895 results on '"van Zwam, Wim H."'
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152. Additional file 1 of Impact of the lockdown on acute stroke treatments during the first surge of the COVID-19 outbreak in the Netherlands
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Benali, Faysal, Stolze, Lotte J., Rozeman, Anouk D., Dinkelaar, Wouter, Coutinho, Jonathan M., Emmer, Bart J., Gons, Rob A. R., Yo, Lonneke F. S., van Tuijl, Julia H., Boukrab, Issam, van Dam-Nolen, Dianne H. K., van den Wijngaard, Ido R., Lycklama �� Nijeholt, Geert J., de Laat, Karlijn F., van Dijk, Lukas C., den Hertog, Heleen M., Flach, H. Zwenneke, Wermer, Marieke J. H., van Walderveen, Marianne A. A., Brouwers, Paul J. A. M., Bulut, Tomas, Vermeer, Sarah E., Bernsen, Marie Louise E., Uyttenboogaart, Maarten, Bokkers, Reinoud P. H., Boogaarts, Jeroen D., de Leeuw, Frank-Erik, van der Worp, H. Bart, van der Schaaf, Irene C., Schonewille, Wouter J., Vos, Jan A., Remmers, Michel J. M., Imani, Farshad, Dippel, Diederik W. J., van Zwam, Wim H., Nederkoorn, Paul J., and van Oostenbrugge, Robert J.
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Additional file 1: Supplemental table 1. Subdivision in regions. *Total number of new COVID-19 hospital admissions in all hospital in a region from March 15th, 2020 until May 11th, 2020, based on data from the Dutch public health service (GGD)16 and Statistics Netherlands (CBS)17. This illustrates the severity of crowding due to COVID-19 in a region. Supplemental figure 1. Map of the different regions with corresponding EVT-centers. *Total number of new COVID-19 hospital admissions in all hospital in a region from March 15th, 2020 until May 11th, 2020, based on data from the Dutch public health service (GGD) [16] and Statistics Netherlands (CBS) [17]. This illustrates the severity of crowding due to COVID-19 in a region. Supplemental table 2. All treated AIS-patients from March 15th until May 11th, 2020 (lockdown) and 2019 (reference), subdivided in regions. * All times are displayed in minutes.
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- 2022
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153. sj-docx-1-wso-10.1177_17474930221092262 – Supplemental material for Outcome prediction in large vessel occlusion ischemic stroke with or without endovascular stroke treatment: THRIVE-EVT
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Flint, Alexander C, Chan, Sheila L, Edwards, Nancy J, Rao, Vivek A, Klingman, Jeffrey G, Nguyen-Huynh, Mai N, Yan, Bernard, Mitchell, Peter J, Davis, Stephen M., Campbell, Bruce CV, Dippel, Diederik W, Roos, Yvo BWEM, van Zwam, Wim H, Saver, Jeffrey L, Kidwell, Chelsea S, Hill, Michael D, Goyal, Mayank, Demchuk, Andrew M, Bracard, Serge, Bendszus, Martin, and Donnan, Geoffrey A
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FOS: Clinical medicine ,Cardiology ,Medicine ,110904 Neurology and Neuromuscular Diseases - Abstract
Supplemental material, sj-docx-1-wso-10.1177_17474930221092262 for Outcome prediction in large vessel occlusion ischemic stroke with or without endovascular stroke treatment: THRIVE-EVT by Alexander C Flint, Sheila L Chan, Nancy J Edwards, Vivek A Rao, Jeffrey G Klingman, Mai N Nguyen-Huynh, Bernard Yan, Peter J Mitchell, Stephen M. Davis, Bruce CV Campbell, Diederik W Dippel, Yvo BWEM Roos, Wim H van Zwam, Jeffrey L Saver, Chelsea S Kidwell, Michael D Hill, Mayank Goyal, Andrew M Demchuk, Serge Bracard, Martin Bendszus and Geoffrey A Donnan in International Journal of Stroke
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- 2022
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154. sj-docx-1-eso-10.1177_23969873221112279 – Supplemental material for Timing of symptomatic intracranial hemorrhage after endovascular stroke treatment
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van der Steen, Wouter, van der Ende, Nadinda AM, van Kranendonk, Katinka R, Chalos, Vicky, Brouwer, Josje, van Oostenbrugge, Robert J, van Zwam, Wim H, van Doormaal, Pieter J, van Es, Adriaan CGM, Majoie, Charles BLM, van der Lugt, Aad, Dippel, Diederik WJ, and Roozenbeek, Bob
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FOS: Clinical medicine ,Cardiology ,Medicine ,110904 Neurology and Neuromuscular Diseases - Abstract
Supplemental material, sj-docx-1-eso-10.1177_23969873221112279 for Timing of symptomatic intracranial hemorrhage after endovascular stroke treatment by Wouter van der Steen, Nadinda AM van der Ende, Katinka R van Kranendonk, Vicky Chalos, Josje Brouwer, Robert J van Oostenbrugge, Wim H van Zwam, Pieter J van Doormaal, Adriaan CGM van Es, Charles BLM Majoie, Aad van der Lugt, Diederik WJ Dippel and Bob Roozenbeek in European Stroke Journal
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- 2022
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155. Association of Computed Tomography Ischemic Lesion Location With Functional Outcome in Acute Large Vessel Occlusion Ischemic Stroke
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Ernst, Marielle, Boers, Anna M.M., Aigner, Annette, Berkhemer, Olvert A., Yoo, Albert J., Roos, Yvo B., Dippel, Diederik W.J., van der Lugt, Aad, van Oostenbrugge, Robert J., van Zwam, Wim H., Fiehler, Jens, Marquering, Henk A., and Majoie, Charles B.L.M.
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- 2017
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156. Baseline Blood Pressure Effect on the Benefit and Safety of Intra-Arterial Treatment in MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands)
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Mulder, Maxim J.H.L., Ergezen, Saliha, Lingsma, Hester F., Berkhemer, Olvert A., Fransen, Puck S.S., Beumer, Debbie, van den Berg, Lucie A., Lycklama à Nijeholt, Geert, Emmer, Bart J., van der Worp, H. Bart, Nederkoorn, Paul J., Roos, Yvo B.W.E.M., van Oostenbrugge, Robert J., van Zwam, Wim H., Majoie, Charles B.L.M., van der Lugt, Aad, and Dippel, Diederik W.J.
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- 2017
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157. Associations of Ischemic Lesion Volume With Functional Outcome in Patients With Acute Ischemic Stroke: 24-Hour Versus 1-Week Imaging
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Bucker, Amber, Boers, Anna M., Bot, Joseph C.J., Berkhemer, Olvert A., Lingsma, Hester F., Yoo, Albert J., van Zwam, Wim H., van Oostenbrugge, Robert J., van der Lugt, Aad, Dippel, Diederik W.J., Roos, Yvo B.W.E.M., Majoie, Charles B.L.M., and Marquering, Henk A.
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- 2017
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158. Clot Burden Score on Baseline Computerized Tomographic Angiography and Intra-Arterial Treatment Effect in Acute Ischemic Stroke
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Treurniet, Kilian M., Yoo, Albert J., Berkhemer, Olvert A., Lingsma, Hester F., Boers, Anna M.M., Fransen, Puck S.S., Beumer, Debbie, van den Berg, Lucie A., Sprengers, Marieke E.S., Jenniskens, Sjoerd F.M., Lycklama À Nijeholt, Geert J., van Walderveen, Marianne A.A., Bot, Joseph C.J., Beenen, Ludo F.M., van den Berg, René, van Zwam, Wim H., van der Lugt, Aad, van Oostenbrugge, Robert J., Dippel, Diederik W.J., Roos, Yvo B.W.E.M., Marquering, Henk A., Majoie, Charles B.L.M., Schonewille, Wouter J., Albert Vos, Jan, Nederkoorn, Paul J., Wermer, Marieke J.H., Staals, Julie, Hofmeijer, Jeannette, van Oostayen, Jacques A., Boiten, Jelis, Brouwer, Patrick A., Emmer, Bart J., de Bruijn, Sebastiaan F., van Dijk, Lukas C., Kappelle, L. Jaap, Lo, Rob H., van Dijk, Ewoud J., de Vries, Joost, de Kort, Paul L.M., van den Berg, Jan S.P., van Rooij, Willem Jan J., van Hasselt, Boudewijn A.A.M., Aerden, Leo A.M., Dallinga, René J., Visser, Marieke C., Vroomen, Patrick C., Eshghi, Omid, Schreuder, Tobien H.C.M.L., Heijboer, Roel J.J., Keizer, Koos, Tielbeek, Alexander V., den Hertog, Heleen M., Gerrits, Dick G., van den Berg-Vos, Renske M., Karas, Giorgos B., Koudstaal, Peter J., Boiten, Jelis, van Dijk, Ewoud J., Wermer, Marieke J.H., Flach, H. Zwenneke, and Steyerberg, Ewout W
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- 2016
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159. Influence of Device Choice on the Effect of Intra-Arterial Treatment for Acute Ischemic Stroke in MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands)
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Dippel, Diederik W., Majoie, Charles B., Roos, Yvo B., van der Lugt, Aad, van Oostenbrugge, Robert J., van Zwam, Wim H., Lingsma, Hester F., Koudstaal, Peter J., Treurniet, Kilian M., van den Berg, Lucie A., Beumer, Debbie, Fransen, Puck S., and Berkhemer, Olvert A.
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- 2016
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160. Risk factors of unexplained early neurological deterioration after treatment for ischemic stroke due to large vessel occlusion: a post hoc analysis of the HERMES study.
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Bourcier, Romain, Goyal, Mayank, Muir, Keith W., Desal, Hubert, Dippel, Diederik W. J., Majoie, Charles B. L. M., van Zwam, Wim H., Jovin, Tudor G., Mitchell, Peter J., Demchuk, Andrew M., van Oostenbrugge, Robert J., Brown, Scott B., Campbell, Bruce, White, Philip, Hill, Michael D., Saver, Jeffrey L., Weimar, Christian, Jahan, Reza, Guillemin, Francis, and Bracard, Serge
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CLINICAL deterioration ,STATISTICS ,NEUROLOGICAL disorders ,CEREBRAL hemorrhage ,ISCHEMIC stroke ,MULTIPLE regression analysis ,RISK assessment ,COMPARATIVE studies ,STROKE patients ,DESCRIPTIVE statistics ,RESEARCH funding ,CORONARY occlusion ,ENDOVASCULAR surgery ,DATA analysis ,CORONARY arteries ,DISEASE risk factors ,DISEASE complications - Abstract
Background Early neurological deterioration (END) after endovascular treatment (EVT) in patients with anterior circulation acute ischemic stroke (AIS) is associated with poor outcome. END may remain unexplained by parenchymal hemorrhage (UnEND). We aim to analyze the risk factors of UnEND in the medical management (MM) and EVT arms of the HERMES study. Methods We conducted a post-hoc analysis of anterior AIS patients who underwent EVT for proximal anterior occlusions. Risk factors of UnEND, defined as a worsening of ≥4 points between baseline National Institutes of Health Stroke Scale (NIHSS) and NIHSS at 24 hours without hemorrhage, were compared between both arms using mixed logistic regression models adjusted for baseline characteristics. An interaction analysis between the EVT and MM arms for risk factors of UnEND was conducted. Results Among 1723 patients assessable for UnEND, 160 patients experienced an UnEND (9.3%), including 9.1% (78/854) in the EVT arm and 9.4% (82/869) in the MM arm. There was no significant difference in the incidence of UnEND between the two study arms. In the EVT population, independent risk factors of UnEND were lower baseline NIHSS, higher baseline glucose, and lower collateral grade. In the MM population, the only independent predictor of UnEND was higher baseline glucose. However, we did not demonstrate an interaction between EVT and MM for baseline factors as risk factors of UnEND. UnEND was, similarly in both treatment groups, a significant predictor of unfavorable outcome in both the EVT (p<0.001) and MM (p<0.001) arms. Conclusions UnEND is not an uncommon event, with a similar rate which ever treatment arm is considered. In the clinical scenario of AIS due to large vessel occlusion, no patient-related factor seems to increase the risk for UnEND when treated by EVT compared with MM. [ABSTRACT FROM AUTHOR]
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- 2023
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161. Association between type of intervention center and outcomes after endovascular treatment for acute ischemic stroke: Results from the MR CLEAN Registry.
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Olthuis, Susanne GH, Hinsenveld, Wouter H, Pinckaers, Florentina ME, Amini, Marzyeh, Lingsma, Hester F, Staals, Julie, HCML Schreuder, Tobien, Schonewille, Wouter J, Yo, Lonneke SF, BWEM Roos, Yvo, Postma, Alida A, Dippel, Diederik WJ, van Zwam, Wim H, van Oostenbrugge, Robert J, and de Ridder, Inger R
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- 2023
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162. Timing and causes of death after endovascular thrombectomy in patients with acute ischemic stroke.
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Sluis, Wouter M, Hinsenveld, Wouter H, Goldhoorn, Robert-Jan B, Potters, Lianne H, Bruggeman, Agnetha AE, van der Hoorn, Anouk, Bot, Joseph CJ, van Oostenbrugge, Robert J, Lingsma, Hester F, Hofmeijer, Jeannette, van Zwam, Wim H, BLM Majoie, Charles, and Bart van der Worp, H
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- 2023
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163. Successful reperfusion in relation to the number of passes: comparing outcomes of first pass expanded Treatment In Cerebral Ischemia (eTICI) 2B with multiple- pass eTICI 3.
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Bruggeman, Agnetha A. E., Kappelhof, Manon, den Hartog, Sanne J., Burke, James F., Berkhemer, Olvert A., van Es, Adriaan C. G. M., van Zwam, Wim H., Dippel, Diederik W. J., Coutinho, Jonathan M., Marquering, Henk A., Majoie, Charles B. L. M., and Emmer, Bart J.
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CONFIDENCE intervals ,TREATMENT effectiveness ,COMPARATIVE studies ,RESEARCH funding ,REPERFUSION ,ENDOVASCULAR surgery ,ODDS ratio ,CEREBRAL ischemia ,EVALUATION - Abstract
Background Higher expanded Treatment In Cerebral Ischemia (eTICI) reperfusion scores after endovascular treatment (EVT) are associated with better outcomes. However, the influence of the number of passes on this association is unclear. We aimed to compare outcomes of single-pass good reperfusion (eTICI 2B) with multiplepass excellent/complete reperfusion (eTICI 2C/3) in daily clinical practice. Methods We compared outcomes of patients in the MR CLEAN Registry with good reperfusion (eTICI 2B) in a single pass to those with excellent/complete reperfusion (eTICI 2C/3) in multiple passes. Regression models were used to investigate the association of single-pass eTICI 2B versus multiple- pass eTICI 2C/3 reperfusion with 90-day functional outcome (modified Rankin Scale (mRS)), functional independence (mRS 0-2), per-procedural complications and safety outcomes. Results We included 699 patients: 178 patients with single-pass eTICI 2B, and 242 and 279 patients with eTICI 2C/3 after 2 and ≥3 passes, respectively. Patients with eTICI 2C/3 after 2 or ≥3 passes did not achieve significantly better functional outcomes compared with patients with single-pass eTICI 2B (adjusted common OR (acOR) 1.06, 95% CI 0.75 to 1.50 and acOR 0.88, 95% CI 0.74 to 1.05 for 90-day mRS, and adjusted OR (aOR) 1.24, 95% CI 0.78 to 1.97 and aOR 0.79, 95% CI 0.52 to 1.22 for functional independence). Conclusions Our results did not show better outcomes for patients who achieved eTICI 2C/3 in multiple, that is, two or more, passes when compared with patients with single-pass eTICI 2B. However, this concerns observational data. Further research is necessary to investigate the per-pass effect in relation to reperfusion and functional outcome. [ABSTRACT FROM AUTHOR]
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- 2023
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164. Influence of the interventionist's experience on outcomes of endovascular thrombectomy in acute ischemic stroke: results from the MR CLEAN Registry.
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Olthuis, Susanne G. H., den Hartog, Sanne J., van Kuijk, Sander M. J., Staals, Julie, Benali, Faysal, van der Leij, Christiaan, Beumer, Debbie, Lycklama à. Nijeholt, Geert J., Uyttenboogaart, Maarten, Martens, Jasper M., van Doormaal, Pieter-Jan, Vos, Jan Albert, Emmer, Bart J., Dippel, Diederik W. J., van Zwam, Wim H., van Oostenbrugge, Robert J., and de Ridder, Inger R.
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CONFIDENCE intervals ,ISCHEMIC stroke ,WORK ,NIH Stroke Scale ,REGRESSION analysis ,TREATMENT effectiveness ,DIAGNOSTIC imaging ,THROMBECTOMY ,EXPERIENTIAL learning ,DESCRIPTIVE statistics ,RESEARCH funding ,ENDOVASCULAR surgery ,ODDS ratio - Abstract
Background The relationship between the interventionist's experience and outcomes of endovascular thrombectomy (EVT) for acute ischemic stroke of the anterior circulation, is unclear. Objective To assess the effect of the interventionist's level of experience on clinical, imaging, and workflow outcomes. Secondly, to determine which of the three experience definitions is most strongly associated with these outcome measures. Methods We analysed data from 2700 patients, included in the MR CLEAN Registry. We defined interventionist's experience as the number of procedures performed in the year preceding the intervention (EXPfreq), total number of procedures performed (EXPno), and years of experience (EXPyears). Our outcomes were the baseline-adjusted National Institutes of Health Stroke Scale (NIHSS) score at 24-48 hours post-EVT, recanalization (extended Thrombolysis in Cerebral Infarction (eTICI) score ≥2B), and procedural duration. We used multilevel regression models with interventionists as random intercept. For EXPfreq and EXPno results were expressed per 10 procedures. Results Increased EXPfreq was associated with lower 24-48 hour NIHSS scores (adjusted (a)β:-0.46, 95% CI -0.70 to -0.21). EXPno and EXPyears were not associated with short-term neurological outcomes. Increased EXPfreq and EXPno were both associated with recanalization (aOR=1.20, 95% CI 1.11 to 1.31 and aOR=1.08, 95% CI 1.04 to 1.12, respectively), and increased EXPfreq, EXPno, and EXPyears were all associated with shorter procedure times (aβ:-3.08, 95% CI-4.32 to -1.84; aβ:-1.34, 95% CI-1.84 to -0.85; and aβ:-0.79, 95% CI-1.45 to -0.13, respectively). Conclusions Higher levels of interventionist's experience are associated with better outcomes after EVT, in particular when experience is defined as the number of patients treated in the preceding year. Every 20 procedures more per year is associated with approximately one NIHSS score point decrease, an increased probability for recanalization (aOR=1.44), and a 6-minute shorter procedure time. [ABSTRACT FROM AUTHOR]
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- 2023
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165. Bifurcation occlusions and endovascular treatment outcome in acute ischemic stroke
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Arrarte Terreros, Nerea, primary, Bruggeman, Agnetha A E, additional, van Voorst, Henk, additional, Konduri, Praneeta R, additional, Jansen, Ivo G H, additional, Kappelhof, Manon, additional, Tolhuisen, Manon L, additional, Boodt, Nikki, additional, Dippel, Diederik W J, additional, van der Lugt, Aad, additional, van Zwam, Wim H, additional, van Oostenbrugge, Robert J, additional, van der Worp, H. Bart, additional, Emmer, Bart J, additional, Meijer, Frederick J A, additional, Roos, Yvo B W E M, additional, van Bavel, Ed, additional, Marquering, Henk A, additional, and Majoie, Charles B L M, additional
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- 2022
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166. Risk factors of unexplained early neurological deterioration after treatment for ischemic stroke due to large vessel occlusion: a post hoc analysis of the HERMES study
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Bourcier, Romain, primary, Goyal, Mayank, additional, Muir, Keith W, additional, Desal, Hubert, additional, Dippel, Diederik W J, additional, Majoie, Charles B L M, additional, van Zwam, Wim H, additional, Jovin, Tudor G, additional, Mitchell, Peter J, additional, Demchuk, Andrew M, additional, van Oostenbrugge, Robert J, additional, Brown, Scott B, additional, Campbell, Bruce, additional, White, Philip, additional, Hill, Michael D, additional, Saver, Jeffrey L, additional, Weimar, Christian, additional, Jahan, Reza, additional, Guillemin, Francis, additional, Bracard, Serge, additional, and Naggara, Olivier, additional
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- 2022
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167. Prediction of Stroke Infarct Growth Rates by Baseline Perfusion Imaging
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Wouters, Anke, primary, Robben, David, additional, Christensen, Soren, additional, Marquering, Henk A., additional, Roos, Yvo B.W.E.M., additional, van Oostenbrugge, Robert J., additional, van Zwam, Wim H., additional, Dippel, Diederik W.J., additional, Majoie, Charles B.L.M., additional, Schonewille, Wouter J., additional, van der Lugt, Aad, additional, Lansberg, Maarten, additional, Albers, Gregory W., additional, Suetens, Paul, additional, and Lemmens, Robin, additional
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- 2022
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168. Successful reperfusion in relation to the number of passes: comparing outcomes of first pass expanded Treatment In Cerebral Ischemia (eTICI) 2B with multiple-pass eTICI 3
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Bruggeman, Agnetha A E, primary, Kappelhof, Manon, additional, den Hartog, Sanne J, additional, Burke, James F, additional, Berkhemer, Olvert A, additional, van Es, Adriaan C G M, additional, van Zwam, Wim H, additional, Dippel, Diederik W J, additional, Coutinho, Jonathan M, additional, Marquering, Henk A, additional, Majoie, Charles B L M, additional, and Emmer, Bart J, additional
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- 2022
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169. Influence of the interventionist’s experience on outcomes of endovascular thrombectomy in acute ischemic stroke: results from the MR CLEAN Registry
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Olthuis, Susanne G H, primary, den Hartog, Sanne J, additional, van Kuijk, Sander M J, additional, Staals, Julie, additional, Benali, Faysal, additional, van der Leij, Christiaan, additional, Beumer, Debbie, additional, Lycklama à Nijeholt, Geert J, additional, Uyttenboogaart, Maarten, additional, Martens, Jasper M, additional, van Doormaal, Pieter-Jan, additional, Vos, Jan Albert, additional, Emmer, Bart J, additional, Dippel, Diederik W J, additional, van Zwam, Wim H, additional, van Oostenbrugge, Robert J, additional, and de Ridder, Inger R, additional
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- 2022
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170. Efficacy of Radiation Safety Glasses in Interventional Radiology
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van Rooijen, Bart D., de Haan, Michiel W., Das, Marco, Arnoldussen, Carsten W. K. P., de Graaf, R., van Zwam, Wim H., Backes, Walter H., and Jeukens, Cécile R. L. P. N.
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- 2014
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171. Supplement to: Supplement to “A randomized trial of intra-arterial treatment for acute ischemic stroke”
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Berkhemer, Olvert A., Fransen, Puck S.S., Beumer, Debbie, van den Berg, Lucie A., Lingsma, Hester F., Yoo, Albert J., Schonewille, Wouter J., Vos, Jan Albert, Nederkoorn, Paul J., Wermer, Marieke J.H., van Walderveen, Marianne A.A., Staals, Julie, Hofmeijer, Jeannette, van Oostayen, Jacques A., Lycklama à Nijeholt, Geert J., Boiten, Jelis, Brouwer, Patrick A., Emmer, Bart J., de Bruijn, Sebastiaan F., van Dijk, Lukas C., Kappelle, Jaap L., Lo, Rob H., van Dijk, Ewoud J., Vries, Joost de, de Kort, Paul L.M., van Rooij, Willem Jan J., van den Berg, Jan S.P., van Hasselt, Boudewijn A.A.M., Aerden, Leo A.M., Dallinga, Rene J., Visser, Marieke C., Bot, Joseph C.J., Vroomen, Patrick C., Eshghi, Omid, Schreuder, Tobien H.C.M.L., Heijboer, Roel J.J., Keizer, Koos, Tielbeek, Alexander V., den Hertog, Heleen M., Gerrits, Dick G., van den Berg-Vos, Renske M., Karas, Giorgos B., Steyerberg, Ewout W., Flach, Zwenneke H., Marquering, Henk A., Sprengers, Marieke E.S., Jenniskens, Sjoerd F.M., Beenen, Ludo F.M., den Berg, Rene van, Koudstaal, Peter J., van Zwam, Wim H., Roos, Yvo B.W.E.M., der Lugt, Aad van, van Oostenbrugge, Robert J., Majoie, Charles B.L.M., and Dippel, Diederik W.J.
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- 2015
172. Hospital Variation in Time to Endovascular Treatment for Ischemic Stroke: What Is the Optimal Target for Improvement?
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den Hartog, Sanne J., primary, Lingsma, Hester F., additional, van Doormaal, Pieter‐Jan, additional, Hofmeijer, Jeannette, additional, Yo, Lonneke S. F., additional, Majoie, Charles B. L. M., additional, Dippel, Diederik W. J., additional, van der Lugt, Aad, additional, Roozenbeek, Bob, additional, Roos, Yvo B. W. E. M., additional, van Oostenbrugge, Robert J., additional, van Zwam, Wim H., additional, Boiten, Jelis, additional, Vos, Jan Albert, additional, Jansen, Ivo G. H., additional, Mulder, Maxim J. H. L., additional, Goldhoorn, Robert‐ Jan B., additional, Compagne, Kars C. J., additional, Kappelhof, Manon, additional, Brouwer, Josje, additional, den Hartog, Sanne J., additional, Hinsenveld, Wouter H., additional, van Es, Adriaan C. G. M., additional, Emmer, Bart J., additional, Coutinho, Jonathan M., additional, Schonewille, Wouter J., additional, Wermer, Marieke J. H., additional, van Walderveen, Marianne A. A., additional, Staals, Julie, additional, Martens, Jasper M., additional, Lycklama à Nijeholt, Geert J., additional, de Bruijn, Sebastiaan F., additional, van Dijk, Lukas C., additional, van der Worp, H. Bart, additional, Lo, Rob H., additional, van Dijk, Ewoud J., additional, Boogaarts, Hieronymus D., additional, de Vries, J., additional, de Kort, Paul L. M., additional, van Tuijl, Julia, additional, Peluso, Jo P., additional, Fransen, Puck, additional, van den Berg, Jan S. P., additional, van Hasselt, Boudewijn A. A. M., additional, Aerden, Leo A. M., additional, Dallinga, René J., additional, Uyttenboogaart, Maarten, additional, Eschgi, Omid, additional, Bokkers, Reinoud P. H., additional, Schreuder, Tobien H. C. M. L., additional, Heijboer, Roel J. J., additional, Keizer, Koos, additional, den Hertog, Heleen M., additional, Sturm, Emiel J. C., additional, Brouwers, Paul J. A. M., additional, Sprengers, Marieke E. S., additional, Jenniskens, Sjoerd F. M., additional, van den Berg, René, additional, Yoo, Albert J., additional, Beenen, Ludo F. M., additional, Postma, Alida A., additional, Roosendaal, Stefan D., additional, van der Kallen, Bas F. W., additional, van den Wijngaard, Ido R., additional, Bot, Joost, additional, Meijer, Anton, additional, Ghariq, Elyas, additional, van Proosdij, Marc P., additional, Menno Krietemeijer, G., additional, Gerrits, Dick, additional, Dinkelaar, Wouter, additional, Appelman, Auke P. A., additional, Hammer, Bas, additional, Pegge, Sjoert, additional, van der Hoorn, Anouk, additional, Vinke, Saman, additional, Zwenneke Flach, H, additional, Ghannouti, Naziha el, additional, Sterrenberg, Martin, additional, Pellikaan, Wilma, additional, Sprengers, Rita, additional, Elfrink, Marjan, additional, Simons, Michelle, additional, Vossers, Marjolein, additional, de Meris, Joke, additional, Vermeulen, Tamara, additional, Geerlings, Annet, additional, van Vemde, Gina, additional, Simons, Tiny, additional, Messchendorp, Gert, additional, Nicolaij, Nynke, additional, Bongenaar, Hester, additional, Bodde, Karin, additional, Kleijn, Sandra, additional, Lodico, Jasmijn, additional, Droste, Hanneke, additional, Wollaert, Maureen, additional, Verheesen, Sabrina, additional, Jeurrissen, D., additional, Bos, Erna, additional, Drabbe, Yvonne, additional, Sandiman, Michelle, additional, Aaldering, Nicoline, additional, Zweedijk, Berber, additional, Vervoort, Jocova, additional, Ponjee, Eva, additional, Romviel, Sharon, additional, Kanselaar, Karin, additional, Barning, Denn, additional, Venema, Esmee, additional, Chalos, Vicky, additional, Geuskens, Ralph R., additional, van Straaten, Tim, additional, Ergezen, Saliha, additional, Harmsma, Roger R. M., additional, Muijres, Daan, additional, de Jong, Anouk, additional, Berkhemer, Olvert A., additional, Boers, Anna M. M., additional, Huguet, J., additional, Groot, P. F. C., additional, Mens, Marieke A., additional, van Kranendonk, Katinka R., additional, Treurniet, Kilian M., additional, Tolhuisen, Manon L., additional, Alves, Heitor, additional, Weterings, Annick J., additional, Kirkels, Eleonora L. F., additional, Voogd, Eva J. H. F., additional, Schupp, Lieve M., additional, Collette, Sabine L., additional, Groot, Adrien E. D., additional, LeCouffe, Natalie E., additional, Konduri, Praneeta R., additional, Prasetya, Haryadi, additional, Arrarte‐Terreros, Nerea, additional, and Ramos, Lucas A., additional
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- 2021
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173. A Randomized Trial of Intravenous Alteplase before Endovascular Treatment for Stroke
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LeCouffe, Natalie E., primary, Kappelhof, Manon, additional, Treurniet, Kilian M., additional, Rinkel, Leon A., additional, Bruggeman, Agnetha E., additional, Berkhemer, Olvert A., additional, Wolff, Lennard, additional, van Voorst, Henk, additional, Tolhuisen, Manon L., additional, Dippel, Diederik W.J., additional, van der Lugt, Aad, additional, van Es, Adriaan C.G.M., additional, Boiten, Jelis, additional, Lycklama à Nijeholt, Geert J., additional, Keizer, Koos, additional, Gons, Rob A.R., additional, Yo, Lonneke S.F., additional, van Oostenbrugge, Robert J., additional, van Zwam, Wim H., additional, Roozenbeek, Bob, additional, van der Worp, H. Bart, additional, Lo, Rob T.H., additional, van den Wijngaard, Ido R., additional, de Ridder, Inger R., additional, Costalat, Vincent, additional, Arquizan, Caroline, additional, Lemmens, Robin, additional, Demeestere, Jelle, additional, Hofmeijer, Jeannette, additional, Martens, Jasper M., additional, Schonewille, Wouter J., additional, Vos, Jan-Albert, additional, Uyttenboogaart, Maarten, additional, Bokkers, Reinoud P.H., additional, van Tuijl, Julia H., additional, Kortman, Hans, additional, Schreuder, Floris H.B.M., additional, Boogaarts, Hieronymus D., additional, de Laat, Karlijn F., additional, van Dijk, Lukas C., additional, den Hertog, Heleen M., additional, van Hasselt, Boudewijn A.A.M., additional, Brouwers, Paul J.A.M., additional, Bulut, Tomas, additional, Remmers, Michel J.M., additional, van Norden, Anouk, additional, Imani, Farshad, additional, Rozeman, Anouk D., additional, Elgersma, Otto E.H., additional, Desfontaines, Philippe, additional, Brisbois, Denis, additional, Samson, Yves, additional, Clarençon, Frédéric, additional, Krietemeijer, G. Menno, additional, Postma, Alida A., additional, van Doormaal, Pieter-Jan, additional, van den Berg, René, additional, van der Hoorn, Anouk, additional, Beenen, Ludo F.M., additional, Nieboer, Daan, additional, Lingsma, Hester F., additional, Emmer, Bart J., additional, Coutinho, Jonathan M., additional, Majoie, Charles B.L.M., additional, and Roos, Yvo B.W.E.M., additional
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- 2021
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174. Endovascular treatment for calcified cerebral emboli in patients with acute ischemic stroke
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Bruggeman, Agnetha A. E., primary, Kappelhof, Manon, additional, Arrarte Terreros, Nerea, additional, Tolhuisen, Manon L., additional, Konduri, Praneeta R., additional, Boodt, Nikki, additional, van Beusekom, Heleen M. M., additional, Hund, Hajo M., additional, Taha, Aladdin, additional, van der Lugt, Aad, additional, Roos, Yvo B. W. E. M., additional, van Es, Adriaan C. G. M., additional, van Zwam, Wim H., additional, Postma, Alida A., additional, Dippel, Diederik W. J., additional, Lingsma, Hester F., additional, Marquering, Henk A., additional, Emmer, Bart J., additional, Majoie, Charles B. L. M., additional, and _, _, additional
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- 2021
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175. Brain atrophy and endovascular treatment effect in acute ischemic stroke: a secondary analysis of the MR CLEAN trial
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Luijten, Sven PR, primary, Compagne, Kars CJ, additional, van Es, Adriaan CGM, additional, Roos, Yvo BWEM, additional, Majoie, Charles BLM, additional, van Oostenbrugge, Robert J, additional, van Zwam, Wim H, additional, Dippel, Diederik WJ, additional, Wolters, Frank J, additional, van der Lugt, Aad, additional, and Bos, Daniel, additional
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- 2021
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176. The Capillary Index Score as a Marker of Viable Cerebral Tissue: Proof of Concept—The Capillary Index Score in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Trial
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Al-Ali, Firas, Berkhemer, Olvert A., Yousman, Wina P., Elias, John J., Bender, Evin N., Lingsma, Hester F., van der Lugt, Aad, Dippel, Diederik W.J., Roos, Yvo B.W.E.M., van Oostenbrugge, Robert J., van Zwam, Wim H., Dillon, William P., and Majoie, Charles B.L.M.
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- 2016
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177. Collateral Status on Baseline Computed Tomographic Angiography and Intra-Arterial Treatment Effect in Patients With Proximal Anterior Circulation Stroke
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Berkhemer, Olvert A., Jansen, Ivo G.H., Beumer, Debbie, Fransen, Puck S.S., van den Berg, Lucie A., Yoo, Albert J., Lingsma, Hester F., Sprengers, Marieke E.S., Jenniskens, Sjoerd F.M., Lycklama à Nijeholt, Geert J., van Walderveen, Marianne A.A., van den Berg, René, Bot, Joseph C.J., Beenen, Ludo F.M., Boers, Anna M.M., Slump, Cornelis H., Roos, Yvo B.W.E.M., van Oostenbrugge, Robert J., Dippel, Diederik W.J., van der Lugt, Aad, van Zwam, Wim H., Marquering, Henk A., and Majoie, Charles B.L.M.
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- 2016
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178. Thrombus Permeability Is Associated With Improved Functional Outcome and Recanalization in Patients With Ischemic Stroke
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Santos, Emilie M.M., Marquering, Henk A., den Blanken, Mark D., Berkhemer, Olvert A., Boers, Anna M.M., Yoo, Albert J., Beenen, Ludo F., Treurniet, Kilian M., Wismans, Carrie, van Noort, Kim, Lingsma, Hester F., Dippel, Diederik W.J., van der Lugt, Aad, van Zwam, Wim H., Roos, Yvo B.W.E.M., van Oostenbrugge, Robert J., Niessen, Wiro J., and Majoie, Charles B.
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- 2016
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179. Time to Reperfusion and Treatment Effect for Acute Ischemic Stroke: A Randomized Clinical Trial
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Fransen, Puck S. S., Berkhemer, Olvert A., Lingsma, Hester F., Beumer, Debbie, van den Berg, Lucie A., Yoo, Albert J., Schonewille, Wouter J., Vos, Jan Albert, Nederkoorn, Paul J., Wermer, Marieke J. H., van Walderveen, Marianne A. A., Staals, Julie, Hofmeijer, Jeannette, van Oostayen, Jacques A., Lycklama à Nijeholt, Geert J., Boiten, Jelis, Brouwer, Patrick A., Emmer, Bart J., de Bruijn, Sebastiaan F., van Dijk, Lukas C., Kappelle, L. Jaap, Lo, Rob H., van Dijk, Ewoud J., de Vries, Joost, de Kort, Paul L. M., van den Berg, J. S. Peter, van Hasselt, Boudewijn A. A. M., Aerden, Leo A. M., Dallinga, René J., Visser, Marieke C., Bot, Joseph C. J., Vroomen, Patrick C., Eshghi, Omid, Schreuder, Tobien H. C. M. L., Heijboer, Roel J. J., Keizer, Koos, Tielbeek, Alexander V., den Hertog, Heleen M., Gerrits, Dick G., van den Berg-Vos, Renske M., Karas, Giorgos B., Steyerberg, Ewout W., Flach, H. Zwenneke, Marquering, Henk A., Sprengers, Marieke E. S., Jenniskens, Sjoerd F. M., Beenen, Ludo F. M., van den Berg, René, Koudstaal, Peter J., van Zwam, Wim H., Roos, Yvo B.W. E. M., van Oostenbrugge, Robert J., Majoie, Charles B. L. M., van der Lugt, Aad, and Dippel, Diederik W. J.
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- 2016
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180. Brain atrophy and endovascular treatment effect in acute ischemic stroke: a secondary analysis of the MR CLEAN trial.
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Luijten, Sven PR, Compagne, Kars CJ, van Es, Adriaan CGM, Roos, Yvo BWEM, Majoie, Charles BLM, van Oostenbrugge, Robert J, van Zwam, Wim H, Dippel, Diederik WJ, Wolters, Frank J, van der Lugt, Aad, and Bos, Daniel
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CEREBRAL atrophy ,ENDOVASCULAR surgery ,ISCHEMIC stroke ,TREATMENT effectiveness ,STROKE patients - Abstract
Background: Brain atrophy is suggested to impair the potential for functional recovery after acute ischemic stroke. We assessed whether the effect of endovascular treatment is modified by brain atrophy in patients with acute ischemic stroke due to large vessel occlusion. Methods: We used data from MR CLEAN, a multicenter trial including patients with acute ischemic stroke due to anterior circulation large vessel occlusion randomized to endovascular treatment plus medical care (intervention) versus medical care alone (control). We segmented total brain volume (TBV) and intracranial volume (ICV) on baseline non-contrast computed tomography (n = 410). Next, we determined the degree of atrophy as the proportion of brain volume in relation to head size (1 − TBV/ICV) × 100%, analyzed as continuous variable and in tertiles. The primary outcome was a shift towards better functional outcome on the modified Rankin Scale expressed as adjusted common odds ratio. Treatment effect modification was tested using an interaction term between brain atrophy (as continuous variable) and treatment allocation. Results: We found that brain atrophy significantly modified the effect of endovascular treatment on functional outcome (P for interaction = 0.04). Endovascular treatment led to larger shifts towards better functional outcome in the higher compared to the lower range of atrophy (adjusted common odds ratio, 1.86 [95% CI: 0.97–3.56] in the lowest tertile vs. 1.97 [95% CI: 1.03–3.74] in the middle tertile vs. 3.15 [95% CI: 1.59–6.24] in the highest tertile). Conclusion: Benefit of endovascular treatment is larger in the higher compared to the lower range of atrophy, demonstrating that advanced atrophy should not be used as an argument to withhold endovascular treatment. [ABSTRACT FROM AUTHOR]
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- 2022
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181. Endovascular Therapy Is Effective and Safe for Patients With Severe Ischemic Stroke: Pooled Analysis of Interventional Management of Stroke III and Multicenter Randomized Clinical Trial of Endovascular Therapy for Acute Ischemic Stroke in the Netherlands Data
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Broderick, Joseph P., Berkhemer, Olvert A., Palesch, Yuko Y., Dippel, Diederik W.J., Foster, Lydia D., Roos, Yvo B.W.E.M., van der Lugt, Aad, Tomsick, Thomas A., Majoie, Charles B.L.M., van Zwam, Wim H., Demchuk, Andrew M., van Oostenbrugge, Robert J., Khatri, Pooja, Lingsma, Hester F., Hill, Michael D., Roozenbeek, Bob, Jauch, Edward C., Jovin, Tudor G., Yan, Bernard, von Kummer, Rüdiger, Molina, Carlos A., Goyal, Mayank, Schonewille, Wouter J., Mazighi, Mikael, Engelter, Stefan T., Anderson, Craig S., Spilker, Judith, Carrozzella, Janice, Ryckborst, Karla J., Janis, L. Scott, and Simpson, Kit N.
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- 2015
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182. Value of Computed Tomographic Perfusion–Based Patient Selection for Intra-Arterial Acute Ischemic Stroke Treatment
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Borst, Jordi, Berkhemer, Olvert A., Roos, Yvo B.W.E.M., van Bavel, Ed, van Zwam, Wim H., van Oostenbrugge, Robert J., van Walderveen, Marianne A.A., Lingsma, Hester F., van der Lugt, Aad, Dippel, Diederik W.J., Yoo, Albert J., Marquering, Henk A., and Majoie, Charles B.L.M.
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- 2015
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183. autoTICI: Automatic Brain Tissue Reperfusion Scoring on 2D DSA Images of Acute Ischemic Stroke Patients
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Su, Ruisheng, primary, Cornelissen, Sandra A. P., additional, van der Sluijs, Matthijs, additional, van Es, Adriaan C. G. M., additional, van Zwam, Wim H., additional, Dippel, Diederik W. J., additional, Lycklama, Geert, additional, van Doormaal, Pieter Jan, additional, Niessen, Wiro J., additional, van der Lugt, Aad, additional, and van Walsum, Theo, additional
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- 2021
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184. White Matter Lesions and Outcomes After Endovascular Treatment for Acute Ischemic Stroke: MR CLEAN Registry Results
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Uniken Venema, Simone M., primary, Postma, Alida A., additional, van den Wijngaard, Ido R., additional, Vos, Jan Albert, additional, Lingsma, Hester F., additional, Bokkers, Reinoud P.H., additional, Hofmeijer, Jeannette, additional, Dippel, Diederik W.J., additional, Majoie, Charles B., additional, van der Worp, H. Bart, additional, Lugt, Aad van der, additional, Roos, Yvo B.W.E.M., additional, van Oostenbrugge, Robert J., additional, van Zwam, Wim H., additional, Boiten, Jelis, additional, Jansen, Ivo G.H., additional, Mulder, Maxim J.H.L., additional, Goldhoorn, Robert- Jan B., additional, Compagne, Kars C.J., additional, Kappelhof, Manon, additional, Brouwer, Josje, additional, den Hartog, Sanne J., additional, Hinsenveld, Wouter H., additional, Roozenbeek, Bob, additional, van Es, Adriaan C.G.M., additional, Emmer, Bart J., additional, Coutinho, Jonathan M., additional, Schonewille, Wouter J., additional, Wermer, Marieke J.H., additional, van Walderveen, Marianne A.A., additional, Staals, Julie, additional, Martens, Jasper M., additional, Lycklama à Nijeholt, Geert J., additional, de Bruijn, Sebastiaan F., additional, van Dijk, Lukas C., additional, Lo, Rob H., additional, van Dijk, Ewoud J., additional, Boogaarts, Hieronymus D., additional, de Vries, J., additional, de Kort, Paul L.M., additional, van Tuijl, Julia, additional, Peluso, Jo P., additional, Fransen, Puck, additional, van den Berg, Jan S.P., additional, van Hasselt, Boudewijn A.A.M., additional, Aerden, Leo A.M., additional, Dallinga, René J., additional, Uyttenboogaart, Maarten, additional, Eschgi, Omid, additional, Schreuder, Tobien H.C.M.L., additional, Heijboer, Roel J.J., additional, Keizer, Koos, additional, Yo, Lonneke S.F., additional, den Hertog, Heleen M., additional, Sturm, Emiel J.C., additional, Brouwers, Paul J.A.M., additional, van der Lugt, Aad, additional, Sprengers, Marieke E.S., additional, Jenniskens, Sjoerd F.M., additional, van den Berg, René, additional, Yoo, Albert J., additional, Beenen, Ludo F.M., additional, Roosendaal, Stefan D., additional, van der Kallen, Bas F.W., additional, Bot, Joost, additional, van Doormaal, Pieter-Jan, additional, Meijer, Anton, additional, Ghariq, Elyas, additional, van Proosdij, Marc P., additional, Krietemeijer, G. Menno, additional, Lo, Rob, additional, Gerrits, Dick, additional, Dinkelaar, Wouter, additional, Appelman, Auke P.A., additional, Hammer, Bas, additional, Pegge, Sjoert, additional, van der Hoorn, Anouk, additional, Vinke, Saman, additional, Flach, H. Zwenneke, additional, el Ghannouti, Naziha, additional, Sterrenberg, Martin, additional, Pellikaan, Wilma, additional, Sprengers, Rita, additional, Elfrink, Marjan, additional, Simons, Michelle, additional, Vossers, Marjolein, additional, de Meris, Joke, additional, Vermeulen, Tamara, additional, Geerlings, Annet, additional, van Vemde, Gina, additional, Simons, Tiny, additional, Messchendorp, Gert, additional, Nicolaij, Nynke, additional, Bongenaar, Hester, additional, Bodde, Karin, additional, Kleijn, Sandra, additional, Lodico, Jasmijn, additional, Droste, Hanneke, additional, Wollaert, Maureen, additional, Verheesen, Sabrina, additional, Jeurrissen, D., additional, Bos, Erna, additional, Drabbe, Yvonne, additional, Sandiman, Michelle, additional, Aaldering, Nicoline, additional, Zweedijk, Berber, additional, Vervoort, Jocova, additional, Ponjee, Eva, additional, Romviel, Sharon, additional, Kanselaar, Karin, additional, Barning, Denn, additional, Venema, Esmee, additional, Chalos, Vicky, additional, Geuskens, Ralph R., additional, van Straaten, Tim, additional, Ergezen, Saliha, additional, Harmsma, Roger R.M., additional, Muijres, Daan, additional, de Jong, Anouk, additional, Berkhemer, Olvert A., additional, Boers, Anna M.M., additional, Huguet, J., additional, Groot, P.F.C., additional, Mens, Marieke A., additional, van Kranendonk, Katinka R., additional, Treurniet, Kilian M., additional, Tolhuisen, Manon L., additional, Alves, Heitor, additional, Weterings, Annick J., additional, Kirkels, Eleonora L.F., additional, Voogd, Eva J.H.F., additional, Schupp, Lieve M., additional, Collette, Sabine L., additional, Groot, Adrien E.D., additional, LeCouffe, Natalie E., additional, Konduri, Praneeta R., additional, Prasetya, Haryadi, additional, Arrarte-Terreros, Nerea, additional, and Ramos, Lucas A., additional
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- 2021
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185. Diagnostic performance of an algorithm for automated large vessel occlusion detection on CT angiography
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Luijten, Sven P R, primary, Wolff, Lennard, additional, Duvekot, Martijne H C, additional, van Doormaal, Pieter-Jan, additional, Moudrous, Walid, additional, Kerkhoff, Henk, additional, Lycklama a Nijeholt, Geert J, additional, Bokkers, Reinoud P H, additional, Yo, Lonneke S F, additional, Hofmeijer, Jeannette, additional, van Zwam, Wim H, additional, van Es, Adriaan C G M, additional, Dippel, Diederik W J, additional, Roozenbeek, Bob, additional, and van der Lugt, Aad, additional
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- 2021
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186. From Three-Months to Five-Years: Sustaining Long-Term Benefits of Endovascular Therapy for Ischemic Stroke
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Ganesh, Aravind, primary, Ospel, Johanna Maria, additional, Marko, Martha, additional, van Zwam, Wim H., additional, Roos, Yvo B. W. E. M., additional, Majoie, Charles B. L. M., additional, and Goyal, Mayank, additional
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- 2021
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187. Predictors of poor outcome despite successful endovascular treatment for ischemic stroke: results from the MR CLEAN Registry
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van de Graaf, Rob A, primary, Samuels, Noor, additional, Chalos, Vicky, additional, Lycklama a Nijeholt, Geert J, additional, van Beusekom, Heleen, additional, Yoo, Albert J, additional, van Zwam, Wim H, additional, Majoie, Charles B L M, additional, Roos, Yvo B W E M, additional, van Doormaal, Pieter Jan, additional, Ben Hassen, Wagih, additional, van der Lugt, Aad, additional, Dippel, Diederik W J, additional, Lingsma, Hester F, additional, van Es, Adriaan C G M, additional, and Roozenbeek, Bob, additional
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- 2021
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188. Stent-Retriever Thrombectomy for Stroke
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Berkhemer, Olvert A., van Zwam, Wim H., and Dippel, Diederik W.J.
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- 2015
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189. Type of Anesthesia and Differences in Clinical Outcome After Intra-Arterial Treatment for Ischemic Stroke
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van den Berg, Lucie A., Koelman, Diederik L.H., Berkhemer, Olvert A., Rozeman, Anouk D., Fransen, Puck S.S., Beumer, Debbie, Dippel, Diederik W., van der Lugt, Aad, van Oostenbrugge, Robert J., van Zwam, Wim H., Brouwer, Patrick A., Jenniskens, Sjoerd, Boiten, Jelis, Lycklama à Nijeholt, Geert A., Vos, Jan Albert, Schonewille, Wouter J., Majoie, Charles B.L.M., Roos, Yvo B.W.E.M., de Bruijn, Sebastiaan, van Dijk, Lukas, Kappelle, Jaap, Lo, Rob, de Kort, Paul, van Rooij, Willem Jan, Hofmeijer, Jeannette, van Oostayen, Jacques, van Dijk, Ewoud, de Vries, Joost, Schreuder, Tobien, Heijboer, Roel, Vroomen, Patrick, Eshghi, Omid, Aerden, Leo, Dallinga, René, van den Berg, Jan, van Hasselt, Boudewijn, den Hertog, Heleen, Tielbeek, Alexander, Wermer, Marieke, and van Walderveen, Marianne
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- 2015
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190. A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke
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Berkhemer, Olvert A., Fransen, Puck S.S., Beumer, Debbie, van den Berg, Lucie A., Lingsma, Hester F., Yoo, Albert J., Schonewille, Wouter J., Vos, Jan Albert, Nederkoorn, Paul J., Wermer, Marieke J.H., van Walderveen, Marianne A.A., Staals, Julie, Hofmeijer, Jeannette, van Oostayen, Jacques A., Lycklama à Nijeholt, Geert J., Boiten, Jelis, Brouwer, Patrick A., Emmer, Bart J., de Bruijn, Sebastiaan F., van Dijk, Lukas C., Kappelle, Jaap L., Lo, Rob H., van Dijk, Ewoud J., de Vries, Joost, de Kort, Paul L.M., van Rooij, Willem Jan J., van den Berg, Jan S.P., van Hasselt, Boudewijn A.A.M., Aerden, Leo A.M., Dallinga, René J., Visser, Marieke C., Bot, Joseph C.J., Vroomen, Patrick C., Eshghi, Omid, Schreuder, Tobien H.C.M.L., Heijboer, Roel J.J., Keizer, Koos, Tielbeek, Alexander V., den Hertog, Heleen M., Gerrits, Dick G., van den Berg-Vos, Renske M., Karas, Giorgos B., Steyerberg, Ewout W., Flach, Zwenneke H., Marquering, Henk A., Sprengers, Marieke E.S., Jenniskens, Sjoerd F.M., Beenen, Ludo F.M., van den Berg, René, Koudstaal, Peter J., van Zwam, Wim H., Roos, Yvo B.W.E.M., van der Lugt, Aad, van Oostenbrugge, Robert J., Majoie, Charles B.L.M., and Dippel, Diederik W.J.
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- 2015
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191. Prediction of Outcome and Endovascular Treatment Benefit: Validation and Update of the MR PREDICTS Decision Tool.
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Venema, Esmee, Venema, Esmee, Roozenbeek, Bob, Mulder, Maxim JHL, Brown, Scott, Majoie, Charles BLM, Steyerberg, Ewout W, Demchuk, Andrew M, Muir, Keith W, Dávalos, Antoni, Mitchell, Peter J, Bracard, Serge, Berkhemer, Olvert A, Lycklama À Nijeholt, Geert J, van Oostenbrugge, Robert J, Roos, Yvo BWEM, van Zwam, Wim H, van der Lugt, Aad, Hill, Michael D, White, Philip, Campbell, Bruce CV, Guillemin, Francis, Saver, Jeffrey L, Jovin, Tudor G, Goyal, Mayank, Dippel, Diederik WJ, Lingsma, Hester F, HERMES collaborators and MR CLEAN Registry Investigators*, Venema, Esmee, Venema, Esmee, Roozenbeek, Bob, Mulder, Maxim JHL, Brown, Scott, Majoie, Charles BLM, Steyerberg, Ewout W, Demchuk, Andrew M, Muir, Keith W, Dávalos, Antoni, Mitchell, Peter J, Bracard, Serge, Berkhemer, Olvert A, Lycklama À Nijeholt, Geert J, van Oostenbrugge, Robert J, Roos, Yvo BWEM, van Zwam, Wim H, van der Lugt, Aad, Hill, Michael D, White, Philip, Campbell, Bruce CV, Guillemin, Francis, Saver, Jeffrey L, Jovin, Tudor G, Goyal, Mayank, Dippel, Diederik WJ, Lingsma, Hester F, and HERMES collaborators and MR CLEAN Registry Investigators*
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Background and purposeBenefit of early endovascular treatment (EVT) for ischemic stroke varies considerably among patients. The MR PREDICTS decision tool, derived from MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), predicts outcome and treatment benefit based on baseline characteristics. Our aim was to externally validate and update MR PREDICTS with data from international trials and daily clinical practice.MethodsWe used individual patient data from 6 randomized controlled trials within the HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) collaboration to validate the original model. Then, we updated the model and performed a second validation with data from the observational MR CLEAN Registry. Primary outcome was functional independence (defined as modified Rankin Scale score 0–2) 3 months after stroke. Treatment benefit was defined as the difference between the probability of functional independence with and without EVT. Discriminative performance was evaluated using a concordance (C) statistic.ResultsWe included 1242 patients from HERMES (633 assigned to EVT, 609 assigned to control) and 3156 patients from the MR CLEAN Registry (all of whom underwent EVT within 6.5 hours). The C-statistic for functional independence was 0.74 (95% CI, 0.72–0.77) in HERMES and, after model updating, 0.80 (0.78–0.82) in the Registry. Median predicted treatment benefit of routinely treated patients (Registry) was 10.3% (interquartile range, 5.8%–14.4%). Patients with low (<1%) predicted treatment benefit (n=135/3156 [4.3%]) had low rates of functional independence, irrespective of reperfusion status, suggesting potential absence of treatment benefit. The updated model was made available online for clinicians and researchers at www.mrpredicts.com.ConclusionsBecause of the substantial treatment effect and small potential harm of EVT, most patients arriving within 6 hours
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- 2021
192. Effect of Heparinized Flush Concentration on Safety and Efficacy During Endovascular Thrombectomy for Acute Ischemic Stroke:Results from the MR CLEAN Registry
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Benali, Faysal, Hinsenveld, Wouter H., van der Leij, Christiaan, Roozenbeek, Bob, van de Graaf, Rob A., Staals, Julie, Lingsma, Hester F., van der Lugt, Aad, Majoie, Charles B.M., van Zwam, Wim H., Benali, Faysal, Hinsenveld, Wouter H., van der Leij, Christiaan, Roozenbeek, Bob, van de Graaf, Rob A., Staals, Julie, Lingsma, Hester F., van der Lugt, Aad, Majoie, Charles B.M., and van Zwam, Wim H.
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Background: Currently, there are no recommendations regarding the use of heparinized flush during endovascular thrombectomy (EVT) for acute ischemic stroke. Periprocedural heparin could, however, affect functional outcome and symptomatic intracranial hemorrhage (sICH). We surveyed protocols on heparin flush concentrations in Dutch EVT centers and assessed its effect on safety and efficacy outcomes. Methods: Patients registered in the MR CLEAN Registry, from 2014 up to 2017 were included. We collected data on center protocols regarding heparin flush concentrations (IU/L) and grouped patients by their per protocol administered heparin flush concentration. We used a random effects model with random intercepts by EVT center and analyzed endpoints using regression models. Endpoints were sICH, mRS at 90 days, mortality and reperfusion rates. Results: A total of 3157 patients were included of which 45% (6 centers) received no heparin in the flush fluids, 1.8% (1 center) received flush fluids containing 2000 IU/L heparin, 26% (4 centers) received 5000 IU/L, 22% (4 centers) received 10.000 IU/L and 5.6% (1 center) received 25.000 IU/L. Higher heparin concentration was associated with increased sICH (aOR 1.15; 95% CI 1.02–1.29), but not with functional outcome, mortality or reperfusion rates. Conclusion: Effect of heparin in flush fluids should not be ignored by clinicians or researchers as higher concentrations may be associated with higher rates of ICH. The observed variation in protocols regarding heparin concentrations between EVT centers should encourage further studies, ideally in a controlled way, resulting in recommendations on heparin use in flush fluids in future guidelines.
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- 2021
193. A randomized trial of intravenous alteplase before endovascular treatment for stroke
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LeCouffe, Natalie E., Kappelhof, Manon, Treurniet, Kilian M., Rinkel, Leon A., Bruggeman, Agnetha E., Berkhemer, Olvert A., Wolff, Lennard, van Voorst, Henk, Tolhuisen, Manon L., Dippel, Diederik W.J., van der Lugt, Aad, van Es, Adriaan C.G.M., Boiten, Jelis, Lycklama à Nijeholt, Geert J., Keizer, Koos, Gons, Rob A.R., Yo, Lonneke S.F., van Oostenbrugge, Robert J., van Zwam, Wim H., Roozenbeek, Bob, van der Worp, H. Bart, Lo, Rob T.H., van den Wijngaard, Ido R., de Ridder, Inger R., Costalat, Vincent, Arquizan, Caroline, Lemmens, Robin, Demeestere, Jelle, Hofmeijer, Jeannette, Martens, Jasper M., Schonewille, Wouter J., Vos, Jan Albert, Uyttenboogaart, Maarten, Bokkers, Reinoud P.H., van Tuijl, Julia H., Kortman, Hans, Schreuder, Floris H.B.M., Boogaarts, Hieronymus D., de Laat, Karlijn F., van Dijk, Lukas C., den Hertog, Heleen M., van Hasselt, Boudewijn A.A.M., Brouwers, Paul J.A.M., Bulut, Tomas, Remmers, Michel J.M., Imani, Farshad, van Doormaal, Pieter Jan, Nieboer, Daan, Lingsma, Hester F., Emmer, Bart J., Majoie, Charles B.L.M., Roos, Yvo B.W.E.M., LeCouffe, Natalie E., Kappelhof, Manon, Treurniet, Kilian M., Rinkel, Leon A., Bruggeman, Agnetha E., Berkhemer, Olvert A., Wolff, Lennard, van Voorst, Henk, Tolhuisen, Manon L., Dippel, Diederik W.J., van der Lugt, Aad, van Es, Adriaan C.G.M., Boiten, Jelis, Lycklama à Nijeholt, Geert J., Keizer, Koos, Gons, Rob A.R., Yo, Lonneke S.F., van Oostenbrugge, Robert J., van Zwam, Wim H., Roozenbeek, Bob, van der Worp, H. Bart, Lo, Rob T.H., van den Wijngaard, Ido R., de Ridder, Inger R., Costalat, Vincent, Arquizan, Caroline, Lemmens, Robin, Demeestere, Jelle, Hofmeijer, Jeannette, Martens, Jasper M., Schonewille, Wouter J., Vos, Jan Albert, Uyttenboogaart, Maarten, Bokkers, Reinoud P.H., van Tuijl, Julia H., Kortman, Hans, Schreuder, Floris H.B.M., Boogaarts, Hieronymus D., de Laat, Karlijn F., van Dijk, Lukas C., den Hertog, Heleen M., van Hasselt, Boudewijn A.A.M., Brouwers, Paul J.A.M., Bulut, Tomas, Remmers, Michel J.M., Imani, Farshad, van Doormaal, Pieter Jan, Nieboer, Daan, Lingsma, Hester F., Emmer, Bart J., Majoie, Charles B.L.M., and Roos, Yvo B.W.E.M.
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The value of administering intravenous alteplase before endovascular treatment (EVT) for acute ischemic stroke has not been studied extensively, particularly in non-Asian populations. METHODS We performed an open-label, multicenter, randomized trial in Europe involving patients with stroke who presented directly to a hospital that was capable of providing EVT and who were eligible for intravenous alteplase and EVT. Patients were randomly assigned in a 1:1 ratio to receive EVT alone or intravenous alteplase followed by EVT (the standard of care). The primary end point was functional outcome on the modified Rankin scale (range, 0 [no disability] to 6 [death]) at 90 days. We assessed the superiority of EVT alone over alteplase plus EVT, as well as noninferiority by a margin of 0.8 for the lower boundary of the 95% confidence interval for the odds ratio of the two trial groups. Death from any cause and symptomatic intracerebral hemorrhage were the main safety end points. RESULTS The analysis included 539 patients. The median score on the modified Rankin scale at 90 days was 3 (interquartile range, 2 to 5) with EVT alone and 2 (interquartile range, 2 to 5) with alteplase plus EVT. The adjusted common odds ratio was 0.84 (95% confidence interval [CI], 0.62 to 1.15; P=0.28), which showed neither superiority nor noninferiority of EVT alone. Mortality was 20.5% with EVT alone and 15.8% with alteplase plus EVT (adjusted odds ratio, 1.39; 95% CI, 0.84 to 2.30). Symptomatic intracerebral hemorrhage occurred in 5.9% and 5.3% of the patients in the respective groups (adjusted odds ratio, 1.30; 95% CI, 0.60 to 2.81). CONCLUSIONS In a randomized trial involving European patients, EVT alone was neither superior nor noninferior to intravenous alteplase followed by EVT with regard to disability outcome at 90 days after stroke. The incidence of symptomatic intracerebral hemorrhage was similar in the two groups.
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- 2021
194. Endovascular Therapy for Stroke Due to Basilar-Artery Occlusion
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Langezaal, L. C. M., van der Hoeven, Erik J. R. J., Mont'Alverne, Francisco J. A., de Carvalho, Joao J. F., Lima, Fabricio O., Dippel, Diederik W. J., van der Lugt, Aad, Lo, Rob T. H., Boiten, Jelis, Lycklama a Nijeholt, Geert J., Staals, Julie, van Zwam, Wim H., Nederkoorn, Paul J., Majoie, Charles B. L. M., Gerber, Johannes C., Mazighi, Mikael, Piotin, Michel, Zini, Andrea, Vallone, Stefano, Hofmeijer, Jeannette, Martins, Sheila O., Nolte, Christian H., Szabo, Kristina, Dias, Francisco A., Abud, Daniel G., Wermer, Marieke J. H., Remmers, Michel J. M., Schneider, Hauke, Rueckert, Christina M., de Laat, Karlijn F., Yoo, Albert J., van Doormaal, Pieter-Jan, van Es, Adriaan C. G. M., Emmer, Bart J., Michel, Patrik, Puetz, Volker, Audebert, Heinrich J., Pontes-Neto, Octavio M., Vos, Jan-Albert, Kappelle, L. Jaap, Algra, Ale, Schonewille, Wouter J., BASICS Study Group, Langezaal, L. C. M., van der Hoeven, Erik J. R. J., Mont'Alverne, Francisco J. A., de Carvalho, Joao J. F., Lima, Fabricio O., Dippel, Diederik W. J., van der Lugt, Aad, Lo, Rob T. H., Boiten, Jelis, Lycklama a Nijeholt, Geert J., Staals, Julie, van Zwam, Wim H., Nederkoorn, Paul J., Majoie, Charles B. L. M., Gerber, Johannes C., Mazighi, Mikael, Piotin, Michel, Zini, Andrea, Vallone, Stefano, Hofmeijer, Jeannette, Martins, Sheila O., Nolte, Christian H., Szabo, Kristina, Dias, Francisco A., Abud, Daniel G., Wermer, Marieke J. H., Remmers, Michel J. M., Schneider, Hauke, Rueckert, Christina M., de Laat, Karlijn F., Yoo, Albert J., van Doormaal, Pieter-Jan, van Es, Adriaan C. G. M., Emmer, Bart J., Michel, Patrik, Puetz, Volker, Audebert, Heinrich J., Pontes-Neto, Octavio M., Vos, Jan-Albert, Kappelle, L. Jaap, Algra, Ale, Schonewille, Wouter J., and BASICS Study Group
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Background The effectiveness of endovascular therapy in patients with stroke caused by basilar-artery occlusion has not been well studied.Methods We randomly assigned patients within 6 hours after the estimated time of onset of a stroke due to basilar-artery occlusion, in a 1:1 ratio, to receive endovascular therapy or standard medical care. The primary outcome was a favorable functional outcome, defined as a score of 0 to 3 on the modified Rankin scale (range, 0 to 6, with 0 indicating no disability, 3 indicating moderate disability, and 6 indicating death) at 90 days. The primary safety outcomes were symptomatic intracranial hemorrhage within 3 days after the initiation of treatment and mortality at 90 days.Results A total of 300 patients were enrolled (154 in the endovascular therapy group and 146 in the medical care group). Intravenous thrombolysis was used in 78.6% of the patients in the endovascular group and in 79.5% of those in the medical group. Endovascular treatment was initiated at a median of 4.4 hours after stroke onset. A favorable functional outcome occurred in 68 of 154 patients (44.2%) in the endovascular group and 55 of 146 patients (37.7%) in the medical care group (risk ratio, 1.18; 95% confidence interval [CI], 0.92 to 1.50). Symptomatic intracranial hemorrhage occurred in 4.5% of the patients after endovascular therapy and in 0.7% of those after medical therapy (risk ratio, 6.9; 95% CI, 0.9 to 53.0); mortality at 90 days was 38.3% and 43.2%, respectively (risk ratio, 0.87; 95% CI, 0.68 to 1.12).Conclusions Among patients with stroke from basilar-artery occlusion, endovascular therapy and medical therapy did not differ significantly with respect to a favorable functional outcome, but, as reflected by the wide confidence interval for the primary outcome, the results of this trial may not exclude a substantial benefit of endovascular therapy. Larger trials are needed to determine the efficacy and safety of endovascular the
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- 2021
195. AutoTICI:Automatic Brain Tissue Reperfusion Scoring on 2D DSA Images of Acute Ischemic Stroke Patients
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Su, Ruisheng, Cornelissen, Sandra A.P., Van Der Sluijs, Matthijs, Van Es, Adriaan C.G.M., Van Zwam, Wim H., Dippel, Diederik W.J., Lycklama, Geert, Van Doormaal, Pieter Jan, Niessen, Wiro J., Van Der Lugt, Aad, Van Walsum, Theo, Su, Ruisheng, Cornelissen, Sandra A.P., Van Der Sluijs, Matthijs, Van Es, Adriaan C.G.M., Van Zwam, Wim H., Dippel, Diederik W.J., Lycklama, Geert, Van Doormaal, Pieter Jan, Niessen, Wiro J., Van Der Lugt, Aad, and Van Walsum, Theo
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The Thrombolysis in Cerebral Infarction (TICI) score is an important metric for reperfusion therapy assessment in acute ischemic stroke. It is commonly used as a technical outcome measure after endovascular treatment (EVT). Existing TICI scores are defined in coarse ordinal grades based on visual inspection, leading to inter- and intra-observer variation. In this work, we present autoTICI, an automatic and quantitative TICI scoring method. First, each digital subtraction angiography (DSA) acquisition is separated into four phases (non-contrast, arterial, parenchymal and venous phase) using a multi-path convolutional neural network (CNN), which exploits spatio-temporal features. The network also incorporates sequence level label dependencies in the form of a state-transition matrix. Next, a minimum intensity map (MINIP) is computed using the motion corrected arterial and parenchymal frames. On the MINIP image, vessel, perfusion and background pixels are segmented. Finally, we quantify the autoTICI score as the ratio of reperfused pixels after EVT. On a routinely acquired multi-center dataset, the proposed autoTICI shows good correlation with the extended TICI (eTICI) reference with an average area under the curve (AUC) score of 0.81. The AUC score is 0.90 with respect to the dichotomized eTICI. In terms of clinical outcome prediction, we demonstrate that autoTICI is overall comparable to eTICI.
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- 2021
196. Effect of first-pass reperfusion on outcome after endovascular treatment for ischemic stroke
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Venema, Esmee, Den Hartog, Sanne J., Zaidat, Osama, Roozenbeek, Bob, van Es, Adriaan C.G.M., Bruggeman, Agnetha A.E., Emmer, Bart J., Majoie, Charles B.L.M., van Zwam, Wim H., van den Wijngaard, Ido R., van Doormaal, Pieter Jan, Lingsma, Hester F., Burke, James F., Dippel, Diederik W.J., van der Lugt, Aad, Mulder, Maxim, Compagne, Kars, Dinkelaar, Wouter, El Ghannouti, Naziha, Sterrenberg, Martin, Chalos, Vicky, Ergezen, Saliha, Harmsma, Roger, de Jong, Anouk, Berkhemer, Olvert, Venema, Esmee, Den Hartog, Sanne J., Zaidat, Osama, Roozenbeek, Bob, van Es, Adriaan C.G.M., Bruggeman, Agnetha A.E., Emmer, Bart J., Majoie, Charles B.L.M., van Zwam, Wim H., van den Wijngaard, Ido R., van Doormaal, Pieter Jan, Lingsma, Hester F., Burke, James F., Dippel, Diederik W.J., van der Lugt, Aad, Mulder, Maxim, Compagne, Kars, Dinkelaar, Wouter, El Ghannouti, Naziha, Sterrenberg, Martin, Chalos, Vicky, Ergezen, Saliha, Harmsma, Roger, de Jong, Anouk, and Berkhemer, Olvert
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BACKGROUND: First-pass reperfusion (FPR) is associated with favorable outcome after endovascular treatment. It is unknown whether this effect is independent of patient characteristics and whether FPR has better outcomes compared with excellent reperfusion (Expanded Thrombolysis in Cerebral Infarction [eTICI] 2C-3) after multiple-passes reperfusion. We aimed to evaluate the association between FPR and outcome with adjustment for patient, imaging, and treatment characteristics to single out the contribution of FPR. METHODS AND RESULTS: FPR was defined as eTICI 2C-3 after 1 pass. Multivariable regression models were used to investigate characteristics associated with FPR and to investigate the effect of FPR on outcomes. We included 2686 patients of the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry. Factors associated with FPR were as follows: history of hyperlipidemia (adjusted odds ratio [OR], 1.05; 95% CI, 1.01–1.10), middle cerebral artery versus intracranial carotid artery occlusion (adjusted OR, 1.11; 95% CI, 1.06–1.16), and aspiration versus stent thrombectomy (adjusted OR, 1.07; 95% CI, 1.03–1.11). Interventionist experience increased the likelihood of FPR (adjusted OR, 1.03 per 50 patients previously treated; 95% CI, 1.01–1.06). Adjusted for patient, imaging, and treatment characteristics, FPR remained associated with a better 24-hour National Institutes of Health Stroke Scale (NIHSS) score (−37%; 95% CI, −43% to −31%) and a better modified Rankin Scale (mRS) score at 3 months (adjusted common OR, 2.16; 95% CI, 1.83–2.54) compared with no FPR (multiple-passes reperfusion+no excellent reperfusion), and compared with multiple-passes reperfusion alone (24hour NIHSS score, (−23%; 95% CI, −31% to −14%), and mRS score (adjusted common OR, 1.45; 95% CI, 1.19–1.78)). CONCLUSIONS: FPR compared with multiple-passes reperfusion is associated with favorable outcome, independently of patie
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- 2021
197. Prediction of Outcome and Endovascular Treatment Benefit:Validation and Update of the MR PREDICTS Decision Tool
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Venema, Esmee, Roozenbeek, Bob, Mulder, Maxim J.H.L., Brown, Scott, Majoie, Charles B.L.M., Steyerberg, Ewout W., Demchuk, Andrew M., Muir, Keith W., Dávalos, Antoni, Mitchell, Peter J., Bracard, Serge, Berkhemer, Olvert A., Lycklama À Nijeholt, Geert J., Van Oostenbrugge, Robert J., Roos, Yvo B.W.E.M., Van Zwam, Wim H., Van Der Lugt, Aad, Hill, Michael D., White, Philip, Campbell, Bruce C.V., Guillemin, Francis, Saver, Jeffrey L., Jovin, Tudor G., Goyal, Mayank, Dippel, Diederik W.J., Lingsma, Hester F., Venema, Esmee, Roozenbeek, Bob, Mulder, Maxim J.H.L., Brown, Scott, Majoie, Charles B.L.M., Steyerberg, Ewout W., Demchuk, Andrew M., Muir, Keith W., Dávalos, Antoni, Mitchell, Peter J., Bracard, Serge, Berkhemer, Olvert A., Lycklama À Nijeholt, Geert J., Van Oostenbrugge, Robert J., Roos, Yvo B.W.E.M., Van Zwam, Wim H., Van Der Lugt, Aad, Hill, Michael D., White, Philip, Campbell, Bruce C.V., Guillemin, Francis, Saver, Jeffrey L., Jovin, Tudor G., Goyal, Mayank, Dippel, Diederik W.J., and Lingsma, Hester F.
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Background and Purpose: Benefit of early endovascular treatment (EVT) for ischemic stroke varies considerably among patients. The MR PREDICTS decision tool, derived from MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), predicts outcome and treatment benefit based on baseline characteristics. Our aim was to externally validate and update MR PREDICTS with data from international trials and daily clinical practice. Methods: We used individual patient data from 6 randomized controlled trials within the HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) collaboration to validate the original model. Then, we updated the model and performed a second validation with data from the observational MR CLEAN Registry. Primary outcome was functional independence (defined as modified Rankin Scale score 0-2) 3 months after stroke. Treatment benefit was defined as the difference between the probability of functional independence with and without EVT. Discriminative performance was evaluated using a concordance (C) statistic. Results: We included 1242 patients from HERMES (633 assigned to EVT, 609 assigned to control) and 3156 patients from the MR CLEAN Registry (all of whom underwent EVT within 6.5 hours). The C-statistic for functional independence was 0.74 (95% CI, 0.72-0.77) in HERMES and, after model updating, 0.80 (0.78-0.82) in the Registry. Median predicted treatment benefit of routinely treated patients (Registry) was 10.3% (interquartile range, 5.8%-14.4%). Patients with low (<1%) predicted treatment benefit (n=135/3156 [4.3%]) had low rates of functional independence, irrespective of reperfusion status, suggesting potential absence of treatment benefit. The updated model was made available online for clinicians and researchers at www.mrpredicts.com. Conclusions: Because of the substantial treatment effect and small potential harm of EVT, most patients arriving w
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- 2021
198. Quantified health and cost effects of faster endovascular treatment for large vessel ischemic stroke patients in the Netherlands
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Van Voorst, Henk, Kunz, Wolfgang G., Van Den Berg, Lucie A., Kappelhof, Manon, Pinckaers, Floor M.E., Goyal, Mayank, Hunink, Myriam G.M., Emmer, Bart J., Mulder, Maxim J.H.L., DIppel, DIederik W.J., Coutinho, Jonathan M., Marquering, Henk A., Boogaarts, Hieronymus D., Van Der Lugt, Aad, Van Zwam, Wim H., Roos, Yvo B.W.E.M., Buskens, Erik, DIjkgraaf, Marcel G.W., Majoie, Charles B.L.M., Van Voorst, Henk, Kunz, Wolfgang G., Van Den Berg, Lucie A., Kappelhof, Manon, Pinckaers, Floor M.E., Goyal, Mayank, Hunink, Myriam G.M., Emmer, Bart J., Mulder, Maxim J.H.L., DIppel, DIederik W.J., Coutinho, Jonathan M., Marquering, Henk A., Boogaarts, Hieronymus D., Van Der Lugt, Aad, Van Zwam, Wim H., Roos, Yvo B.W.E.M., Buskens, Erik, DIjkgraaf, Marcel G.W., and Majoie, Charles B.L.M.
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Background The effectiveness of endovascular treatment (EVT) for large vessel occlusion (LVO) stroke severely depends on time to treatment. However, it remains unclear what the value of faster treatment is in the years after index stroke. The aim of this study was to quantify the value of faster EVT in terms of health and healthcare costs for the Dutch LVO stroke population. Methods A Markov model was used to simulate 5-year follow-up functional outcome, measured with the modified Rankin Scale (mRS), of 69-year-old LVO patients. Post-treatment mRS was extracted from the MR CLEAN Registry (n=2892): costs per unit of time and Quality-Adjusted Life Years (QALYs) per mRS sub-score were retrieved from follow-up data of the MR CLEAN trial (n=500). Net Monetary Benefit (NMB) at a willingness to pay of €80 000 per QALY was reported as primary outcome, and secondary outcome measures were days of disability-free life gained and costs. Results EVT administered 1 min faster resulted in a median NMB of €309 (IQR: 226;389), 1.3 days of additional disability-free life (IQR: 1.0;1.6), while cumulative costs remained largely unchanged (median: -€15, IQR: -65;33) over a 5-year follow-up period. As costs over the follow-up period remained stable while QALYs decreased with longer time to treatment, which this results in a near-linear decrease of NMB. Since patients with faster EVT lived longer, they incurred more healthcare costs. Conclusion One-minute faster EVT increases QALYs while cumulative costs remain largely unaffected. Therefore, faster EVT provides better value of care at no extra healthcare costs.
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- 2021
199. Thrombectomy for acute ischemic stroke patients with isolated distal internal carotid artery occlusion:a retrospective observational study
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Hoving, Jan W., Kappelhof, Manon, Schembri, Mark, Emmer, Bart J., Berkhemer, Olvert A., Groot, Adrien E.D., Dippel, Diederik W.J., van Zwam, Wim H., Coutinho, Jonathan M., Marquering, Henk A., Majoie, Charles B.L.M., van den Berg, René, Hoving, Jan W., Kappelhof, Manon, Schembri, Mark, Emmer, Bart J., Berkhemer, Olvert A., Groot, Adrien E.D., Dippel, Diederik W.J., van Zwam, Wim H., Coutinho, Jonathan M., Marquering, Henk A., Majoie, Charles B.L.M., and van den Berg, René
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Purpose: Acute stroke patients presenting with a distal internal carotid artery occlusion and patent carotid terminus, allowing for collateral flow via the circle of Willis, may have a more favorable natural history. Therefore, benefit of endovascular treatment (EVT) is less evident. We performed an exploratory analysis of EVT results compared to conservative treatment in patients with ‘carotid-I’ occlusions. Methods: We report on EVT-treated and non-EVT-treated patients with carotid-I occlusions from the MR CLEAN Registry, MR CLEAN trial, and our comprehensive stroke center. CT-angiography was reviewed on primary collateral patency and choroid plexus enhancement. Perfusion deficits were assessed on CT-perfusion (CTP). Clot migration was assessed by comparing clot location on baseline CTA to its location on periprocedural digital subtraction angiography. Outcomes included 90-day functional independence (mRS 0–2), successful reperfusion and mortality. Results: We included 51 patients. Forty-one patients received EVT, ten patients did not. Intravenous thrombolysis was administered in 32 (78%) EVT-treated patients and 6 (60%) non-EVT-treated patients. CTP, available for 17 patients, showed hypoperfusion on cerebral blood flow maps in 13 (76%) patients. Successful reperfusion after EVT occurred in 23 (56%), and clot migration in 8 patients (20%). Functional independence was achieved in 54% (21/39) of EVT-treated and in 10% (1/10) of non-EVT-treated patients. Mortality was 26% (10/39) and 30% (3/10), respectively. Anterior choroidal artery patency and choroid plexus enhancement were positively associated with functional independence. Conclusion: In our population, data suggest improved outcomes after EVT in carotid-I occlusion patients and provide no arguments to withhold EVT in these patients.
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- 2021
200. Endovascular treatment in anterior circulation stroke beyond 6.5 hours after onset or time last seen well:Results from the MR CLEAN Registry
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Dekker, Luuk, Venema, Esmee, Pirson, F. Anne V., Majoie, Charles B.L.M., Emmer, Bart J., Jansen, Ivo G.H., Mulder, Maxim J.H.L., Lemmens, Robin, Goldhoorn, Robert Jan B., Wermer, Marieke J.H., Boiten, Jelis, Nijeholt, Geert J.Lycklama À., Roos, Yvo B.W.E.M., Van Es, Adriaan C.G.M., Lingsma, Hester F., Dippel, Diederik W.J., Van Zwam, Wim H., Van Oostenbrugge, Robert J., Van Den Wijngaard, Ido R., Dekker, Luuk, Venema, Esmee, Pirson, F. Anne V., Majoie, Charles B.L.M., Emmer, Bart J., Jansen, Ivo G.H., Mulder, Maxim J.H.L., Lemmens, Robin, Goldhoorn, Robert Jan B., Wermer, Marieke J.H., Boiten, Jelis, Nijeholt, Geert J.Lycklama À., Roos, Yvo B.W.E.M., Van Es, Adriaan C.G.M., Lingsma, Hester F., Dippel, Diederik W.J., Van Zwam, Wim H., Van Oostenbrugge, Robert J., and Van Den Wijngaard, Ido R.
- Abstract
Background Randomised controlled trials with perfusion selection have shown benefit of endovascular treatment (EVT) for ischaemic stroke between 6 and 24 hours after symptom onset or time last seen well. However, outcomes after EVT in these late window patients without perfusion imaging are largely unknown. We assessed their characteristics and outcomes in routine clinical practice. Methods The Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry, a prospective, multicentre study in the Netherlands, included patients with an anterior circulation occlusion who underwent EVT between 2014 and 2017. CT perfusion was no standard imaging modality. We used adjusted ordinal logistic regression analysis to compare patients treated within versus beyond 6.5 hours after propensity score matching on age, prestroke modified Rankin Scale (mRS), National Institutes of Health Stroke Scale, Alberta Stroke Programme Early CT Score (ASPECTS), collateral status, location of occlusion and treatment with intravenous thrombolysis. Outcomes included 3-month mRS score, functional independence (defined as mRS 0-2), and death. Results Of 3264 patients who underwent EVT, 106 (3.2%) were treated beyond 6.5 hours (median 8.5, IQR 6.9-10.6), of whom 93 (87.7%) had unknown time of stroke onset. CT perfusion was not performed in 87/106 (80.2%) late window patients. Late window patients were younger (mean 67 vs 70 years, p<0.04) and had slightly lower ASPECTS (median 8 vs 9, p<0.01), but better collateral status (collateral score 2-3: 68.3% vs 57.7%, p=0.03). No differences were observed in proportions of functional independence (43.3% vs 40.5%, p=0.57) or death (24.0% vs 28.9%, p=0.28). After matching, outcomes remained similar (adjusted common OR for 1 point improvement in mRS 1.04, 95% CI 0.56 to 1.93). Conclusions Without the use of CT perfusion selection criteria, EVT in the 6.5-24-hour time window was not associated with
- Published
- 2021
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