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

Author

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

Published
2024
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2. Dual thrombolytic therapy with mutant pro-urokinase and small bolus alteplase for ischemic stroke (DUMAS): study protocol for a multicenter randomized controlled phase II trial

Author

van der Ende, Nadinda A. M., Roozenbeek, Bob, Smagge, Lucas E. M., Luijten, Sven P. R., Aerden, Leo A. M., Kraayeveld, Petra, van den Wijngaard, Ido R., Lycklama à Nijeholt, Geert J., den Hertog, Heleen M., Flach, H. Zwenneke, Wallace, Alexis C., Gurewich, Victor, del Zoppo, Gregory J., Meurer, William J., Lingsma, Hester F., van der Lugt, Aad, and Dippel, Diederik W. J.

Published
2022
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3. Mild Stroke, Serious Problems: Limitations in Balance and Gait Capacity and the Impact on Fall Rate, and Physical Activity

Author

Roelofs, Jolanda M. B., primary, Zandvliet, Sarah B., additional, Schut, Ingrid M., additional, Huisinga, Anouk C. M., additional, Schouten, Alfred C., additional, Hendricks, Henk T., additional, de Kam, Digna, additional, Aerden, Leo A. M., additional, Bussmann, Johannes B. J., additional, Geurts, Alexander C. H., additional, and Weerdesteyn, Vivian, additional

Published
2023
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4. Association between thrombus composition and stroke etiology in the MR CLEAN Registry biobank

Author

Hund, Hajo M., Boodt, Nikki, Hansen, Daniel, Haffmans, Willem A., Lycklama à Nijeholt, Geert J., Hofmeijer, Jeannette, Dippel, Diederik W. J., van der Lugt, Aad, van Es, Adriaan C. G. M., van Beusekom, Heleen M. M., Majoie, Charles B. L. M., Roos, Yvo B. W. E. M., van Oostenbrugge, Robert J., van Zwam, Wim H., Boiten, Jelis, Vos, Jan Albert, Jansen, Ivo G. H., Mulder, Maxim J. H. L., Goldhoorn, Robert- Jan B., Compagne, Kars C. J., Kappelhof, Manon, Brouwer, Josje, den Hartog, Sanne J., Hinsenveld, Wouter H., Roozenbeek, Bob, Emmer, Bart J., Coutinho, Jonathan M., Schonewille, Wouter J., Wermer, Marieke J. H., van Walderveen, Marianne A. A., Staals, Julie, Martens, Jasper M., de Bruijn, Sebastiaan F., van Dijk, Lukas C., van der Worp, H. Bart, Lo, Rob H., van Dijk, Ewoud J., Boogaarts, Hieronymus D., de Vries, J., de Kort, Paul L. M., van Tuijl, Julia, Peluso, Jo P., Fransen, Puck, van den Berg, Jan S. P., van Hasselt, Boudewijn A. A. M., Aerden, Leo A. M., Dallinga, René J., Uyttenboogaart, Maarten, Eschgi, Omid, Bokkers, Reinoud P. H., Schreuder, Tobien H. C. M. L., Heijboer, Roel J. J., Keizer, Koos, Yo, Lonneke S. F., den Hertog, Heleen M., Bulut, Tomas, Brouwers, Paul J. A. M., Sprengers, Marieke E. S., Jenniskens, Sjoerd F. M., van den Berg, René, Yoo, Albert J., Beenen, Ludo F. M., Postma, Alida A., Roosendaal, Stefan D., van der Kallen, Bas F. W., van den Wijngaard, Ido R., Bot, Joost, van Doormaal, Pieter-Jan, Meijer, Anton, Ghariq, Elyas, van Proosdij, Marc P., Krietemeijer, G. Menno, Dinkelaar, Wouter, Appelman, Auke P. A., Hammer, Bas, Pegge, Sjoert, van der Hoorn, Anouk, Vinke, Saman, Flach, H. Zwenneke, Lingsma, Hester F., el Ghannouti, Naziha, Sterrenberg, Martin, Pellikaan, Wilma, Sprengers, Rita, Elfrink, Marjan, Simons, Michelle, Vossers, Marjolein, de Meris, Joke, Vermeulen, Tamara, Geerlings, Annet, van Vemde, Gina, Simons, Tiny, Messchendorp, Gert, Nicolaij, Nynke, Bongenaar, Hester, Bodde, Karin, Kleijn, Sandra, Lodico, Jasmijn, Droste, Hanneke, Wollaert, Maureen, Verheesen, Sabrina, Jeurrissen, D., Bos, Erna, Drabbe, Yvonne, Sandiman, Michelle, Aaldering, Nicoline, Zweedijk, Berber, Vervoort, Jocova, Ponjee, Eva, Romviel, Sharon, Kanselaar, Karin, Barning, Denn, Venema, Esmee, Chalos, Vicky, Geuskens, Ralph R., van Straaten, Tim, Ergezen, Saliha, Harmsma, Roger R. M., Muijres, Daan, de Jong, Anouk, Berkhemer, Olvert A., Boers, Anna M. M., Huguet, J., Groot, P. F. C., Mens, Marieke A., van Kranendonk, Katinka R., Treurniet, Kilian M., Tolhuisen, Manon L., Alves, Heitor, Weterings, Annick J., Kirkels, Eleonora L.F., Voogd, Eva J. H. F., Schupp, Lieve M., Collette, Sabine L., Groot, Adrien E. D., LeCouffe, Natalie E., Konduri, Praneeta R., Prasetya, Haryadi, Arrarte-Terreros, Nerea, Ramos, Lucas A., Radiology and Nuclear Medicine, ACS - Microcirculation, ANS - Neurovascular Disorders, Neurology, ACS - Atherosclerosis & ischemic syndromes, ANS - Cellular & Molecular Mechanisms, ANS - Compulsivity, Impulsivity & Attention, Graduate School, Biomedical Engineering and Physics, AMS - Amsterdam Movement Sciences, ANS - Brain Imaging, Adult Psychiatry, APH - Methodology, ​Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Damage and Repair in Cancer Development and Cancer Treatment (DARE), Cardiology, Radiology & Nuclear Medicine, Radiology and nuclear medicine, Internal medicine, Pediatrics, Amsterdam Neuroscience - Neurovascular Disorders, and CCA - Imaging and biomarkers

Subjects
Microscopy, Ischemic stroke, Radiology, Nuclear Medicine and imaging, Endovascular treatment, Neurology (clinical), Cardiology and Cardiovascular Medicine, Mechanical thrombectomy, Stent-retriever, Thrombus
Abstract

Purpose The composition of thrombi retrieved during endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) due to large vessel occlusion (LVO) may differ depending on their origin. In this study, we investigated the association between thrombus composition and stroke etiology in a large population of patients from the Dutch MR CLEAN Registry treated with EVT in daily clinical practice. Methods The thrombi of 332 patients with AIS were histologically analyzed for red blood cells (RBC), fibrin/platelets (F/P), and white blood cells (leukocytes) using a machine learning algorithm. Stroke etiology was assessed using the Trial of Org 10,172 in acute stroke treatment (TOAST) classification. Results The thrombi of cardioembolic origin contained less RBC and more F/P than those of non-cardioembolic origin (25.8% vs 41.2% RBC [p = 0.003] and 67.1% vs 54.5% F/P [p = 0.004]). The likelihood of a non-cardioembolic source of stroke increased with increasing thrombus RBC content (OR 1.02; [95% CI 1.00–1.06] for each percent increase) and decreased with a higher F/P content (OR 1.02; [95% CI 1.00–1.06]). Thrombus composition in patients with a cardioembolic origin and undetermined origin was similar. Conclusion Thrombus composition is significantly associated with stroke etiology, with an increase in RBC and a decrease in F/P raising the odds for a non-cardioembolic cause. No difference between composition of cardioembolic thrombi and of undetermined origin was seen. This emphasizes the need for more extensive monitoring for arrhythmias and/or extended cardiac analysis in case of an undetermined origin.

Published
2023
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5. Prehospital Stroke Triage: A Modeling Study on the Impact of Triage Tools in Different Regions

Author

Duvekot, Martijne H. C., primary, Garcia, Bjarty L., additional, Dekker, Luuk, additional, Nguyen, Truc My, additional, van den Wijngaard, Ido R., additional, de Laat, Karlijn F., additional, de Schryver, Els L. L. M., additional, Kloos, Loet M. H., additional, Aerden, Leo A. M., additional, Zylicz, Stas A., additional, Bosch, Jan, additional, van Belle, Eduard, additional, van Zwet, Erik W., additional, Rozeman, Anouk D., additional, Moudrous, Walid, additional, Vermeij, Frédérique H., additional, Lingsma, Hester F., additional, Bakker, Jeannette, additional, van Doormaal, Pieter Jan, additional, van Es, Adriaan C. G. M., additional, van der Lugt, Aad, additional, Wermer, Marieke J. H., additional, Dippel, Diederik W. J., additional, Kerkhoff, Henk, additional, Roozenbeek, Bob, additional, Kruyt, Nyika D., additional, and Venema, Esmee, additional

Published
2023
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6. Validity of Early Outcomes as Indicators for Comparing Hospitals on Quality of Stroke Care

Author

Amini, Marzyeh, primary, Eijkenaar, Frank, additional, Lingsma, Hester F., additional, den Hartog, Sanne J., additional, Olthuis, Susanne G. H., additional, Martens, Jasper, additional, van der Worp, Bart, additional, van Zwam, Wim, additional, van der Hoorn, Anouk, additional, Roosendaal, Stefan D., additional, Roozenbeek, Bob, additional, Dippel, Diederik, additional, van Leeuwen, Nikki, additional, Dippel, Diederik W. J., additional, van der Lugt, Aad, additional, Majoie, Charles B. L. M., 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, Brouwer, Josje, additional, Hinsenveld, Wouter H., additional, Kappelhof, Manon, additional, Compagne, Kars C. J., additional, Goldhoorn, Robert‐Jan B., additional, Mulder, Maxim J. H. L., additional, Jansen, Ivo G. 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, Hofmeijer, Jeannette, 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 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, Yo, Lonneke S. F., additional, den Hertog, Heleen M., additional, Sturm, Emiel J. C., additional, Brouwers, Paul, 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, van der Kallen, Bas F. W., additional, van den Wijngaard, Ido R., additional, Bot, Joost, additional, van Doormaal, Pieter‐Jan, additional, Meijer, Anton, additional, Ghariq, Elyas, additional, van Proosdij, Marc P., additional, Krietemeijer, G. Menno, additional, Peluso, Jo P., additional, Lo, Rob, additional, Dinkelaar, Wouter, additional, Appelman, Auke P. A., additional, Hammer, Bas, additional, Pegge, Sjoert, additional, Vinke, Saman, additional, Flach, H. Zwenneke, additional, el Ghannouti, Naziha, additional, Sterrenberg, Martin, additional, Puppels, Corina, 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, van Rijswijk, Cathelijn, 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, Khalilzada, Mostafa, 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, 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

Published
2023
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7. Prehospital stroke triage: a modeling study on the impact of triage tools in different regions

Author

Duvekot, Martijne H. C., Garcia, Bjarty L., Dekker, Luuk, Nguyen, Truc My, van den Wijngaard, Ido R., de Laat, Karlijn F., de Schryver, Els L. L. M., Kloos, Loet M. H., Aerden, Leo A. M., Zylicz, Stas A., Bosch, Jan, van Belle, Eduard, van Zwet, Erik W., Rozeman, Anouk D., Moudrous, Walid, Vermeij, Frédérique H., Lingsma, Hester F., Bakker, Jeannette, van Doormaal, Pieter Jan, van Es, Adriaan C. G. M., van der Lugt, Aad, Wermer, Marieke J. H., Dippel, Diederik W. J., Kerkhoff, Henk, Roozenbeek, Bob, Kruyt, Nyika D., and Venema, Esmee

Abstract

Direct transportation to a thrombectomy-capable intervention center is beneficial for patients with ischemic stroke due to large vessel occlusion (LVO), but can delay intravenous thrombolytics (IVT). The aim of this modeling study was to estimate the effect of prehospital triage strategies on treatment delays and overtriage in different regions. We used data from two prospective cohort studies in the Netherlands: the Leiden Prehospital Stroke Study and the PRESTO study. We included stroke code patients within 6 h from symptom onset. We modeled outcomes of Rapid Arterial oCclusion Evaluation (RACE) scale triage and triage with a personalized decision tool, using drip-and-ship as reference. Main outcomes were overtriage (stroke code patients incorrectly triaged to an intervention center), reduced delay to endovascular thrombectomy (EVT), and delay to IVT. We included 1798 stroke code patients from four ambulance regions. Per region, overtriage ranged from 1-13% (RACE triage) and 3-15% (personalized tool). Reduction of delay to EVT varied by region between 24 ± 5 min (n = 6) to 78 ± 3 (n = 2), while IVT delay increased with 5 (n = 5) to 15 min (n = 21) for non-LVO patients. The personalized tool reduced delay to EVT for more patients (25 ± 4 min [n = 8] to 49 ± 13 [n = 5]), while delaying IVT with 3-14 min (8-24 patients). In region C, most EVT patients were treated faster (reduction of delay to EVT 31 ± 6 min (n = 35), with RACE triage and the personalized tool. In this modeling study, we showed that prehospital triage reduced time to EVT without disproportionate IVT delay, compared to a drip-and-ship strategy. The effect of triage strategies and the associated overtriage varied between regions. Implementation of prehospital triage should therefore be considered on a regional level.

Published
2023
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8. A decrease in blood pressure is associated with unfavorable outcome in patients undergoing thrombectomy under general anesthesia

Author

Treurniet, Kilian M, Berkhemer, Olvert A, Immink, Rogier V, Lingsma, Hester F, Ward-van der Stam, Vivian M C, Hollmann, Markus W, Vuyk, Jaap, van Zwam, Wim H, van der Lugt, Aad, van Oostenbrugge, Robert J, Dippel, Diederik W J, Coutinho, Jonathan M, Roos, Yvo B W E M, Marquering, Henk A, Majoie, Charles B L M, Dippel, Diederik W J, Lugt, Aad van der, Majoie, Charles B L M, Roos, Yvo B W E M, van Oostenbrugge, Robert J, van Zwam, Wim H, Berkhemer, Olvert A, Fransen, Puck S S, Beumer, Debbie, van den Berg, Lucie A, Schonewille, Wouter J, Vos, Jan Albert, Majoie, Charles B L M, Roos, Yvo B W E M, Nederkoorn, Paul J, Wermer, Marieke J H, Walderveen, Marianne A A van, van Oostenbrugge, Robert J, van Zwam, Wim H, Staals, Julie, Hofmeijer, Jeannette, van Oostayen, Jacques A, Nijeholt, Geert J Lycklama à, Boiten, Jelis, Dippel, Diederik W J, 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, Bot, Joseph C J, Vroomen, Patrick C, Eshghi, Omid, Schreuder, Tobien H C M L, Heijboer, Roel J J, Keizer, Koos, Tielbeek, Alexander V, Hertog, Heleen M den, Gerrits, Dick G, van den Berg-Vos, Renske M, Karas, Giorgos B, Majoie, Charles B L M, van Zwam, Wim H, van der Lugt, Aad, Nijeholt, Geert J Lycklama à, van Walderveen, Marianne A A, Bot, Joseph C J, Marquering, Henk A, Beenen, Ludo F, Sprengers, Marieke E S, Jenniskens, Sjoerd F M, van den Berg, René, Berkhemer, Olvert A, Yoo, Albert J, Roos, Yvo B W E M, Koudstaal, Peter J, Boiten, Jelis, van Dijk, Ewoud J., van Oostenbrugge, Robert J, Wermer, Marieke J H, Flach, H Zwenneke, Steyerberg, Ewout W, and Lingsma, Hester F

Published
2018
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9. Comparison of Prehospital Assessment by Paramedics and In-Hospital Assessment by Physicians in Suspected Stroke Patients: Results From 2 Prospective Cohort Studies.

Author

Dekker, Luuk, Daems, Jasper D., Duvekot, Martijne H. C., My Nguyen, T. Truc, Venema, Esmee, van Es, Adriaan C. G. M., Rozeman, Anouk D., Moudrous, Walid, Dorresteijn, Kirsten R. I. S., Hensen, Jan-Hein J., Bosch, Jan, van Zwet, Erik W., de Schryver, Els L. L. M., Kloos, Loet M. H., de Laat, Karlijn F., Aerden, Leo A. M., van den Wijngaard, Ido R., Dippel, Diederik W. J., Kerkhoff, Henk, and Wermer, Marieke J. H.

Published
2023
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10. Safety and Efficacy of Dual Thrombolytic Therapy With Mutant Prourokinase and Small Bolus Alteplase for Ischemic Stroke: A Randomized Clinical Trial.

Author

van der Ende, Nadinda A. M., Roozenbeek, Bob, Smagge, Lucas E. M., Luijten, Sven P. R., Aerden, Leo A. M., Kraayeveld, Petra, van den Wijngaard, Ido R., Lycklama à Nijeholt, Geert J., den Hertog, Heleen M., Flach, H. Zwenneke, Postma, Alida A., Roosendaal, Stefan D., Krietemeijer, G. Menno, Yo, Lonneke S. F., de Maat, Moniek P. M., Nieboer, Daan, Del Zoppo, Gregory J., Meurer, William J., Lingsma, Hester F., and van der Lugt, Aad

Published
2023
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11. Additional file 1 of Dual thrombolytic therapy with mutant pro-urokinase and small bolus alteplase for ischemic stroke (DUMAS): study protocol for a multicenter randomized controlled phase II trial

Author

van der Ende, Nadinda A. M., Roozenbeek, Bob, Smagge, Lucas E. M., Luijten, Sven P. R., Aerden, Leo A. M., Kraayeveld, Petra, van den Wijngaard, Ido R., Lycklama à Nijeholt, Geert J., den Hertog, Heleen M., Flach, H. Zwenneke, Wallace, Alexis C., Gurewich, Victor, del Zoppo, Gregory J., Meurer, William J., Lingsma, Hester F., van der Lugt, Aad, and Dippel, Diederik W. J.

Abstract

Additional file 1.

Published
2022
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12. Time to Reperfusion and Treatment Effect for Acute Ischemic Stroke: A Randomized Clinical Trial

Author

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.

Published
2016
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13. Hospital Variation in Time to Endovascular Treatment for Ischemic Stroke: What Is the Optimal Target for Improvement?

Author

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

Published
2021
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15. Effect of First‐Pass Reperfusion on Outcome After Endovascular Treatment for Ischemic Stroke

Author

den Hartog, Sanne J., primary, Zaidat, Osama, additional, Roozenbeek, Bob, additional, van Es, Adriaan C. G. M., additional, Bruggeman, Agnetha A. E., additional, Emmer, Bart J., additional, Majoie, Charles B. L. M., additional, van Zwam, Wim H., additional, van den Wijngaard, Ido R., additional, van Doormaal, Pieter Jan, additional, Lingsma, Hester F., additional, Burke, James F., additional, Dippel, Diederik W. J., additional, van der Lugt, Aad, additional, Roos, Yvo B. W. E. M., additional, van Oostenbrugge, Robert J., 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, Hinsenveld, Wouter H., additional, Coutinho, Jonathan M., additional, Schonewille, Wouter J., additional, Wermer, Marieke J. H., additional, van Walderveen, Marianne A. A., additional, Staals, Julie, additional, Hofmeijer, Jeannette, 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, Yo, Lonneke S. F., 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, Bot, Joost, additional, Meijer, Anton, additional, Ghariq, Elyas, additional, van Proosdij, Marc P., additional, Krietemeijer, G. Menno, 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

Published
2021
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16. National Institutes of Health Stroke Scale: An Alternative Primary Outcome Measure for Trials of Acute Treatment for Ischemic Stroke

Author

Chalos, Vicky, van der Ende, Nadinda A. M., Lingsma, Hester F., Mulder, Maxim J. H. L., Venema, Esmee, Dijkland, Simone A., Berkhemer, Olvert A., Yoo, Albert J., Broderick, Joseph P., Palesch, Yuko Y., Yeatts, Sharon D., Roos, Yvo B. W. E. M., van Oostenbrugge, Robert J., van Zwam, Wim H., Majoie, Charles B. L. M., van der Lugt, Aad, Roozenbeek, Bob, Dippel, Diederik W. J., Fransen, Puck S. S., Beumer, Debbie, van den Berg, Lucie A., 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., Nijeholt, Geert J. Lycklama 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 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, H. Zwenneke, Marquering, Henk A., Sprengers, Marieke E. S., Jenniskens, Sjoerd F. M., Beenen, Ludo F. M., van den Berg, Rene, Koudstaal, Peter J., Radiology and nuclear medicine, VU University medical center, Neurology, Amsterdam Neuroscience - Neurovascular Disorders, ACS - Atherosclerosis & ischemic syndromes, Public Health, Radiology & Nuclear Medicine, Radiology and Nuclear Medicine, ANS - Neurovascular Disorders, ACS - Microcirculation, ACS - Amsterdam Cardiovascular Sciences, Graduate School, ACS - Pulmonary hypertension & thrombosis, AGEM - Digestive immunity, AGEM - Re-generation and cancer of the digestive system, ARD - Amsterdam Reproduction and Development, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, MUMC+: Hersen en Zenuw Centrum (3), RS: Carim - B05 Cerebral small vessel disease, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: Carim - B06 Imaging, MUMC+: MA AIOS Neurologie (9), and MUMC+: MA Med Staf Spec Neurologie (9)

Subjects
Male, endovascular treatment, Original Contributions, 030204 cardiovascular system & hematology, law.invention, Brain Ischemia, 0302 clinical medicine, Randomized controlled trial, Modified Rankin Scale, Informed consent, law, Stroke, Netherlands, Confounding, Endovascular Procedures, informed consent, Middle Aged, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], stroke, 3. Good health, thrombectomy, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, outcome, Female, Cardiology and Cardiovascular Medicine, SURROGATE END-POINTS, CLINICAL-TRIALS, medicine.medical_specialty, Mechanical Thrombolysis, ENDOVASCULAR THERAPY, Clinical Sciences, 03 medical and health sciences, ALTEPLASE, Internal medicine, medicine, Humans, cardiovascular diseases, PLASMINOGEN-ACTIVATOR, Aged, Advanced and Specialized Nursing, Surrogate endpoint, business.industry, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Odds ratio, medicine.disease, United States, RANDOMIZED-TRIAL, Clinical trial, SEVERITY, National Institutes of Health (U.S.), Neurology (clinical), business, 030217 neurology & neurosurgery, Follow-Up Studies, NIHSS
Abstract

Supplemental Digital Content is available in the text., Background and Purpose— The modified Rankin Scale (mRS) at 3 months is the most commonly used primary outcome measure in stroke treatment trials, but it lacks specificity and requires long-term follow-up interviews, which consume time and resources. An alternative may be the National Institutes of Health Stroke Scale (NIHSS), early after stroke. Our aim was to evaluate whether the NIHSS assessed within 1 week after treatment could serve as a primary outcome measure for trials of acute treatment for ischemic stroke. Methods— We used data from 2 randomized controlled trials of endovascular treatment for ischemic stroke: the positive MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands; N=500) and the neutral IMS (Interventional Management of Stroke) III trial (N=656). We used a causal mediation model, with linear and ordinal logistic regression adjusted for confounders, to evaluate the NIHSS 24 hours and 5 to 7 days after endovascular treatment as primary outcome measures (instead of the mRS at 3 months) in both trials. Patients who had died before the NIHSS was assessed received the maximum score of 42. NIHSS+1 was then log10-transformed. Results— In both trials, there was a significant correlation between the NIHSS at 24 hours and 5 to 7 days and the mRS. In MR CLEAN, we found a significant effect of endovascular treatment on the mRS and on the NIHSS at 24 hours and 5 to 7 days. After adjustment for NIHSS at 24 hours and 5 to 7 days, the effect of endovascular treatment on the mRS decreased from common odds ratio 1.68 (95% CI, 1.22–2.32) to respectively 1.36 (95% CI, 0.97–1.91) and 1.24 (95% CI, 0.87–1.79), indicating that treatment effect on the mRS is in large part mediated by the NIHSS. In the IMS III trial there was no treatment effect on the NIHSS at 24 hours and 5 to 7 days, corresponding with the absence of a treatment effect on the mRS. Conclusions— The NIHSS within 1 week satisfies the requirements for a surrogate end point and may be used as a primary outcome measure in trials of acute treatment for ischemic stroke, particularly in phase II(b) trials. This could reduce stroke-outcome assessment to its essentials (ie, neurological deficit), and reduce trial duration and costs. Whether and under which conditions it could be used in phase III trials requires a debate in the field with all parties. Clinical Trial Registration— URL: http://www.isrctn.com. Unique identifier: ISRCTN10888758; https://www.clinicaltrials.gov. Unique identifier: NCT00359424.

Published
2020
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17. Comparison of Prehospital Scales for Predicting Large Anterior Vessel Occlusion in the Ambulance Setting

Author

Nguyen, T. Truc My, primary, van den Wijngaard, Ido R., additional, Bosch, Jan, additional, van Belle, Eduard, additional, van Zwet, Erik W., additional, Dofferhoff-Vermeulen, Tamara, additional, Duijndam, Dion, additional, Koster, Gaia T., additional, de Schryver, Els L. L. M., additional, Kloos, Loet M. H., additional, de Laat, Karlijn F., additional, Aerden, Leo A. M., additional, Zylicz, Stas A., additional, Wermer, Marieke J. H., additional, and Kruyt, Nyika D., additional

Published
2021
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18. 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, Robert-Jan B., Mulder, Maxim J. H. L., Jansen, Ivo G. H., van Zwam, Wim H., Staals, Julie, van der Lugt, Aad, Dippel, Diederik W. J., Lingsma, Hester F., Vos, Jan Albert, Boiten, Jelis, van den Wijngaard, Ido R., Majoie, Charles B. L. M., Roos, Yvo B. W. E. M., van Oostenbrugge, Robert J., Schonewille, Wouter J., Coutinho, Jonathan M., Wermer, Marieke J. H., van Walderveen, Marianne A. A., Hofmeijer, Jeannette, Martens, Jasper M., Nijeholt, Geert J. Lycklama A., Roozenbeek, Bob, Emmer, Bart J., de Bruijn, Sebastiaan F., van Dijk, Lukas C., van der Worp, H. Bart, Lo, Rob H., van Dijk, Ewoud J., Boogaarts, Hieronymus D., de Kort, Paul L. M., Peluso, Jo J. P., van den Berg, Jan S. P., van Hasselt, Boudewijn A. A. M., Aerden, Leo A. M., Dallinga, Rene J., Uyttenboogaart, Maarten, Eshghi, Omid, Schreuder, Tobien H. C. M. L., Heijboer, Roel J. J., Keizer, Koos, Yo, Lonneke S. F., den Hertog, Heleen M., Sturm, Emiel J. C., Sprengers, Marieke E. S., Jenniskens, Sjoerd F. M., Postma, Alida, Hinsenveld, Wouter, Groot, P. F. C., MR CLEAN Registry Investigators, Goldhoorn, Robert-Jan B., Mulder, Maxim J. H. L., Jansen, Ivo G. H., van Zwam, Wim H., Staals, Julie, van der Lugt, Aad, Dippel, Diederik W. J., Lingsma, Hester F., Vos, Jan Albert, Boiten, Jelis, van den Wijngaard, Ido R., Majoie, Charles B. L. M., Roos, Yvo B. W. E. M., van Oostenbrugge, Robert J., Schonewille, Wouter J., Coutinho, Jonathan M., Wermer, Marieke J. H., van Walderveen, Marianne A. A., Hofmeijer, Jeannette, Martens, Jasper M., Nijeholt, Geert J. Lycklama A., Roozenbeek, Bob, Emmer, Bart J., de Bruijn, Sebastiaan F., van Dijk, Lukas C., van der Worp, H. Bart, Lo, Rob H., van Dijk, Ewoud J., Boogaarts, Hieronymus D., de Kort, Paul L. M., Peluso, Jo J. P., van den Berg, Jan S. P., van Hasselt, Boudewijn A. A. M., Aerden, Leo A. M., Dallinga, Rene J., Uyttenboogaart, Maarten, Eshghi, Omid, Schreuder, Tobien H. C. M. L., Heijboer, Roel J. J., Keizer, Koos, Yo, Lonneke S. F., den Hertog, Heleen M., Sturm, Emiel J. C., Sprengers, Marieke E. S., Jenniskens, Sjoerd F. M., Postma, Alida, Hinsenveld, Wouter, Groot, P. F. C., and MR CLEAN Registry Investigators

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 = 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

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

Author

van Kranendonk, Katinka R., Treumiet, Kilian M., Boers, Anna M. M., Berkhemer, Olvert A., van den Berg, Lucie A., Chalos, Vicky, Lingsma, Hester F., 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., Fransen, Puck S. S., Beumer, Debbie, Yoo, Albert J., Schonewille, Wouter J., Vos, Jan Albert, Nederkoorn, Paul J., Wenner, Marieke J. H., van Walderveen, Marianne A. A., Staals, Julie, Hofmeijer, Jeannette, van Oostayen, Jacques A., Nijeholt, Geert J. Lycklama a, Boiten, Jells, Brouwer, Patrick A., Emmet, 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 Rooij, Willem Jan J., van den Berg, Jan S. P., van Hassell, 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, den Hertog, Heleen M., MR CLEAN Investigators, van Kranendonk, Katinka R., Treumiet, Kilian M., Boers, Anna M. M., Berkhemer, Olvert A., van den Berg, Lucie A., Chalos, Vicky, Lingsma, Hester F., 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., Fransen, Puck S. S., Beumer, Debbie, Yoo, Albert J., Schonewille, Wouter J., Vos, Jan Albert, Nederkoorn, Paul J., Wenner, Marieke J. H., van Walderveen, Marianne A. A., Staals, Julie, Hofmeijer, Jeannette, van Oostayen, Jacques A., Nijeholt, Geert J. Lycklama a, Boiten, Jells, Brouwer, Patrick A., Emmet, 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 Rooij, Willem Jan J., van den Berg, Jan S. P., van Hassell, 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, den Hertog, Heleen M., and MR CLEAN Investigators

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 PResults- 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 mmHg) 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 hemorr

Published
2019

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

Author

Jansen, Ivo G. H., Mulder, Maxim J. H. L., Goldhoorn, Robert-Jan B., Boers, Anna M. M., van Es, Adriaan C. G. M., Yo, Lonneke S. F., Hofmeijer, Jeannette, Martens, Jasper M., van Walderveen, Marianne A. A., van der Kallen, Bas F. W., Jenniskens, Sjoerd F. M., Treurniet, Kilian M., Marqueriny, Henk A., Sprengers, Marieke E. S., Schonewille, Wouter J., Bot, Joost, Lycklama A Nijeholt, Geert J., Lingsma, Hester F., Liebeskind, David S., Boiten, Jelis, Vos, Jan-Albert, Roos, Yvo B. W. E. M., van Oostenbrugge, Robert J., van der Lugt, Aad, van Zwam, Wim H., Dippel, Diederik W. J., van den Wijngaard, Ido R., Majoie, Charles B. L. M., Coutinho, Jonathan M., Wermern, Marieke J. H., Staals, Julie, Roozenbeek, Bob, Emmer, Bart J., de Bruijn, Sebastiaan F., van Dijk, Lukas C., van der Worp, H. Bart, Lo, Rob H., van Dijk, Ewoud J., Boogaarts, Hieronymus D., de Kort, Paul L. M., Peluso, Jo J. P., van den Berg, Jan S. P., van Hasselt, Boudewijn A. A. M., Aerden, Leo A. M., Dallinga, Rene J., Uyttenboogaart, Maarten, Eshghi, Omid, Schreuder, Tobien H. C. M. L., Heijboer, Roel J. J., Groot, P. F. C., MR CLEAN Registry Investigators, Jansen, Ivo G. H., Mulder, Maxim J. H. L., Goldhoorn, Robert-Jan B., Boers, Anna M. M., van Es, Adriaan C. G. M., Yo, Lonneke S. F., Hofmeijer, Jeannette, Martens, Jasper M., van Walderveen, Marianne A. A., van der Kallen, Bas F. W., Jenniskens, Sjoerd F. M., Treurniet, Kilian M., Marqueriny, Henk A., Sprengers, Marieke E. S., Schonewille, Wouter J., Bot, Joost, Lycklama A Nijeholt, Geert J., Lingsma, Hester F., Liebeskind, David S., Boiten, Jelis, Vos, Jan-Albert, Roos, Yvo B. W. E. M., van Oostenbrugge, Robert J., van der Lugt, Aad, van Zwam, Wim H., Dippel, Diederik W. J., van den Wijngaard, Ido R., Majoie, Charles B. L. M., Coutinho, Jonathan M., Wermern, Marieke J. H., Staals, Julie, Roozenbeek, Bob, Emmer, Bart J., de Bruijn, Sebastiaan F., van Dijk, Lukas C., van der Worp, H. Bart, Lo, Rob H., van Dijk, Ewoud J., Boogaarts, Hieronymus D., de Kort, Paul L. M., Peluso, Jo J. P., van den Berg, Jan S. P., van Hasselt, Boudewijn A. A. M., Aerden, Leo A. M., Dallinga, Rene J., Uyttenboogaart, Maarten, Eshghi, Omid, Schreuder, Tobien H. C. M. L., Heijboer, Roel J. J., Groot, P. F. C., and MR CLEAN Registry Investigators

Abstract

Background Collateral 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.Methods We 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.Results 1412 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 (PConclusion In 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

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

Author

Chalos, Vicky, primary, LeCouffe, Natalie E., additional, Uyttenboogaart, Maarten, additional, Lingsma, Hester F., additional, Mulder, Maxim J. H. L., additional, Venema, Esmee, additional, Treurniet, Kilian M., additional, Eshghi, Omid, additional, van der Worp, H. Bart, additional, van der Lugt, Aad, additional, Roos, Yvo B. W. E. M., additional, Majoie, Charles B. L. M., additional, Dippel, Diederik W. J., additional, Roozenbeek, Bob, additional, Coutinho, Jonathan M., additional, van Oostenbrugge, Robert J., additional, van Zwam, Wim H., additional, Boiten, Jelis, additional, Vos, Jan Albert, additional, Jansen, Ivo G. H., additional, Goldhoorn, Robert‐Jan B., additional, Schonewille, Wouter J., additional, Wermer, Marieke J. H., additional, van Walderveen, Marianne A. A., additional, Staals, Julie, additional, Hofmeijer, Jeannette, additional, Martens, Jasper M., additional, Lycklama à Nijeholt, Geert J., additional, Emmer, Bart 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 Kort, Paul L. M., additional, Peluso, Jo J. P., additional, van den Berg, Jan S. P., additional, van Hasselt, Boudewijn A. A. M., additional, Aerden, Leo A. M., additional, Dallinga, René J., 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, 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, van den Wijngaard, Ido R., additional, van Es, Adriaan C. G. M., additional, Bot, Joseph C. J., additional, van Doormaal, Pieter‐Jan, additional, Flach, H. Zwenneke, additional, el Ghannouti, Naziha, additional, Sterrenberg, Martin, additional, Puppels, Corina, additional, Pellikaan, Wilma, additional, Sprengers, Rita, additional, Elfrink, Marjan, additional, de Meris, Joke, additional, Vermeulen, Tamara, additional, Geerlings, Annet, additional, van Vemde, Gina, additional, Simons, Tiny, additional, van Rijswijk, Cathelijn, additional, Messchendorp, Gert, additional, Bongenaar, Hester, additional, Bodde, Karin, additional, Kleijn, Sandra, additional, Lodico, Jasmijn, additional, Droste, Hanneke, additional, Wollaert, M., additional, Jeurrissen, D., additional, Bos, Ernas, additional, Drabbe, Yvonne, additional, Zweedijk, Berber, additional, Khalilzada, Mostafa, additional, Compagne, Kars C. J., additional, Geuskens, Ralph R., additional, van Straaten, Tim, additional, Ergezen, Saliha, additional, Harmsma, Roger R. M., additional, de Jong, Anouk, additional, Hinsenveld, Wouter, additional, Berkhemer, Olvert A., additional, Boers, Anna M. M., additional, Groot, P. F. C., additional, Mens, Marieke A., additional, van Kranendonk, Katinka R., additional, Kappelhof, Manon, additional, Tolhuijsen, Manon L., additional, and Alves, Heitor, additional

Published
2019
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22. Observer variability of absolute and relative thrombus density measurements in patients with acute ischemic stroke

Author

Santos, Emilie M. M., Yoo, Albert J., Beenen, Ludo F., Berkhemer, Olvert A., den Blanken, Mark D., Wismans, Carrie, Niessen, Wiro J., Majoie, Charles B., Marquering, Henk A., Fransen, Puck S. S., Beumer, Debbie, van den Berg, Lucie A., Lingsma, Hester F., 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, Jan S. P., A A M van Hasselt, Boudewijn, 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., Hertog, Heleen M. Den, Gerrits, Dick G., van den Berg-Vos, Renske M., Sprengers, Marieke E. S., van den Berg, René, Roos, Yvo B. W. E. M., Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: CARIM - R3.11 - Imaging, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, RS: CARIM - R3.03 - Cerebral small vessel disease, Other departments, ANS - Neurovascular Disorders, Graduate School, Radiology and Nuclear Medicine, Other Research, ACS - Amsterdam Cardiovascular Sciences, Biomedical Engineering and Physics, Neurology, and Radiology & Nuclear Medicine

Subjects
Male, Observer (quantum physics), Computed Tomography Angiography, Intraclass correlation, Clinical Neurology, Sensitivity and Specificity, 030218 nuclear medicine & medical imaging, X-ray, 03 medical and health sciences, Brain ischemia, Absorptiometry, Photon, 0302 clinical medicine, Thromboembolism, Observer agreements, medicine, Humans, Radiology, Nuclear Medicine and imaging, In patient, cardiovascular diseases, Thrombus, Acute ischemic stroke, Computed tomography, Diagnostic Neuroradiology, Aged, Netherlands, Neuroradiology, Observer Variation, Measurement method, business.industry, Reproducibility of Results, Thrombosis, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], medicine.disease, Cerebral Angiography, Radiographic Image Enhancement, Stroke, Radiology Nuclear Medicine and imaging, Interobserver Variation, Acute Disease, Radiographic Image Interpretation, Computer-Assisted, Female, Neurology (clinical), Intracranial Thrombosis, Cardiology and Cardiovascular Medicine, business, Nuclear medicine, Algorithms, 030217 neurology & neurosurgery
Abstract

Introduction Thrombus density may be a predictor for acute ischemic stroke treatment success. However, only limited data on observer variability for thrombus density measurements exist. This study assesses the variability and bias of four common thrombus density measurement methods by expert and non-expert observers. Methods For 132 consecutive patients with acute ischemic stroke, three experts and two trained observers determined thrombus density by placing three standardized regions of interest (ROIs) in the thrombus and corresponding contralateral arterial segment. Subsequently, absolute and relative thrombus densities were determined using either one or three ROIs. Intraclass correlation coefficient (ICC) was determined, and Bland–Altman analysis was performed to evaluate interobserver and intermethod agreement. Accuracy of the trained observer was evaluated with a reference expert observer using the same statistical analysis. Results The highest interobserver agreement was obtained for absolute thrombus measurements using three ROIs (ICCs ranging from 0.54 to 0.91). In general, interobserver agreement was lower for relative measurements, and for using one instead of three ROIs. Interobserver agreement of trained non-experts and experts was similar. Accuracy of the trained observer measurements was comparable to the expert interobserver agreement and was better for absolute measurements and with three ROIs. The agreement between the one ROI and three ROI methods was good. Conclusion Absolute thrombus density measurement has superior interobserver agreement compared to relative density measurement. Interobserver variation is smaller when multiple ROIs are used. Trained non-expert observers can accurately and reproducibly assess absolute thrombus densities using three ROIs. Electronic supplementary material The online version of this article (doi:10.1007/s00234-015-1607-4) contains supplementary material, which is available to authorized users.

Published
2016

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

Author

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, and Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) investigators

Subjects
Multicenter Study, Research Support, Non-U.S. Gov't, Randomized Controlled Trial, Journal Article
Abstract

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

24. Automated Entire Thrombus Density Measurements for Robust and Comprehensive Thrombus Characterization in Patients with Acute Ischemic Stroke

Author

Santos, Emilie M. M., Niessen, Wiro J., Yoo, Albert J., Berkhemer, Olvert A., Beenen, Ludo F., Majoie, Charles B., Marquering, Henk A., Fransen, Puck S. S., Beumer, Debbie, van den Berg, Lucie A., Lingsma, Hester F., 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, 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., Sprengers, Marieke E. S., van den Berg, René, Roos, Yvo B. W. E. M., Other departments, Radiology and Nuclear Medicine, ACS - Amsterdam Cardiovascular Sciences, ANS - Neurovascular Disorders, Graduate School, Other Research, Biomedical Engineering and Physics, Neurology, Public and occupational health, EMGO - Quality of care, Radiology and nuclear medicine, Amsterdam Neuroscience - Neurovascular Disorders, Medical Informatics, Radiology & Nuclear Medicine, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, RS: CARIM - R3.03 - Cerebral small vessel disease, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), and RS: CARIM - R3.11 - Imaging

Subjects
Male, medicine.medical_specialty, lcsh:Medicine, Research Support, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Absorptiometry, Photon, 0302 clinical medicine, Interquartile range, Linear regression, medicine, Journal Article, Humans, cardiovascular diseases, Thrombus, Absorptiometry, lcsh:Science, Non-U.S. Gov't, Stroke, Acute ischemic stroke, Tomography, Aged, Multidisciplinary, business.industry, Research Support, Non-U.S. Gov't, lcsh:R, Thrombosis, Cerebral Arteries, Middle Aged, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], medicine.disease, Photon, Internal, X-Ray Computed, Kurtosis, cardiovascular system, lcsh:Q, Female, Radiology, Carotid Artery, Tomography, X-Ray Computed, business, Carotid Artery, Internal, 030217 neurology & neurosurgery, Research Article, circulatory and respiratory physiology
Abstract

Contains fulltext : 168317.PDF (Publisher’s version ) (Open Access) BACKGROUND AND PURPOSE: In acute ischemic stroke (AIS) management, CT-based thrombus density has been associated with treatment success. However, currently used thrombus measurements are prone to inter-observer variability and oversimplify the heterogeneous thrombus composition. Our aim was first to introduce an automated method to assess the entire thrombus density and then to compare the measured entire thrombus density with respect to current standard manual measurements. MATERIALS AND METHOD: In 135 AIS patients, the density distribution of the entire thrombus was determined. Density distributions were described using medians, interquartile ranges (IQR), kurtosis, and skewedness. Differences between the median of entire thrombus measurements and commonly applied manual measurements using 3 regions of interest were determined using linear regression. RESULTS: Density distributions varied considerably with medians ranging from 20.0 to 62.8 HU and IQRs ranging from 9.3 to 55.8 HU. The average median of the thrombus density distributions (43.5 +/- 10.2 HU) was lower than the manual assessment (49.6 +/- 8.0 HU) (p

Published
2016
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25. Association of Reperfusion With Brain Edema in Patients With Acute Ischemic Stroke : A Secondary Analysis of the MR CLEAN Trial

Author

Kimberly, W. Taylor, Dutra, Bruna Garbugio, Boers, Anna M. M., Alves, Heitor C. B. R., Berkhemer, Olvert A., van den Berg, Lucie, Sheth, Kevin N., Roos, Yvo B. W. E. M., van der Lugt, Aad, Beenen, Ludo F. M., Dippel, Diederik W. J., van Zwam, Wim H., van Oostenbrugge, Robert J., Lingsma, Hester F., Marquering, Henk, Majoie, Charles B. L. M., Koudstaal, Peter J., van den Berg, Lucie A., Nederkoorn, Paul J., Beumer, Debbie, Staals, Julie, Boiten, Jelis, Wermer, Marieke J. H., Kappelle, L. Jaap, van Dijk, Ewoud J., Schonewille, Wouter J., Hofmeijer, Jeannette, van Oostayen, Jacques A., Vroomen, Patrick C., de Kort, Paul L. M., Keizer, Koos, de Bruijn, Sebastiaan F., van den Berg, J. S. Peter, Schreuder, Tobien H. C. M. L., Aerden, Leo A. M., Flach, H. Zwenneke, Visser, Marieke C., den Hertog, Heleen M., Brouwer, Patrick A., Emmer, Bart J., Sprengers, Marieke E. S., van den Berg, René, Nijeholt, Geert J. Lycklamaà, van Walderveen, Marianne A. A., Lo, Rob H., de Vries, Joost, Vos, Jan Albert, Eshghi, Omid, Tielbeek, Alexander V., van Dijk, Lukas C., van Hasselt, Boudewijn A. A. M., Heijboer, Roel J. J., Dallinga, René J., Bot, Joseph C. J., Gerrits, Dick G., Fransen, Puck S. S., Marquering, Henk A., Steyerberg, Ewout W., Yoo, Albert J., Jenniskens, Sjoerd F. M., van den Berg-Vos, Renske M., Karas, Giorgos B., Brown, Martin M., Liebig, Thomas, Stijnen, Theo, Andersson, Tommy, Mattle, Heinrich, Wahlgren, Nils, van der Heijden, Esther, Ghannouti, Naziha, Fleitour, Nadine, Hooijenga, Imke, Puppels, Corina, Pellikaan, Wilma, Geerling, Annet, Lindl-Velema, Annemieke, van Vemde, Gina, Klinieken, Isala, de Ridder, Ans, Greebe, Paut, de Bont-Stikkelbroeck, José, de Meris, Joke, Janssen, Kirsten, Struijk, Willy, Licher, Silvan, Boodt, Nikki, Ros, Adriaan, Venema, Esmee, Slokkers, Ilse, Ganpat, Raymie-Jayce, Mulder, Maxim, Saiedie, Nawid, Heshmatollah, Alis, Schipperen, Stefanie, Vinken, Stefan, van Boxtel, Tiemen, Koets, Jeroen, Neurology, Radiology & Nuclear Medicine, Public Health, Radiology and nuclear medicine, VU University medical center, Amsterdam Neuroscience - Neurovascular Disorders, Beeldvorming, RS: CARIM - R3.03 - Cerebral small vessel disease, RS: CARIM - R3.11 - Imaging, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, Klinische Neurowetenschappen, MUMC+: MA Neurologie (3), Radiology and Nuclear Medicine, ACS - Amsterdam Cardiovascular Sciences, ANS - Neurovascular Disorders, Graduate School, Other Research, ARD - Amsterdam Reproduction and Development, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, ACS - Microcirculation, ACS - Atherosclerosis & ischemic syndromes, and ACS - Pulmonary hypertension & thrombosis

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Infarction, Brain Edema, ANGIOGRAPHY, THERAPY, Cerebral edema, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Midline shift, Modified Rankin Scale, Internal medicine, Outcome Assessment, Health Care, medicine, INJURY, Journal Article, Humans, 030212 general & internal medicine, cardiovascular diseases, PREDICTORS, Stroke, Aged, Netherlands, Retrospective Studies, Original Investigation, THROMBOLYSIS, business.industry, Cerebral infarction, Endovascular Procedures, Odds ratio, Thrombolysis, Middle Aged, medicine.disease, MIDDLE-CEREBRAL-ARTERY, DIFFUSION, THRESHOLDS, Treatment Outcome, TISSUE, Reperfusion, Cardiology, Female, Neurology (clinical), business, INFARCTION, 030217 neurology & neurosurgery
Abstract

Importance: It is uncertain whether therapeutic reperfusion with endovascular treatment yields more or less brain edema. Objective: To elucidate the association between reperfusion and brain edema. The secondary objectives were to evaluate whether brain edema could partially be responsible for worse outcomes in patients with later reperfusion or lower Alberta Stroke Program Early Computed Tomography Score. Design, Setting, and Participants: This was a post hoc analysis of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), which was a prospective, randomized, multicenter clinical trial of endovascular treatment compared with conventional care of patients with acute anterior circulation ischemic stroke. Of 502 patients enrolled from December 2010 to June 2014, 2 patients declined to participate. Additionally, exclusion criteria were absence of follow-up imaging or presence of parenchymal hematoma, resulting in 462 patients included in this study. Brain edema was assessed retrospectively, from December 10, 2016, to July 24, 2017, by measuring midline shift (MLS) in all available follow-up scans. Observers were blinded to clinical data. Main Outcomes and Measures: Midline shift was assessed as present or absent and as a continuous variable. Reperfusion status was assessed by the modified thrombolysis in cerebral infarction score in the endovascular treatment arm. The modified arterial occlusive lesion score was used to evaluate the recanalization status in both arms. The modified Rankin scale score at 90 days was used for functional outcome. Results: Of 462 patients, the mean (SD) age was 65 (11) years, and 41.8% (n = 193) were women. Successful reperfusion and recanalization were associated with a reduced likelihood of having MLS (adjusted common odds ratio, 0.25; 95% CI, 0.12-0.53; P

Published
2018
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26. Time to Reperfusion and Treatment Effect for Acute Ischemic Stroke: A Randomized Clinical Trial

Author

ZL Cerebrovasculaire Ziekten Medisch, Brain, MS Radiologie, Circulatory Health, 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, Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) investigators, ZL Cerebrovasculaire Ziekten Medisch, Brain, MS Radiologie, Circulatory Health, 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, and Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) investigators

Published
2016

29. Caregiver strain and fatigue are independent determinants of anxiety among patients early after stroke.

Author

van der Velde MY, Aerden LAM, van Oort A, Bodde K, Rambaran Mishre R, and Oosterveer DM

Subjects
Humans, Cross-Sectional Studies, Depression diagnosis, Depression etiology, Depression psychology, Anxiety etiology, Fatigue etiology, Fatigue complications, Caregivers psychology, Stroke complications, Stroke psychology
Abstract

Anxiety and depression are common mental health disorders in stroke patients, and often co-occur. However, in contrast to depression, there is limited research about anxiety after stroke, although impact of anxiety can be substantial. Therefore, this cross-sectional observational study investigated determinants of anxiety after stroke and compared them with determinants of depression after stroke. Stroke surviving patients ( n  = 284) were seen six weeks after discharge from the hospital or rehabilitation setting. Of these, 238 patients answered all questions of the Hospital Anxiety and Depression Scale measuring anxiety (HADS-a) and 239 patients answered all questions measuring depression (HADS-d). Step-wise regression was used to identify independent determinants of anxiety and depression after stroke. Higher levels of anxiety were associated with a higher caregiver strain ( p  < 0.01) and more fatigue ( p  < 0.05). In contrast, higher levels of depression were associated with lower life satisfaction ( p  < 0.001) and less daily activities ( p  < 0.05), but also more fatigue ( p  < 0.001). Hence, our results show that both fatigue and caregiver strain are associated with higher levels of anxiety, but of these only fatigue is also associated with higher levels of depression. Practitioners should therefore ask for both anxiety and depression symptoms in stroke patients.

Published
2023
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30. A randomized trial of intraarterial treatment for acute ischemic stroke.

Author

Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJ, van Walderveen MA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle LJ, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach HZ, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, van den Berg R, Koudstaal PJ, van Zwam WH, Roos YB, van der Lugt A, van Oostenbrugge RJ, Majoie CB, and Dippel DW

Subjects
Acute Disease, Adult, Aged, Aged, 80 and over, Brain Ischemia drug therapy, Catheterization, Combined Modality Therapy, Female, Humans, Logistic Models, Male, Middle Aged, Odds Ratio, Single-Blind Method, Stroke drug therapy, Brain Ischemia therapy, Fibrinolytic Agents therapeutic use, Mechanical Thrombolysis, Stroke therapy, Tissue Plasminogen Activator therapeutic use, Urokinase-Type Plasminogen Activator therapeutic use
Abstract

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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