odds ratio, adjusted for prespecified prognostic factors. The adjusted common odds ratio measured the likelihood that intraarterial treatment would lead to lower modified Rankin scores, as compared with usual care alone (shift analysis). RESULTS: We enrolled 500 patients at 16 medical centers in The Netherlands (233 assigned to intraarterial treatment and 267 to usual care alone). The mean age was 65 years (range, 23 to 96), and 445 patients (89.0%) were treated with intravenous alteplase before randomization. Retrievable stents were used in 190 of the 233 patients (81.5%) assigned to intraarterial treatment. The adjusted common odds ratio was 1.67 (95% confidence interval [CI], 1.21 to 2.30). There was an absolute difference of 13.5 percentage points (95% CI, 5.9 to 21.2) in the rate of functional independence (modified Rankin score, 0 to 2) in favor of the intervention (32.6% vs. 19.1%). There were no significant differences in mortality or the occurrence of symptomatic intracerebral hemorrhage. CONCLUSIONS: In patients with acute ischemic stroke caused by a proximal intracranial occlusion of the anterior circulation, intraarterial treatment administered within 6 hours after stroke onset was effective and safe. (Funded by the Dutch Heart Foundation and others; MR CLEAN Netherlands Trial Registry number, NTR1804, and Current Controlled Trials number, ISRCTN10888758.).
Published: 2015
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17. Temporal profile of body temperature in acute ischemic stroke: Relation to infarct size and outcome

Author: Geurts, Marjolein, Scheijmans, Féline E.V., van Seeters, Tom, Biessels, Geert Jan, Kappelle, L. Jaap, Velthuis, Birgitta K., van der Worp, H. Bart, Majoie, C.B., Roos, Y.B., Duijm, L.E., Keizer, K., van der Lugt, A., Dippel, D.W., Greve, Droogh de, Bienfait, H.P., van Walderveen, Marianne A. A., Wermer, M.J., Lycklama à Nijeholt, G. J., Boiten, J., Duyndam, D.A., Kwa, V.I.H., Meijer, Frederick J. A., van Dijk, E. J., Kesselring, F.O., Hofmeijer, J., Vos, J. A., Schonewille, Wouter J., van Rooij, W.J.J., de Kort, P.L., Pleiter, C. Constantijn, Bakker, S. L., Bot, J., Visser, M. C., van der Schaaf, Irene C., Dankbaar, J.W., Mali, W.P., van Seeters, T., Horsch, Alexander D., Niesten, Joris M., Biessels, G.J., Luitse, M.J., van der Graaf, Y., Radiology and Nuclear Medicine, ANS - Neurovascular Disorders, ACS - Microcirculation, Neurology, ACS - Atherosclerosis & ischemic syndromes, Public and occupational health, Molecular cell biology and Immunology, Radiology and nuclear medicine, and Pathology
Subjects: Male, medicine.medical_specialty, Time Factors, Neurology, Clinical Neurology, Hypothermia, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Hypothermia, Induced, Modified Rankin Scale, Journal Article, medicine, Humans, Body temperature, cardiovascular diseases, Stroke, Aged, medicine.diagnostic_test, business.industry, Cerebral infarction, Magnetic resonance imaging, Recovery of Function, General Medicine, Prognosis, medicine.disease, Magnetic Resonance Imaging, Confidence interval, Relative risk, Anesthesia, Female, Neurology (clinical), medicine.symptom, business, 030217 neurology & neurosurgery, Research Article
Abstract: Background: High body temperatures after ischemic stroke have been associated with larger infarct size, but the temporal profile of this relation is unknown. We assess the relation between temporal profile of body temperature and infarct size and functional outcome in patients with acute ischemic stroke. Methods: In 419 patients with acute ischemic stroke we assessed the relation between body temperature on admission and during the first 3 days with both infarct size and functional outcome. Infarct size was measured in milliliters on CT or MRI after 3 days. Poor functional outcome was defined as a modified Rankin Scale score ≥3 at 3 months. Results: Body temperature on admission was not associated with infarct size or poor outcome in adjusted analyses. By contrast, each additional 1.0 °C in body temperature on day 1 was associated with 0.31 ml larger infarct size (95% confidence interval (CI) 0.04-0.59), on day 2 with 1.13 ml larger infarct size(95% CI, 0.83-1.43), and on day 3 with 0.80 ml larger infarct size (95% CI, 0.48-1.12), in adjusted linear regression analyses. Higher peak body temperatures on days two and three were also associated with poor outcome (adjusted relative risks per additional 1.0 °C in body temperature, 1.52 (95% CI, 1.17-1.99) and 1.47 (95% CI, 1.22-1.77), respectively). Conclusions: Higher peak body temperatures during the first days after ischemic stroke, rather than on admission, are associated with larger infarct size and poor functional outcome. This suggests that prevention of high temperatures may improve outcome if continued for at least 3 days.
Published: 2016
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18. Hyperglycemia predicts poststroke infections in acute ischemic stroke

Author: Zonneveld, Thomas P., Nederkoorn, Paul J., Westendorp, Willeke F., Brouwer, Matthijs C., van de Beek, Diederik, Kruyt, Nyika D., Vermeij, J.-D., Zock, E., Hooijenga, I. J., Kerkhoff, H., Kleyweg, R. P., Kwa, V. I. H., Bosboom, J. L. W., Weisfelt, M., Remmers, M. J. M., van Dijk, E. J., Vermeij, F. H., Schreuder, A. H. C. M. L., Vermeer, S. E., ten Houten, R., Dippel, D. W. J., Kappelle, L. J., van der Worp, H. B., Merkies, I. S. J., de Bruijn, S. F. T. M., de Laat, K. F., Jellema, K., Keizer, K., de Rijk, M. C., Vermeij, A. J., Visser, M. C., Aerden, L. A. M., Schut, E. S., Reichman, L. J. A., de Gans, K., van den Berg-Vos, R. M., van Goor, M. P. J., Wijnhoud, A. D., van der Ree, T. C., Janmaat, M., van Orshoven, N. P., Manschot, S. M., Graduate School, Neurology, ACS - Amsterdam Cardiovascular Sciences, AII - Infectious diseases, ANS - Neuroinfection & -inflammation, AII - Amsterdam institute for Infection and Immunity, Other departments, and ACS - Atherosclerosis & ischemic syndromes
Subjects: Blood Glucose, Male, medicine.medical_specialty, Infections, law.invention, Brain Ischemia, Brain ischemia, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Modified Rankin Scale, Predictive Value of Tests, Diabetes mellitus, Internal medicine, Odds Ratio, Medicine, Humans, 030212 general & internal medicine, Stroke, Aged, Aged, 80 and over, Infection Control, Chi-Square Distribution, business.industry, Ceftriaxone, Odds ratio, Middle Aged, medicine.disease, Anti-Bacterial Agents, Predictive value of tests, Hyperglycemia, Physical therapy, Female, Neurology (clinical), business, Chi-squared distribution, 030217 neurology & neurosurgery
Abstract: Objective:To investigate whether admission hyperglycemia predicts poststroke infections and, if so, whether poststroke infections modify the effect of admission hyperglycemia on functional outcome in ischemic stroke.Methods:We used data from acute ischemic stroke patients in the Preventive Antibiotics in Stroke Study (PASS), a multicenter randomized controlled trial (n = 2,550) investigating the effect of preventive antibiotics on functional outcome. Admission hyperglycemia was defined as blood glucose ≥7.8 mmol/L and poststroke infection as any infection during admission judged by an expert adjudication committee. Functional outcome at 3 months was assessed with the modified Rankin Scale.Results:Of 1,676 nondiabetic ischemic stroke patients, 338 (20%) had admission hyperglycemia. After adjustment for potential confounding variables, admission hyperglycemia was associated with poststroke infection (adjusted odds ratio [aOR] 2.31, 95% CI 1.31–4.07), worse 3-month functional outcome (common aOR 1.40, 95% CI 1.12–1.73), and 3-month mortality (aOR 2.11, 95% CI 1.40–3.19). Additional adjustment for poststroke infection in the functional outcome analysis, done to assess poststroke infection as an intermediate in the pathway from admission hyperglycemia to functional outcome, did not substantially change the model. In patients with recorded diabetes mellitus (n = 418), admission hyperglycemia was not associated with poststroke infection (aOR 0.49, 95% CI 0.15–1.58).Conclusions:In nondiabetic acute ischemic stroke patients, admission hyperglycemia is associated with poststroke infection and worse functional outcome. Poststroke infections did not modify the effect of admission hyperglycemia on functional outcome in ischemic stroke.
Published: 2016

19. Time to Reperfusion and Treatment Effect for Acute Ischemic Stroke A Randomized Clinical Trial

Author: Fransen, P.S.S., Berkhemer, O.A., Lingsma, H.F., Beumer, D., Berg, L.A. van den, Yoo, A.J., Schonewille, W.J., Vos, J.A., Nederkoorn, P.J., Wermer, 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., Emmer, 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, Berg, J.S.P. van den, Hasselt, 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., Marquering, H.A., Sprengers, M.E.S., Jenniskens, S.F.M., Beenen, L.F.M., Berg, R. van den, Koudstaal, P.J., Zwam, W.H. van, Roos, Y.B.W.E.M., Oostenbrugge, R.J. van, Majoie, C.B.L.M., Lugt, A. van der, Dippel, D.W.J., Multictr Randomized Clin Trial End, Other departments, Radiology and Nuclear Medicine, ACS - Amsterdam Cardiovascular Sciences, ANS - Neurovascular Disorders, Graduate School, Neurology, Biomedical Engineering and Physics, Other Research, MUMC+: MA AIOS Neurologie (9), RS: CARIM - R3.03 - Cerebral small vessel disease, Klinische Neurowetenschappen, MUMC+: MA Med Staf Spec Neurologie (9), RS: CARIM - R3.11 - Imaging, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, Clinical Neurophysiology, Faculty of Science and Technology, Radiology and nuclear medicine, Amsterdam Neuroscience - Neurovascular Disorders, Radiology & Nuclear Medicine, and Public Health
Subjects: Male, Time Factors, ANGIOGRAPHIC REPERFUSION, 030204 cardiovascular system & hematology, THERAPY, law.invention, Brain Ischemia, 0302 clinical medicine, Randomized controlled trial, Modified Rankin Scale, law, Interquartile range, Non-U.S. Gov't, 610 Medicine & health, Stroke, OUTCOMES, Research Support, Non-U.S. Gov't, Endovascular Procedures, Atrial fibrillation, Middle Aged, THROMBECTOMY, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], Multicenter Study, Treatment Outcome, Anesthesia, Tissue Plasminogen Activator, Randomized Controlled Trial, Female, IMAGING SELECTION, INTERVENTION, medicine.medical_specialty, Research Support, METIS-320854, 03 medical and health sciences, Reperfusion therapy, Fibrinolytic Agents, SDG 3 - Good Health and Well-being, medicine, Journal Article, Humans, Aged, Intention-to-treat analysis, COMPLEXITY, business.industry, Other Research Radboud Institute for Health Sciences [Radboudumc 0], medicine.disease, Surgery, INTRAVENOUS T-PA, IR-103531, ENDOVASCULAR TREATMENT, Reperfusion, Neurology (clinical), business, 030217 neurology & neurosurgery, Fibrinolytic agent
Abstract: Item does not contain fulltext IMPORTANCE: Intra-arterial treatment (IAT) for acute ischemic stroke caused by intracranial arterial occlusion leads to improved functional outcome in patients treated within 6 hours after onset. The influence of treatment delay on treatment effect is not yet known. OBJECTIVE: To evaluate the influence of time from stroke onset to the start of treatment and from stroke onset to reperfusion on the effect of IAT. DESIGN, SETTING, AND PARTICIPANTS: The Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) was a multicenter, randomized clinical open-label trial of IAT vs no IAT in 500 patients. The time to the start of treatment was defined as the time from onset of symptoms to groin puncture (TOG). The time from onset of treatment to reperfusion (TOR) was defined as the time to reopening the vessel occlusion or the end of the procedure in cases for which reperfusion was not achieved. Data were collected from December 3, 2010, to June 3, 2014, and analyzed (intention to treat) from July 1, 2014, to September 19, 2015. MAIN OUTCOMES AND MEASURES: Main outcome was the modified Rankin Scale (mRS) score for functional outcome (range, 0 [no symptoms] to 6 [death]). Multiple ordinal logistic regression analysis estimated the effect of treatment and tested for the interaction of time to randomization, TOG, and TOR with treatment. The effect of treatment as a risk difference on reaching independence (mRS score, 0-2) was computed as a function of TOG and TOR. Calculations were adjusted for age, National Institutes of Health Stroke Scale score, previous stroke, atrial fibrillation, diabetes mellitus, and intracranial arterial terminus occlusion. RESULTS: Among 500 patients (58% male; median age, 67 years), the median TOG was 260 (interquartile range [IQR], 210-311) minutes; median TOR, 340 (IQR, 274-395) minutes. An interaction between TOR and treatment (P = .04) existed, but not between TOG and treatment (P = .26). The adjusted risk difference (95% CI) was 25.9% (8.3%-44.4%) when reperfusion was reached at 3 hours, 18.8% (6.6%-32.6%) at 4 hours, and 6.7% (0.4%-14.5%) at 6 hours. CONCLUSION AND RELEVANCE: For every hour of reperfusion delay, the initially large benefit of IAT decreases; the absolute risk difference for a good outcome is reduced by 6% per hour of delay. Patients with acute ischemic stroke require immediate diagnostic workup and IAT in case of intracranial arterial vessel occlusion. TRIAL REGISTRATION: trialregister.nl Identifier: NTR1804.
Published: 2016
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20. Prediction of outcome in patients with suspected acute ischaemic stroke with CT perfusion and CT angiography: the Dutch acute stroke trial (DUST) study protocol

Author: Van Seeters, Tom, Biessels, Geert J., van der Schaaf, Irene C., Dankbaar, Jan W., Horsch, Alexander D., Luitse, Merel J.A., Niesten, Joris M., Mali, Willem P.T.M., Kappelle, L. J., van der Graaf, Yolanda, Velthuis, Birgitta K., Majoie, C. B., Roos, Y. B., Duijm, L. E., Keizer, K., van der Lugt, A., Dippel, D. W., Droogh-de Greeve, K. E., Bienfait, H. P., van Walderveen, M. A., Wermer, M. J., Lycklamaà Nijeholt, G. J., Boiten, J., Duyndam, D., Kwa, V. I., Meijer, F. J., van Dijk, E. J., Kesselring, F. O., Hofmeijer, J., Vos, J. A., Schonewille, W. J., van Rooij, W. J., de Kort, P. L., Pleiter, C. C., Bakker, S. L., Bot, J., Visser, M. C., ACS - Amsterdam Cardiovascular Sciences, ANS - Amsterdam Neuroscience, Radiology and Nuclear Medicine, Neurology, Public Health, Radiology and nuclear medicine, and Public and occupational health
Subjects: medicine.medical_specialty, Infarct, Clinical Neurology, Perfusion scanning, Ischaemia, Brain Ischemia, Cohort Studies, Study Protocol, Modified Rankin Scale, Predictive Value of Tests, medicine, Humans, Prospective Studies, Stage (cooking), Prospective cohort study, Stroke, Netherlands, Receiver operating characteristic, medicine.diagnostic_test, business.industry, General Medicine, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], medicine.disease, Cerebral Angiography, Perfusion, Treatment Outcome, CT angiography, Predictive value of tests, Angiography, CT perfusion, Neurology (clinical), Radiology, business, Prediction, Tomography, X-Ray Computed, Follow-Up Studies
Abstract: Contains fulltext : 136571.pdf (Publisher’s version ) (Open Access) BACKGROUND: Prediction of clinical outcome in the acute stage of ischaemic stroke can be difficult when based on patient characteristics, clinical findings and on non-contrast CT. CT perfusion and CT angiography may provide additional prognostic information and guide treatment in the early stage. We present the study protocol of the Dutch acute Stroke Trial (DUST). The DUST aims to assess the prognostic value of CT perfusion and CT angiography in predicting stroke outcome, in addition to patient characteristics and non-contrast CT. For this purpose, individualised prediction models for clinical outcome after stroke based on the best predictors from patient characteristics and CT imaging will be developed and validated. METHODS/DESIGN: The DUST is a prospective multi-centre cohort study in 1500 patients with suspected acute ischaemic stroke. All patients undergo non-contrast CT, CT perfusion and CT angiography within 9 hours after onset of the neurological deficits, and, if possible, follow-up imaging after 3 days. The primary outcome is a dichotomised score on the modified Rankin Scale, assessed at 90 days. A score of 0-2 represents good outcome, and a score of 3-6 represents poor outcome. Three logistic regression models will be developed, including patient characteristics and non-contrast CT (model A), with addition of CT angiography (model B), and CT perfusion parameters (model C). Model derivation will be performed in 60% of the study population, and model validation in the remaining 40% of the patients. Additional prognostic value of the models will be determined with the area under the curve (AUC) from the receiver operating characteristic (ROC) curve, calibration plots, assessment of goodness-of-fit, and likelihood ratio tests. DISCUSSION: This study will provide insight in the added prognostic value of CTP and CTA parameters in outcome prediction of acute stroke patients. The prediction models that will be developed in this study may help guide future treatment decisions in the acute stage of ischaemic stroke.
Published: 2014
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21. Early administration of aspirin in patients treated with alteplase for acute ischaemic stroke: a randomised controlled trial

Author: Zinkstok, Sanne M., Roos, Yvo B., Aerden, L. A. M., van den Berg-Vos, R. M., Bakker, S. L. M., Bienfait, H. M. E., Bienfait, H. P., Boon, A. E., Brans, J. W. M., Bronner, I. M., de Bruijn, S. F. T. M., Franke, C. L., Hofstee, D. J., Jansen, B. P. W., Jellema, K., Kalkers, N. F., Portegies, P., Keizer, K., Kerkhoff, H., de Gans, K., Kloos, L. M. H., Kok, A. J. M., de Kort, P. L. M., de Kruijk, J. R., van der Kruijk, R. A., Kwa, V. I. H., Kruyt, N. D., Meijer, R. J., van der Meulen, W. D. M., Mulleners, W. M., Nederkoorn, P. J., van der Ree, T. C., Rooyer, F. A., Saxena, R., Schuiling, W. J., Verbiest, H. B. C., Verhey, J. C. B., Vermeer, S. E., Visée, H. F., Visser, M. C., van der Wiel, H. L., van der Worp, H. B., de Haan, R. J., Stam, J., Vermeulen, M., Peters, R. J. G., Majoie, C. B. L. M., Beenen, L. F., Marquering, H. A., van Geloven, N., Epidemiologie, MUMC+: KIO Kemta (9), RS: CAPHRI School for Public Health and Primary Care, Neurology, ACS - Amsterdam Cardiovascular Sciences, ANS - Amsterdam Neuroscience, Other departments, APH - Amsterdam Public Health, Clinical Research Unit, Cardiology, Radiology and Nuclear Medicine, Other Research, and Biomedical Engineering and Physics
Subjects: Male, medicine.medical_specialty, Time Factors, Drug Administration Schedule, law.invention, Fibrinolytic Agents, Randomized controlled trial, Modified Rankin Scale, law, Internal medicine, Secondary Prevention, medicine, Clinical endpoint, Humans, Prospective Studies, Platelet activation, Infusions, Intravenous, Stroke, Aged, Aged, 80 and over, Aspirin, business.industry, Standard treatment, General Medicine, Middle Aged, medicine.disease, Surgery, Treatment Outcome, Tissue Plasminogen Activator, Early Termination of Clinical Trials, Platelet aggregation inhibitor, Drug Therapy, Combination, Female, business, Intracranial Hemorrhages, Platelet Aggregation Inhibitors, medicine.drug
Abstract: Summary Background Thrombolysis with intravenous alteplase is the only approved treatment for acute ischaemic stroke. After alteplase-induced recanalisation, reocclusion occurs in 14–34% of patients, probably because of platelet activation. Early administration of antiplatelet therapy after alteplase could reduce the risk of reocclusion and improve outcome. We compared the effects of early addition of intravenous aspirin to alteplase with standard alteplase without aspirin. Methods In this multicentre, randomised, open-label trial with blind-endpoint assessment, patients with acute ischaemic stroke treated with alteplase were randomly assigned to 300 mg intravenous aspirin within 90 min after start of alteplase treatment or to no additional treatment. In both groups, oral antiplatelet therapy was started 24 h after alteplase treatment. The primary endpoint was favourable outcome, defined as a score of 0–2 on the modified Rankin scale at 3 months. This trial is registered with the Netherlands Trial Register (NTR822). Findings Between July 29, 2008, and April 20, 2011, 642 patients (322 patients aspirin, 320 patients standard treatment) of the targeted 800 patients were enrolled. At that time, the trial was terminated prematurely because of an excess of symptomatic intracranial haemorrhage (SICH) and no evidence of benefit in the aspirin group. At 3 months, 174 (54·0%) patients in the aspirin group versus 183 (57·2%) patients in the standard treatment group had a favourable outcome (absolute difference −3·2%, 95% CI −10·8 to 4·2; crude relative risk 0·94, 0·82 to 1·09, p=0·42). Adjusted odds ratio was 0·91 (95% CI 0·66–1·26, p=0·58). SICH occurred more often in the aspirin group (14 [4·3%] patients) than in the standard treatment group (five [1·6%]; absolute difference 2·8%, 95% CI 0·2–5·4; p=0·04). SICH was more often the cause of poor outcome in the aspirin group compared with the standard treatment group (11 vs 1, p=0·006). Interpretation Early administration of intravenous aspirin in patients with acute ischaemic stroke treated with alteplase does not improve outcome at 3 months and increases the risk of SICH. The results of this trial do not support a change of the current guidelines, which advise to start antiplatelet therapy 24 h after alteplase. Funding The Dutch Heart Foundation.
Published: 2012

22. Rationale and design of a randomized, double-blind, parallel-group study of terutroban 30 mg/day versus aspirin 100 mg/day in stroke patients: the prevention of cerebrovascular and cardiovascular events of ischemic origin with terutroban in patients with a history of ischemic stroke or transient ischemic attack (PERFORM) study

Author: Bousser, M, Amarenco, P, Chamorro, A, Fisher, M, Ford, I, Fox, K, Hennerici, M, Mattle, H, Rothwell, P, Julian, D, Fieschi, G, Fieschi, C, Boysen, G, Pocock, S, Conard, J, Orgogozo, J, Inzitari, D, Erkinjuntti, T, Pasquier, F, O'Brien, J, Mas, J, Gueret, P, Lenzi, G, Leys, D, Lopez Sendon, J, Norrving, B, Ferro, J, Thygesen, K, Cowpply, B, P, Ameriso, S, Donnan, D, Lang, W, Thijs, V, Fernandes, J, Stamenova, P, Teal, P, Lavados, P, Lu, C, Poljakovic, Z, Kalita, Z, Kaste, M, Moulin, T, Vemmos, K, Diener, H, Wong, L, Nagy, Z, Chopra, J, Mccormack, P, Gensini, G, Budrys, V, Droste, D, Tan, K, Benomar, A, Cantu Brito, C, Barber, A, Koudstaal, P, Thomassen, L, Czlonkowska, A, Cunha, L, Bajenaru, O, Yakhno, N, Chen, C, Lisy, L, Zvan, B, Bryer, A, Kim, J, Vivancos, J, Wahlgren, N, Liu, S, Poungvarin, N, Hentati, F, Bahar, S, Mischenko, T, Lees, K, Abdel Masih, M, Barboza, A, Cirio, J, Crespo, E, Escaray, G, Esnaola, M, Rojas Estol, C, Ferrari, J, Fraiman, H, Garrote, M, Gatto, E, Giannaula, R, Gori, H, Herrera, G, Ioli, P, Losano, J, Povedano Reich, E, Rey, R, Rotta Escalante, R, Saredo, G, Zurru, M, Anderson, C, Bladin, C, Crimmins, D, Davis, S, Donnan, G, Dunbabin, D, Frayne, J, Gates, P, Hankey, G, Helme, R, Herkes, G, Karrasch, J, Kimber, T, Jannes, J, Landau, P, Levi, C, Lueck, C, Markus, R, Phan, T, Schwartz, R, Schultz, D, Blacker, D, Read, S, Williams, M, Aichner, F, Auff, E, Bancher, C, Binder, H, Brainin, M, Brucke, T, Eggers, C, Fertl, E, Ladurner, G, Lalouschek, W, Mamoli, B, Mitrovic, N, Noisternig, G, Schmidt, R, Vosko, M, Willeit, J, Zaruba, E, Boon, P, Bourgeois, P, Caekebeke, J, Cals, N, Cras, P, Desfontaines, P, De Deyn, P, Dieudonne, L, De Klippel, N, Laloux, P, Maertens de Noordhout, A, Merlevede, K, Michotte, A, Pandolfo, M, Peeters, A, Peeters, D, Tack, P, Van Buggenhout, E, Van Landegem, W, Vanhooren, G, Vermylen, P, Annes, M, Brondani, R, De Carvalho, J, Cendes, F, Fabio, S, Ferraz, A, De Freitas, G, Gagliardi, R, Gomes Neto, A, Haussen, S, Kowacs, P, Martins, S, Minelli, C, Moro, C, Noujaim, J, Rocha, M, Da Silva, M, Silveira, J, Yamamoto, F, Zetola, V, Baldaranov, D, Deleva, N, Haralanov, L, Milanov, I, Mintchev, D, Petrova, N, Shotekov, P, Stamenov, B, Zahariev, Z, Arts, R, Bayer, N, Beaudry, M, Berger, L, Bozek, C, Collier, T, Cote, R, Desai, H, Durocher, A, Hachinski, V, Hill, M, Hoppe, B, Howse, D, Mackey, A, Maharaj, M, Minuk, J, Moddel, G, Novak, D, Penn, A, Rabinovitch, H, Selchen, D, Shuaib, A, Silva, J, Silver, F, Spence, D, Stotts, G, Tamayo, A, Teitelbaum, J, Veloso, F, Voll, C, Winder, T, Barrientos Uribe, N, Galdames Poblete, D, Garcia Figueroa, P, Gasic Yaconi, K, Jaramillo Munoz, A, Lavados Germain, P, Lavados Montes, M, Nancupil Bello, C, Prina Pacheco, L, Vargas Canas, A, Venegas, F, Chen, P, H, Cheng, Y, Cui, L, Di, Q, Dong, Q, Fan, D, Feng, H, Huang, Y, Li, J, Li, W, Li, Z, Lin, H, Liu, M, Miao, L, Ren, H, Wang, Y, Wu, J, Zhang, W, Zhao, G, Zhao, H, Zhou, H, Antoncic, I, Demarin, V, Lusic, I, Pavlicek, I, Soldo Butkovic, S, Bar, M, Bauer, J, Kalina, M, Kanovsky, P, Jura, R, Neumann, J, Rektor, I, Skoda, O, Vaclavik, D, Eerola, A, Hillbom, M, Kinnunen, E, Koivisto, K, Numminen, H, Rissanen, A, Roine, R, Sivenius, J, Alamowitch, S, Autret, A, Avendano, S, Bataillard, M, Berthier, E, Besson, G, Bille Turc, F, Boulliat, J, Boulesteix, J, Brosset, C, Cesaro, P, Albucher, J, Clavelou, P, Colamarino, R, Crassard, I, de Broucker, T, de Bray, J, Desbordes, P, Diot, E, Ducrocq, X, Ellie, E, Faucheux, J, Giroud, M, Godefroy, O, Guillon, B, Huttin, H, Just, A, Lamy, C, Lejeune, P, Lucas, C, Macian Montoro, F, Mackowiak, A, Maillet Vioud, M, Pico, F, Milandre, L, Milhaud, D, Malbec, M, Neau, J, Pinel, J, Robin, C, Rodier, G, Rosolacci, T, Rouanet, F, Rouhart, F, Sablot, D, Servan, J, Smadja, D, Trouillas, P, Valance, J, Viader, F, Viallet, F, Wolff, V, Zagnoli, F, Zuber, M, Angerer, M, Becker, U, Berlit, P, Berrouschot, J, Biniek, R, Bitsch, A, Brodhun, R, Dichgans, M, Druschky, K, Dux, R, Faiss, J, Ferbert, A, Gahn, G, Grotemeyer, K, Goertler, M, Grau, A, Griewing, B, Grond, M, Haan, J, Haberl, R, Hamann, G, Hamer, H, Harms, L, Heide, W, Henningsen, H, Hetzel, A, Hoffmann, F, Huber, R, Isenmann, S, Jander, S, Joerg, J, Kaps, M, Kastrup, A, Kessler, C, Koehler, W, Koelmel, H, Lichy, C, Luckner, K, Malessa, R, Mallmann, A, Meyding Lamade, U, Molitor, H, Mueller Jensen, A, Muellges, W, Noth, J, Nueckel, M, Ochs, G, Poppert, H, Roether, J, Rosenkranz, M, Sander, D, Schaebitz, W, Schlachetzki, F, Schlegel, U, Schmid, E, Schneider, D, Schwarz, M, Seidel, G, Sieble, M, Sliwka, U, Stingele, R, Stoegbauer, F, Szabo, K, Topper, R, Treib, J, Weissenborn, K, Widder, B, Witte, O, Karageorgiou, K, Mitsikostas, D, Papadimitriou, A, Papathanasopoulos, P, Chan, H, Ng, P, Tsoi, T, Bartos, L, Csanyi, A, Csiba, L, Csornai, M, Dioszeghy, P, Fazekas, A, Harcos, P, Horvath, S, Kaposzta, Z, Kerenyi, L, Kincses, J, Koves, A, Nikl, J, Panczel, G, Pongracz, E, Sebestyen, K, Semjen, J, Szabo, M, Szegedi, N, Valikovics, A, Varszegi, R, Vecsei, L, Borah, N, Ichaporia, N, Kaul, S, Meenakshi Sundaram, S, Mehndiratta, M, Misra, U, Murthy, J, Nayak, D, Poncha, F, Shah, A, Singh, G, Srinivasa, R, Venkateswarlu, K, Wadia, R, Collins, R, Harbison, J, Hickey, P, Kelly, P, Murphy, S, Adami, A, Agnelli, G, Agostoni, E, Anzola, G, Arnaboldi, M, Bassi, P, Billo, G, Bottacchi, E, Bovi, P, Cappa, S, Cappelletti, C, Carolei, A, Cavallini, A, Chiodo Grandi, F, Comi, G, Consoli, D, Corsi, F, Costanzo, E, De Falco, F, Devetag, F, Di Lazzaro, V, Di Piero, V, Diomedi, M, Fattorello Salimbeni, C, Federico, F, Feleppa, M, Ferrarese, C, Gandolfo, C, Giaccaglini, E, Giaquinto, S, Giobbe, D, Giometto, B, Greco, G, Guidetti, D, Guidotti, M, Iudice, A, Lembo, G, Marengo, C, Marini, P, Melis, M, Micieli, G, Musolino, R, Mutani, R, Neri, G, Parati, E, Pastore, L, Porazzi, D, Prati, P, Procaccianti, G, Rasura, M, Rossini, P, Santilli, I, Semplicini, A, Silvestrini, M, Tanganelli, P, Tedeschi, G, Tezzon, F, Tola, M, Villani, A, Zanferrari, C, Zarcone, D, Bickuviene, I, Gumbrevicius, G, Obelieniene, D, Skaringa, A, Virketiene, I, Tharakan, J, Aleman Pedroza, J, Escamilla Garza, J, Fernandez Vera, J, Leal Cantu, R, Leon Flores, L, Lopez Ruiz, M, Reyes Gutierrez, G, Reyes Morales, S, Rivera Castano, L, Rodrigues Leyva, I, Ruiz Sandoval, J, Vega Boada, F, Belahsen, F, Kissani, N, Mosseddaq, R, Slassi, I, Yahyaoui, M, Boiten, J, Bornebroek, M, De Kort, P, De Leeuw, H, Donders, R, Franke, C, Hertzberger, L, Jansen, B, Kappelle, L, Keizer, K, Kuster, J, Limburg, M, Mulleners, W, Pop, P, Van Den Berg, J, Van Gemert, H, Verbiest, H, Weinstein, H, Clark, M, Fink, J, Gommans, J, Jayathissa, S, Kilfoyle, D, Kumar, A, Hurtig, U, Indredavik, B, Kloster, R, Salvesen, R, Drozdowski, W, Fryze, W, Klimek, A, Kochanowski, J, Kozubski, W, Ksiazkiewicz, B, Kwiecinski, H, Kuczynska Zardzewialy, A, Motta, E, Nowacki, P, Nyka, W, Opala, G, Pierzchala, K, Pniewski, J, Podemski, R, Selmaj, K, Stelmasiak, Z, Stepien, A, Strzelecka Gorzynska, M, Szczudlik, A, Wajgt, A, Wiszniewska, M, Wlodek, A, Canhao, P, Correia, C, Grilo Goncalves, J, Machado Candido, J, Salgado, A, Bulboaca, A, Campeanu, A, Lazar, T, Marginean, I, Minea, D, Pascu, I, Pereanu, M, Perju Dumbrava, L, Popescu, C, Simu, M, Stefanache, F, Toldisan, I, Tuta, S, Zaharia, C, Alifirova, V, Arkhipov, S, Balunov, O, Balyazin, V, Belkin, A, Belova, A, Boiko, A, Bogdanov, E, Butko, D, Chukhlovina, M, Doronin, B, Ermilova, E, Evzelman, M, Fedin, A, Fedorova, N, Golikov, K, Golovkin, V, Gusev, E, Gustov, A, Jakupov, E, Kamchatnov, P, Khabirov, F, Kirienko, A, Klimov, I, Klocheva, E, Kotov, S, Kuznetsov, A, Laskov, V, Levin, Y, Mashkova, N, Nazarov, A, Novikova, L, Odinak, M, Parfenov, V, Pilipenko, P, Pokrovsky, A, Poverennova, I, Rodoman, G, Roshkovskaya, L, Shirokov, E, Shmyriov, V, Sholomov, I, Skoromets, A, Skvortsova, V, Spirin, N, Stakhovskaya, L, Sharov, M, Sherman, M, Shutov, A, Strachunskaya, E, Stulin, I, Suslina, Z, Volosevitch, A, Vorobiev, P, Vorobyeva, O, Voronkova, L, Voskresenskaya, O, Zhuliov, N, Chan, B, Chang, H, Ramani, N, Brozman, M, Dvorak, M, Dzugan, J, Garay, R, Gdovinova, Z, Gurcik, L, Krastev, G, Kukumberg, P, Kurca, E, Meluch, S, Nyeky, M, Turcani, P, Vyletelka, J, Klanjscek, G, Zujovic, E, Zupan, M, Bester, F, Carr, J, Coetzee, C, Frost, A, Gardiner, J, Giampaolo, D, Kesler, S, Lurie, D, Retief, C, Roos, J, Bae, H, Cha, J, Cho, K, Heo, J, Kim, E, Lee, B, Lee, K, Lee, J, Rha, J, Yoon, B, Alvarez Sabin, J, Arboix Damunt, A, De Arce Borda, A, Asensi Alvarez JM, Bermejo Pareja, F, Botia Paniagua, E, Casado, I, Naranjo, I, Castillo Sanchez, J, Chamorro Sanchez, A, Davalos Errando, A, Diaz Marin, C, Diez Tejedor, E, Egido Herrero JA, Fernandez Bolanos, R, Fernandez Fernandez, O, Figuerola Roig, A, Geffner Sclarsky, D, Gil Nunez, A, Gomez Sanchez JC, Gomez Escalonilla Escobar CI, Gonzalez Masegosa, A, Gonzalez Menacho, J, Gracia Fleta, F, Izquierdo Ayuso, G, Jimenez Hernandez, D, Jimenez Martinez, C, Lago Martin, A, Lainez Andres JM, Larracoechea Jausoro, J, Lopez Fernandez JC, Maestre Moreno, J, Marti Vilalta JL, Martin Gonzalez, R, Masjuan Vallejo, J, Medina Rodriguez, A, Molto Jorda JM, Moreno Carre tero MJ, Moris de le Tassa, G, Morlan Gracia, L, Mostacero Miguez, E, Osuna Pulido, T, Pareja Martinez, A, Pinedo Brochado, A, Pons Amate JM, Rodriguez Alvarez JR, Roquer Gonzalez, J, Sanahuja Montesinos, J, Sanchez Sanchez MC, Segura Martin, T, Serena Leal, J, Tejada Garcia, J, Trejo Gabriel JM, Vivancos Mora, J, Andersson, B, Bysell, S, Cederin, B, Laska, A, Lindgren, A, Petersson, T, Wallen, T, Baumgartner, R, Beer, H, Hirt, L, Hungerbuehler, H, Lyrer, P, Michel, P, Mueller, F, Tettenborn, B, Chang, K, Jeng, J, Lien, L, Lin, R, Liu, C, Po, H, Wu, S, Chankrachang, S, Laptikultham, S, Nidhinandana, S, Pongpakdee, S, Benammou, S, Frih Ayed, M, Gouider, R, Mhiri, C, M'Rabet, A, Mrissa, R, Balkan, S, Can, U, Dalkara, T, Kirbas, D, Kumral, E, Ozdemir, G, Ozeren, A, Ozmenoglu, M, Ozturk, S, Lebedynets, V, Maly, V, Moskovko, S, Orzheshkovskyy, V, Smolanka, V, Yavors'Ka, V, Zozulya, I, Bamford, J, Barber, M, Barer, D, Baron, J, Bath, P, Broughton, D, Brown, M, Chataway, J, Curless, R, Darawil, K, Datta, P, Dennis, M, Durairaj, R, Egbuji, J, Ellis, S, Ford, G, Freeman, A, Fulcher, R, Gray, C, Harrington, F, Hudson, C, Iveson, E, James, M, Jenkinson, D, Kalra, L, Kelly, D, Krishnamoorthy, S, Langhorne, P, Magorrian, M, Macleod, M, Macwalter, R, Markus, H, Muhiddin, K, Muir, K, Murphy, P, Power, M, Price, C, Rashed, K, Robinson, T, Rudd, A, Sanmuganathan, P, Sharma, J, Shaw, L, Shetty, H, Smithard, D, Tyrrell, P, Vahidassr, M, Venables, G, Watt, M, White, R, Bousser, M, Amarenco, P, Chamorro, A, Fisher, M, Ford, I, Fox, K, Hennerici, M, Mattle, H, Rothwell, P, Ferrarese, C, PERFORM study, I, PERFORM STUDY, Investigator, Tedeschi, Gioacchino, Cras, Patrick, De Deyn, Peter Paul, and et al.
Subjects: perform study, Male, Thromboxane, International Cooperation, Receptors, Thromboxane, antiplatelet therapy, terutroban, Cardiovascular Disease, Receptors, 80 and over, Stroke, Aged, 80 and over, Aspirin, Ischemic Attack, Transient, Ischemic Attack, Transient, Double-Blind Method, Endpoint Determination, Dose-Response Relationship, Drug, Humans, Aged, Propionates, Naphthalenes, Treatment Outcome, Platelet Aggregation Inhibitors, Cardiovascular Diseases, Middle Aged, Female, Propionic Acids, Neurology, Terutroban, Anesthesia, tp receptor antagonist, stroke, secondary prevention, aspirin, Cardiology, Platelet aggregation inhibitor, Settore MED/26 - Neurologia, stroke prevention, Drug, Cardiology and Cardiovascular Medicine, medicine.drug, Human, medicine.medical_specialty, Dose-Response Relationship, Internal medicine, medicine, Dementia, In patient, business.industry, Platelet Aggregation Inhibitor, schemic, medicine.disease, DementiaI, transient ischemic attack, Ischemic stroke, Human medicine, Neurology (clinical), business, Propionic Acid, Naphthalene
Abstract: Background: Ischemic stroke is the leading cause of mortality worldwide and a major contributor to neurological disability and dementia. Terutroban is a specific TP receptor antagonist with antithrombotic, antivasoconstrictive, and antiatherosclerotic properties, which may be of interest for the secondary prevention of ischemic stroke. This article describes the rationale and design of the Prevention of cerebrovascular and cardiovascular Events of ischemic origin with teRutroban in patients with a history oF ischemic strOke or tRansient ischeMic Attack (PERFORM) Study, which aims to demonstrate the superiority of the efficacy of terutroban versus aspirin in secondary prevention of cerebrovascular and cardiovascular events. Methods and Results: The PERFORM Study is a multicenter, randomized, double-blind, parallel-group study being carried out in 802 centers in 46 countries. The study population includes patients aged ≥55 years, having suffered an ischemic stroke (≤3 months) or a transient ischemic attack (≤8 days). Participants are randomly allocated to terutroban (30 mg/day) or aspirin (100 mg/day). The primary efficacy endpoint is a composite of ischemic stroke (fatal or nonfatal), myocardial infarction (fatal or nonfatal), or other vascular death (excluding hemorrhagic death of any origin). Safety is being evaluated by assessing hemorrhagic events. Follow-up is expected to last for 2–4 years. Assuming a relative risk reduction of 13%, the expected number of primary events is 2,340. To obtain statistical power of 90%, this requires inclusion of at least 18,000 patients in this event-driven trial. The first patient was randomized in February 2006. Conclusions: The PERFORM Study will explore the benefits and safety of terutroban in secondary cardiovascular prevention after a cerebral ischemic event.
Published: 2009
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23. PATCH: platelet transfusion in cerebral haemorrhage: study protocol for a multicentre, randomised, controlled trial

Author: de Gans, Koen, de Haan, Rob J., Majoie, Charles B., Koopman, Maria M., Brand, Anneke, Dijkgraaf, Marcel G., Vermeulen, Marinus, Roos, Yvo B., Hofmeijer, J., Vermeer, S. E., Franke, C. L., Mulleners, W. M., Keizer, K., Dijkstra, U. J., van Kooten, F., Bronner, I. M., Kloos, L. M. H., Viseé, H. F., de Bruijn, S. F. T. M., Bienfait, H. M. E., Saxena, R., Meilof, J. F., Raaijmakers, T. W. M., Brans, J. W. M., Jellema, K., Schuiling, W. J., Portegies, P., Rooyer, F. A., Aerden, L. A. M., van der Meulen, W. D. M., de Kruijk, J. R., Jansen, B. P. W., Kwa, V. I. H., Meijer, R. J., Boon, A. E., Schonewille, W. J., de Kort, P. L. M., Bakker, S. L. M., Hofstee, D. J., van den Berg-Vos, R. M., van Dijk, E. J., Klijn, C. J. M., Verhey, J. C. B., Visser, M. C., van der Ree, T. C., Reitsma, J. B., Kamphuisen, P. W., Klijn, C. J., Zinkstok, S. M., Faculteit der Geneeskunde, Amsterdam Cardiovascular Sciences, Amsterdam Neuroscience, Neurology, Amsterdam Public Health, Clinical Research Unit, Radiology and Nuclear Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Epidemiology and Data Science, Other departments, Amsterdam institute for Infection and Immunity, and Vascular Medicine
Subjects: medicine.medical_specialty, Neurology, Time Factors, Clinical Neurology, Platelet Transfusion, lcsh:RC346-429, law.invention, Randomized controlled trial, Clinical Protocols, law, Study protocol, medicine, Humans, Neurochemistry, cardiovascular diseases, Prospective Studies, Prospective cohort study, lcsh:Neurology. Diseases of the nervous system, Cerebral Hemorrhage, business.industry, Brain, General Medicine, Clopidogrel, Surgery, Platelet transfusion, Treatment Outcome, Research Design, Anesthesia, Acute Disease, Platelet aggregation inhibitor, Neurology (clinical), Neurosurgery, business, Platelet Aggregation Inhibitors, medicine.drug, Follow-Up Studies
Abstract: Background Patients suffering from intracerebral haemorrhage have a poor prognosis, especially if they are using antiplatelet therapy. Currently, no effective acute treatment option for intracerebral haemorrhage exists. Limiting the early growth of intracerebral haemorrhage volume which continues the first hours after admission seems a promising strategy. Because intracerebral haemorrhage patients who are on antiplatelet therapy have been shown to be particularly at risk of early haematoma growth, platelet transfusion may have a beneficial effect. Methods/Design The primary objective is to investigate whether platelet transfusion improves outcome in intracerebral haemorrhage patients who are on antiplatelet treatment. The PATCH study is a prospective, randomised, multi-centre study with open treatment and blind endpoint evaluation. Patients will be randomised to receive platelet transfusion within six hours or standard care. The primary endpoint is functional health after three months. The main secondary endpoints are safety of platelet transfusion and the occurrence of haematoma growth. To detect an absolute poor outcome reduction of 20%, a total of 190 patients will be included. Discussion To our knowledge this is the first randomised controlled trial of platelet transfusion for an acute haemorrhagic disease. Trial registration The Netherlands National Trial Register (NTR1303)
Published: 2010

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23 results on '"Keizer, K."'

1. Clinical and Imaging Markers Associated With Hemorrhagic Transformation in Patients With Acute Ischemic Stroke

2. Collateral Circulation and Outcome in Atherosclerotic Versus Cardioembolic Cerebral Large Vessel Occlusion

3. MR CLEAN-NO IV: intravenous treatment followed by endovascular treatment versus direct endovascular treatment for acute ischemic stroke caused by a proximal intracranial occlusion—study protocol for a randomized clinical trial

4. Workflow Intervals of Endovascular Acute Stroke Therapy During On- Versus Off-Hours The MR CLEAN Registry

5. Impact of single phase CT angiography collateral status on functional outcome over time: results from the MR CLEAN Registry

6. Endovascular Treatment With or Without Prior Intravenous Alteplase for Acute Ischemic Stroke

7. Circle of Willis variations in migraine patients with ischemic stroke

8. Safety and Outcome of Endovascular Treatment for Minor Ischemic Stroke: Results From the Multicenter Clinical Registry of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands

9. Intracranial Cerebrospinal Fluid Volume as a Predictor of Malignant Middle Cerebral Artery Infarction

10. Determinants of extended door-to-needle time in acute ischemic stroke and its influence on in-hospital mortality: Results of a nationwide Dutch clinical audit

11. Acute endovascular treatment of patients with ischemic stroke from intracranial large vessel occlusion and extracranial carotid dissection

12. CT angiography and CT perfusion improve prediction of infarct volume in patients with anterior circulation stroke

13. Reader response: Comparative safety and efficacy of combined IVT and MT with direct MT in large vessel occlusion

14. Intracranial Carotid Artery Calcification and Effect of Endovascular Stroke Treatment MR CLEAN Subgroup Analysis

15. Endovascular treatment for acute ischaemic stroke in routine clinical practice: prospective, observational cohort study (MR CLEAN Registry)

16. A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke

17. Temporal profile of body temperature in acute ischemic stroke: Relation to infarct size and outcome

18. Hyperglycemia predicts poststroke infections in acute ischemic stroke

19. Time to Reperfusion and Treatment Effect for Acute Ischemic Stroke A Randomized Clinical Trial

20. Prediction of outcome in patients with suspected acute ischaemic stroke with CT perfusion and CT angiography: the Dutch acute stroke trial (DUST) study protocol

21. Early administration of aspirin in patients treated with alteplase for acute ischaemic stroke: a randomised controlled trial

23. PATCH: platelet transfusion in cerebral haemorrhage: study protocol for a multicentre, randomised, controlled trial

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