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1. Collateral-based selection for endovascular treatment of acute ischaemic stroke in the late window (MR CLEAN-LATE): 2-year follow-up of a phase 3, multicentre, open-label, randomised controlled trial in the Netherlands

Author

van Oostenbrugge, Robert, van Zwam, Wim, Olthuis, Susanne, Pirson, Anne, Hinsenveld, Wouter, Goldhoorn, Robert-Jan, Staals, Julie, Dippel, Diederik, van der Lugt, Aad, van Es, Adriaan, Roozenbeek, Bob, van Doormaal, Pieter-Jan, Roos, Yvo, Majoie, Charles, Coutinho, Jonathan, Emmer, Bart, van der Worp, Bart, Lo, Rob, van Walderveen, Marianne, Wermer, Marieke, van Dijk, Ewoud, Jenniskens, Sjoerd, Boogaarts, Hieronymus, Uyttenboogaart, Maarten, Bokkers, Reinoud, Keizer, Koos, Gons, Rob, Yo, Lonneke, den Hertog, Heleen, van Hasselt, Boudewijn, Schonewille, Wouter, Vos, Jan-Albert, van Tuijl, Julia, Boukrab, Issam, Kortman, Hans, Hofmeijer, Jeannette, Martens, Jasper, van den Wijngaard, Ido, Boiten, Jelis, Lycklama à Nijeholt, Geert, Brouwers, Paul, Sturm, Emiel, Bulut, Tomas, de Laat, Karlijn, van Dijk, Lukas, Remmers, Michel, de Jong, Thijs, Rozeman, Anouk, Elgersma, Otto, Van der Veen, Bas, Sudiono, Davy, Mattle, Heinrich, Fiehler, Jens, van Kuijk, Sander, Nieboer, Daan, Lingsma, Hester, van Nuland, Rick, Roosendaal, Stefan, Krietemeijer, Menno, Postma, Alida, Van den Berg, René, Beenen, Ludo, Hammer, Sebastiaan, Meijer, Anton, van der Hoorn, Anouk, Yoo, Albert, Gerrits, Dick, Jansen, Ben, Truijman, Martine, Manschot, Sanne, Kerkhoff, Henk, Koudstaal, Peter, Chalos, Vicky, Berkhemer, Olvert, Versteeg, Adriaan, Wolff, Lennard, Su, Jiahang, van der Sluijs, Matthijs, van Voorst, Henk, Tolhuisen, Manon, ten Cate, Hugo, de Maat, Moniek, Donse-Donkel, Samantha, van Beusekom, Heleen, Taha, Aladdin, Barakzie, Aarazo, Treurniet, Kilian, van den Berg, Sophie, LeCouffe, Natalie, van de Graaf, Rob, de Ridder, Inger, Pinckaers, Florentina, Ceulemans, Angelique, Knapen, Robrecht, Robbe, Quirien, Sondag, Lotte, Kappelhof, Manon, Reinink, Rik, Silvis, Suzanne, Schreuder, Floris, Uniken Venema, Simone, van Meenen, Laura, Collette, Sabine, van Wijngaarden, Wilma, van der Steen, Wouter, Hoving, Jan, Verheesen, Sabrina, Sterrenberg, Martin, El Ghannouti, Naziha, Sprengers, Rita, van Ahee, Ayla, Zweedijk, Berber, Pellikaan, Wilma, Schonewille, Irati, Blauwendraat, Kitty, Drabbe, Yvonne, Kleine-Kathöfer, Anke, de Meris, Joke, Sandiman, Michelle, Dofferhoff-Vermeulen, Tamara, Simons, Michelle, Bongenaar, Hester, Smallegange, Maylee, van Loon, Anja, Kraus, Karin, Bos-Verheij, Erna, Santegoets, Ester, Kooij, Suze, Slotboom, Annemarie, Ponjee, Eva, Eilander, Rieke, Droste, Hanneke, van Veen, Esther, Visser, Rosalie, Lodico, Jasmijn, de Jong, Marieke, van der Minne, Friedus, Cleophas, Eefje, Muskens, Ernst, Nijst, Amy, Heiligers, Leontien, Martens, Yvonne, Slotboom, Miranda, Hintzen, Rogier, Jacobs, Bart, Huijberts, Ilse, Pinckaers, Florentina M E, Olthuis, Susanne G H, van Kuijk, Sander M J, Postma, Alida A, Boogaarts, Hieronymus D, Roos, Yvo B W E M, Majoie, Charles B L M, Dippel, Diederik W J, van Zwam, Wim H, and van Oostenbrugge, Robert J

Published
2024
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2. Intravenous Thrombolysis Before Endovascular Treatment in Posterior Circulation Occlusions: A MR CLEAN Registry Study

Author

Knapen, Robrecht R.M.M., Pirson, F. Anne V., Langezaal, Lucianne C.M., Brouwer, Josje, Majoie, Charles B.L.M., Emmer, Bart J., Vos, Jan-Albert, van Doormaal, Pieter-Jan, Yoo, Albert J., Bruggeman, Agnetha A.E., Lycklama à Nijeholt, Geert J., van der Leij, Chirstiaan, van Oostenbrugge, Robert J., van Zwam, Wim H., Schonewille, Wouter J., Dippel, Diederik W.J., van der Lugt, Aad, Roos, Yvo B.W.E.M., Boiten, Jelis, Jansen, Ivo G.H., Mulder, Maxim J.H.L., Goldhoorn, Robert-Jan B., Compagne, Kars C.J., Kappelhof, Manon, den Hartog, Sanne J., Hinsenveld, Wouter H., Dippel, Diederik W.J., Roozenbeek, Bob, van der Lugt, Aad, Roos, Yvo B.W.E.M., Wermer, Marieke J.H., van Walderveen, Marianne A.A., van Es, Adriaan C.G.M., Staals, Julie, Hofmeijer, Jeannette, Martens, Jasper M., Boiten, Jelis, de Bruijn, Sebastiaan F., van Dijk, Lukas C., Bart van der Worp, H., 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., Sturm, Emiel J.C., Brouwers, Paul J.A.M., van Walderveen, Marianne A.A., Sprengers, Marieke E.S., Jenniskens, Sjoerd F.M., van den Berg, René, Beenen, Ludo F.M., Postma, Alida A., Roosendaal, Stefan D., van der Kallen, Bas F.W., van den Wijngaard, Ido R., van Es, Adriaan C.G.M., Martens, Jasper M., Yo, Lonneke S.F., Bot, Joost, Meijer, Anton, Ghariq, Elyas, Bokkers, Reinoud P.H., van Proosdij, Marc P., Menno Krietemeijer, G., Peluso, Jo P., Boogaarts, Hieronymus D., Lo, Rob, Dinkelaar, Wouter, Appelman, Auke P.A., Hammer, Bas, Pegge, Sjoert, van der Hoorn, Anouk, Vinke, Saman, Cornelissen, Sandra, Brans, Rutger, Dippel, Diederik W.J., van der Lugt, Aad, Roos, Yvo B.W.E.M., Boiten, Jelis, Hofmeijer, Jeannette, Martens, Jasper M., Bart van der Worp, H., Lo, Rob H., Hofmeijer, Jeannette, Zwenneke Flach, H., 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., and Boodt, Nikki

Published
2024
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3. Prediction of Outcome and Endovascular Treatment Benefit

Author

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, der Lugt, Aad van, Boiten, Jelis, Vos, Jan Albert, Jansen, Ivo GH, Goldhoorn, Robert-Jan B, Compagne, Kars CJ, Kappelhof, Manon, Brouwer, Josje, den Hartog, Sanne J, Hinsenveld, Wouter H, van Es, Adriaan CGM, Emmer, Bart J, Coutinho, Jonathan M, Schonewille, Wouter J, Wermer, Marieke JH, van Walderveen, Marianne AA, Staals, Julie, Hofmeijer, Jeannette, 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, Vries, J de, de Kort, Paul LM, van Tuijl, Julia, Peluso, Jo P, Fransen, Puck, van den Berg, Jan SP, van Hasselt, Boudewijn AAM, Aerden, Leo AM, Dallinga, René J, Uyttenboogaart, Maarten, Eschgi, Omid, Bokkers, Reinoud PH, Schreuder, Tobien HCML, Heijboer, Roel JJ, Keizer, Koos, Yo, Lonneke SF, den Hertog, Heleen M, Bulut, Tomas, Brouwers, Paul JAM, Sprengers, Marieke ES, Jenniskens, Sjoerd FM, van den Berg, René, Yoo, Albert J, Beenen, Ludo FM, Postma, Alida A, Roosendaal, Stefan D, van der Kallen, Bas FW, van den Wijngaard, Ido R, Bot, Joost, van Doormaal, Pieter-Jan, Meijer, Anton, Ghariq, Elyas, van Proosdij, Marc P, Krietemeijer, G Menno, Lo, Rob, Gerrits, Dick, Dinkelaar, Wouter, and Appelman, Auke PA

Subjects
Clinical Trials and Supportive Activities, Clinical Research, Stroke, Brain Disorders, Neurosciences, Aged, Aged, 80 and over, Brain Ischemia, Endovascular Procedures, Humans, Ischemic Stroke, Male, Middle Aged, Registries, Thrombectomy, Treatment Outcome, ischemic stroke, registry, reperfusion, thrombectomy, uncertainty, HERMES collaborators and MR CLEAN Registry Investigators*, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Neurology & Neurosurgery
Abstract

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 (

Published
2021

4. Endovascular treatment versus no endovascular treatment after 6–24 h in patients with ischaemic stroke and collateral flow on CT angiography (MR CLEAN-LATE) in the Netherlands: a multicentre, open-label, blinded-endpoint, randomised, controlled, phase 3 trial

Author

Olthuis, Susanne G H, Pirson, F Anne V, Pinckaers, Florentina M E, Hinsenveld, Wouter H, Nieboer, Daan, Ceulemans, Angelique, Knapen, Robrecht R M M, Robbe, M M Quirien, Berkhemer, Olvert A, van Walderveen, Marianne A A, Lycklama à Nijeholt, Geert J, Uyttenboogaart, Maarten, Schonewille, Wouter J, van der Sluijs, P Matthijs, Wolff, Lennard, van Voorst, Henk, Postma, Alida A, Roosendaal, Stefan D, van der Hoorn, Anouk, Emmer, Bart J, Krietemeijer, Menno G M, van Doormaal, Pieter-Jan, Roozenbeek, Bob, Goldhoorn, Robert-Jan B, Staals, Julie, de Ridder, Inger R, van der Leij, Christiaan, Coutinho, Jonathan M, van der Worp, H Bart, Lo, Rob T H, Bokkers, Reinoud P H, van Dijk, Ewoud I, Boogaarts, Hieronymus D, Wermer, Marieke J H, van Es, Adriaan C G M, van Tuijl, Julia H, Kortman, Hans G J, Gons, Rob A R, Yo, Lonneke S F, Vos, Jan-Albert, de Laat, Karlijn F, van Dijk, Lukas C, van den Wijngaard, Ido R, Hofmeijer, Jeannette, Martens, Jasper M, Brouwers, Paul J A M, Bulut, Tomas, Remmers, Michel J M, de Jong, Thijs E A M, den Hertog, Heleen M, van Hasselt, Boudewijn A A M, Rozeman, Anouk D, Elgersma, Otto E H, van der Veen, Bas, Sudiono, Davy R, Lingsma, Hester F, Roos, Yvo B W E M, Majoie, Charles B L M, van der Lugt, Aad, Dippel, Diederik W J, van Zwam, Wim H, and van Oostenbrugge, Robert J

Published
2023
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5. Prehospital transdermal glyceryl trinitrate in patients with presumed acute stroke (MR ASAP): an ambulance-based, multicentre, randomised, open-label, blinded endpoint, phase 3 trial

Author

van Ahee, Ayla, Visseren, Frank, Halkes, Patricia, van Eijk, Ruben, Simons, Michelle, Pellikaan, Wilma, Van Wijngaarden, Wilma, Ponjee, Eva, Geijtenbeek, Petra, Arts, Ton, Zock, Elles, Oudshoorn, Wilma, Steenwinkel, Frans, Samim, Hamdia, van Zandwijk, Mark, Vrielink, Lisette, Mulder, Peter Jan, Gerritsen, Aico, Ijzermans, Jim, Kooijman, Marjan, Francissen, Oscar, van Nuland, Rick, van Zwam, Wim, Jacobi, Linda, van den Berg, Rene, Beenen, Ludo, van Es, Adriaan, van Doormaal, Pieter-Jan, Lycklama a Nijeholt, Geert, van den Wijngaard, Ido, Yoo, Albert, Yo, Lonneke, Martens, Jasper, Hammer, Bas, Roosendaal, Stefan, Meijer, Anton, Krietemeijer, Menno, Bokkers, Reinoud, van der Hoorn, Anouk, Gerrits, Dick, Coutinho, Jonathan, Jansen, Ben, Manschot, Sanne, Koudstaal, Peter, Keizer, Koos, Chalos, Vicky, Versteeg, Adriaan, Wolff, Lennard, van Voorst, Henk, van der Sluijs, Matthijs, Hoving, Arnolt-Jan, Treurniet, Kilian, LeCouffe, Natalie, van de Graaf, Rob, Goldhoorn, Robert-Jan, Hinseveld, Wouter, Pirson, Anne, Sondag, Lotte, Kappelhof, Manon, Tolhuisen, Manon, Brouwer, Josje, van der Steen, Wouter, Rinkel, Leon, Bruggeman, Agnetha, Sprengers, Rita, Sterrenberg, Martin, Verheesen, Sabrina, Heiligers, Leontien, Martens, Yvonne, El Ghannouti, Naziha, Slotboom, Miranda, van den Berg, Sophie A, Uniken Venema, Simone M, Reinink, Hendrik, Hofmeijer, Jeannette, Schonewille, Wouter J, Miedema, Irene, Fransen, Puck S S, O Pruissen, D Martijn, Raaijmakers, Theodora W M, van Dijk, Gert W, de Leeuw, Frank-Erik, van Vliet, Jorine A, Kwa, Vincent I H, Kerkhoff, Henk, van 't Net, Alex, Boomars, Rene, Siegers, Arjen, Lok, Tycho, Caminada, Klaartje, Esteve Cuevas, Laura M, Visser, Marieke C, Zwetsloot, Casper P, Boomsma, Jooske M F, Schipper, Mirjam H, van Eijkelenburg, Roeland P J, Berkhemer, Olvert A, Nieboer, Daan, Lingsma, Hester F, Emmer, Bart J, van Oostenbrugge, Robert J, van der Lugt, Aad, Roos, Yvo B W E M, Majoie, Charles B L M, Dippel, Diederik W J, Nederkoorn, Paul J, and van der Worp, H Bart

Published
2022
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6. Prognostic Value of Thrombus Volume and Interaction With First-Line Endovascular Treatment Device Choice

Author

van Voorst, Henk, Bruggeman, Agnetha A.E., Andriessen, Jurr, Hoving, Jan W., Konduri, Praneeta R., Yang, Wenjin, Kappelhof, Manon, Arrarte Terreros, Nerea, Roos, Yvo B.W.E.M., van Zwam, Wim H., van der Lugt, Aad, van der Hoorn, Anouk, Boiten, Jelis, Roosendaal, Stefan, Jenniskens, Sjoerd, Caan, Matthan W.A., Marquering, Henk A., Emmer, Bart J., Majoie, Charles B.L.M., Dippel, Diederik W.J., van Oostenbrugge, Robert J., Vos, Jan Albert, Jansen, Ivo G.H., Mulder, Maxim J.H.L., Goldhoorn, Robert- Jan B., Compagne, Kars C.J., Brouwer, Josje, den Hartog, Sanne J., Hinsenveld, Wouter H., Dippel, Diederik W.J., Roozenbeek, Bob, van Es, Adriaan C.G.M., Coutinho, Jonathan M., Schonewille, Wouter J., Vos, Jan Albert, Wermer, Marieke J.H., van Walderveen, Marianne A.A., Staals, Julie, van Oostenbrugge, Robert J., Hofmeijer, Jeannette, Martens, Jasper M., Lycklama à Nijeholt, Geert 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 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., Sturm, Emiel J.C., Brouwers, Paul J.A.M., Lycklama à Nijeholt, Geert J., van Walderveen, Marianne A.A., Sprengers, Marieke E.S., van den Berg, René, Yoo, Albert J., Beenen, Ludo F.M., Postma, Alida A., van der Kallen, Bas F.W., van den Wijngaard, Ido R., van Es, Adriaan C.G.M., Martens, Jasper M., Yo, Lonneke S.F., Vos, Jan Albert, Bot, Joost, van Doormaal, Pieter-Jan, Meijer, Anton, Ghariq, Elyas, Bokkers, Reinoud P.H., van Proosdij, Marc P., Krietemeijer, G. Menno, Peluso, Jo P., Boogaarts, Hieronymus D., Lo, Rob, Gerrits, Dick, Dinkelaar, Wouter, Appelman, Auke P.A., Hammer, Bas, Pegge, Sjoert, Vinke, Saman, Dippel, Diederik W.J., van Oostenbrugge, Robert J., Lycklama à Nijeholt, Geert J., Vos, Jan Albert, Schonewille, Wouter J., Hofmeijer, Jeannette, Martens, Jasper M., van der Worp, H. Bart, Lo, Rob H., van Oostenbrugge, Robert J., Hofmeijer, Jeannette, 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, Groot, Adrien E.D., LeCouffe, Natalie E., Prasetya, Haryadi, and Ramos, Lucas A.

Published
2023
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7. Improvements in Endovascular Treatment for Acute Ischemic Stroke: A Longitudinal Study in the MR CLEAN Registry

Author

Compagne, Kars C.J., Kappelhof, Manon, Hinsenveld, Wouter H., Brouwer, Josje, Goldhoorn, Robert-Jan B., Uyttenboogaart, Maarten, Bokkers, Reinoud P.H., Schonewille, Wouter J., Martens, Jasper M., Hofmeijer, Jeannette, van der Worp, H. Bart, Lo, Rob T.H., Keizer, Koos, Yo, Lonneke S.F., Lycklama à Nijeholt, Geert J., den Hertog, Heleen M., Sturm, Emiel J.C., Brouwers, Paul J.A.M., van Walderveen, Marianne A.A., Wermer, Marieke J.H., de Bruijn, Sebastiaan F., van Dijk, Lukas C., Boogaarts, Hieronymus D., van Dijk, Ewout J., van Tuijl, Julia H., Peluso, Jo P.P., de Kort, Paul L.M., van Hasselt, Boudewijn A.A.M., Fransen, Puck S., Schreuder, Tobien H.C.M.L., Heijboer, Roel J.J., Jenniskens, Sjoerd F.M., Sprengers, Marieke E.S., Ghariq, Elias, van den Wijngaard, Ido R., Roosendaal, Stefan D., Meijer, Anton F.J.A., Beenen, Ludo F.M., Postma, Alida A., van den Berg, René, Yoo, Albert J., van Doormaal, Pieter Jan, van Proosdij, Marc P., Krietemeijer, Menno G.M., Gerrits, Dick G., Hammer, Sebastiaan, Vos, Jan Albert, Boiten, Jelis, Coutinho, Jonathan M., Emmer, Bart J., van Es, Ad C.G.M., Roozenbeek, Bob, Roos, Yvo B.W.E.M., van Zwam, Wim H., van Oostenbrugge, Robert J., Majoie, Charles B.L.M., Dippel, Diederik W.J., and van der Lugt, Aad

Published
2022
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9. Endovascular Treatment for Posterior Circulation Stroke in Routine Clinical Practice: Results of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry

Author

Pirson, F. Anne V., Boodt, Nikki, Brouwer, Josje, Bruggeman, Agnetha A.E., den Hartog, Sanne J., Goldhoorn, Robert-Jan B., Langezaal, Lucianne C.M., Staals, Julie, van Zwam, Wim H., van der Leij, Christiaan, Brans, Rutger J.B., Majoie, Charles B.L.M., Coutinho, Jonathan M., Emmer, Bart J., Dippel, Diederik W.J., van der Lugt, Aad, Vos, Jan-Albert, van Oostenbrugge, Robert J., and Schonewille, Wouter J.

Published
2022
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11. 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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19. 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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20. Timing and causes of death after endovascular thrombectomy in patients with acute ischemic stroke

Author

Opleiding Neurologie, Neurologen, Brain, Circulatory Health, Stroke, Sluis, Wouter M., Hinsenveld, Wouter H., Goldhoorn, Robert Jan B., Potters, Lianne H., Bruggeman, Agnetha A.E., van der Hoorn, Anouk, Bot, Joseph C.J., van Oostenbrugge, Robert J., Lingsma, Hester F., Hofmeijer, Jeannette, van Zwam, Wim H., BLM Majoie, Charles, Bart van der Worp, H., Opleiding Neurologie, Neurologen, Brain, Circulatory Health, Stroke, Sluis, Wouter M., Hinsenveld, Wouter H., Goldhoorn, Robert Jan B., Potters, Lianne H., Bruggeman, Agnetha A.E., van der Hoorn, Anouk, Bot, Joseph C.J., van Oostenbrugge, Robert J., Lingsma, Hester F., Hofmeijer, Jeannette, van Zwam, Wim H., BLM Majoie, Charles, and Bart van der Worp, H.

Published
2023

21. Endovascular treatment for isolated posterior cerebral artery occlusion stroke in the MR CLEAN registry

Author

Brouwer, Josje, Ergezen, Saliha, Mulder, Maxim Johan Heymen Laurence, Nijeholt, Geert J.Lycklama A., Van Es, Adriaan C.G.M., Van Der Lugt, Aad, Dippel, Diederik W.J., Majoie, Charles B.L.M., Roos, Yvo B.W.E.M., Coutinho, J. M., Emmer, Bart J., Van Oostenbrugge, Robert J., Van Zwam, Wim H., Boiten, Jelis, Vos, Jan Albert, Jansen, Ivo G.H., Goldhoorn, Robert Jan B., Compagne, Kars C.J., Kappelhof, Manon, Den Hartog, Sanne J., Hinsenveld, Wouter H., Roozenbeek, Bob, Schonewille, Wouter J., Wermer, Marieke J.H., Van Walderveen, Marianne A.A., Staals, Julie, Hofmeijer, Jeannette, 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., Postma, Alida A., Van Der Leij, Christiaan, Brans, Rutger, Pirson, Anne-France, MR CLEAN Registry Investigators, Brouwer, Josje, Ergezen, Saliha, Mulder, Maxim Johan Heymen Laurence, Nijeholt, Geert J.Lycklama A., Van Es, Adriaan C.G.M., Van Der Lugt, Aad, Dippel, Diederik W.J., Majoie, Charles B.L.M., Roos, Yvo B.W.E.M., Coutinho, J. M., Emmer, Bart J., Van Oostenbrugge, Robert J., Van Zwam, Wim H., Boiten, Jelis, Vos, Jan Albert, Jansen, Ivo G.H., Goldhoorn, Robert Jan B., Compagne, Kars C.J., Kappelhof, Manon, Den Hartog, Sanne J., Hinsenveld, Wouter H., Roozenbeek, Bob, Schonewille, Wouter J., Wermer, Marieke J.H., Van Walderveen, Marianne A.A., Staals, Julie, Hofmeijer, Jeannette, 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., Postma, Alida A., Van Der Leij, Christiaan, Brans, Rutger, Pirson, Anne-France, and MR CLEAN Registry Investigators

Abstract

Background Endovascular treatment (EVT) is standard of care in anterior circulation large vessel occlusions. In posterior circulation occlusions, data on EVT in isolated posterior cerebral artery (PCA) occlusions are limited, although PCA occlusions can cause severe neurological deficit. Objective To describe in a prospective study the clinical manifestations, outcomes, and safety of EVT in isolated PCA occlusions. Methods We used data (2014-2017) from the MR CLEAN Registry, a nationwide, prospective cohort of EVT-treated patients in the Netherlands. We included patients with acute ischemic stroke (AIS) due to an isolated PCA occlusion on CT angiography. Patients with concurrent occlusion of the basilar artery were excluded. Outcomes included change in National Institutes of Health Stroke Scale (?NIHSS) score, modified Rankin Scale (mRS) score 0-3 after 90 days, mortality, expanded Thrombolysis in Cerebral Infarction (eTICI), and periprocedural complications. Results Twenty (12%) of 162 patients with posterior circulation occlusions had an isolated PCA occlusion. Median age was 72 years; 13 (65%) were women. Median baseline NIHSS score was 13 (IQR 5-21). Six (30%) patients were comatose. Twelve patients (60%) received IVT. Median ?NIHSS was -4 (IQR -11-+1). At follow-up, nine patients (45%) had mRS score 0-3. Seven (35%) died. eTICI 2b-3 was achieved in 13 patients (65%). Nine patients (45%) had periprocedural complications. No symptomatic intracranial hemorrhages (sICH) occurred. Conclusions EVT should be considered in selected patients with AIS with an isolated PCA occlusion, presenting with moderate-severe neurological deficits, as EVT was technically feasible in most of our patients and about half had good clinical outcome. In case of lower NIHSS score, a more conservative approach seems warranted, since periprocedural complications are not uncommon. Nonetheless, EVT seems reasonably safe considering the absence of sICH in our study.

Published
2023

22. Endovascular treatment versus no endovascular treatment after 6–24 h in patients with ischaemic stroke and collateral flow on CT angiography (MR CLEAN-LATE) in the Netherlands:a multicentre, open-label, blinded-endpoint, randomised, controlled, phase 3 trial

Author

Olthuis, Susanne G.H., Pirson, F. Anne V., Pinckaers, Florentina M.E., Hinsenveld, Wouter H., Nieboer, Daan, Ceulemans, Angelique, Knapen, Robrecht R.M.M., Robbe, M. M.Quirien, Berkhemer, Olvert A., van Walderveen, Marianne A.A., Lycklama à Nijeholt, Geert J., Uyttenboogaart, Maarten, Schonewille, Wouter J., van der Sluijs, P. Matthijs, Wolff, Lennard, van Voorst, Henk, Postma, Alida A., Roosendaal, Stefan D., van der Hoorn, Anouk, Emmer, Bart J., Krietemeijer, Menno G.M., van Doormaal, Pieter Jan, Roozenbeek, Bob, Goldhoorn, Robert Jan B., Staals, Julie, de Ridder, Inger R., van der Leij, Christiaan, Coutinho, Jonathan M., van der Worp, H. Bart, Lo, Rob T.H., Bokkers, Reinoud P.H., van Dijk, Ewoud I., Boogaarts, Hieronymus D., Wermer, Marieke J.H., van Es, Adriaan C.G.M., van Tuijl, Julia H., Kortman, Hans G.J., Gons, Rob A.R., Yo, Lonneke S.F., Vos, Jan Albert, de Laat, Karlijn F., van Dijk, Lukas C., van den Wijngaard, Ido R., Hofmeijer, Jeannette, Martens, Jasper M., Brouwers, Paul J.A.M., den Hertog, Heleen M., Lingsma, Hester F., van der Lugt, Aad, Dippel, Diederik W.J., Olthuis, Susanne G.H., Pirson, F. Anne V., Pinckaers, Florentina M.E., Hinsenveld, Wouter H., Nieboer, Daan, Ceulemans, Angelique, Knapen, Robrecht R.M.M., Robbe, M. M.Quirien, Berkhemer, Olvert A., van Walderveen, Marianne A.A., Lycklama à Nijeholt, Geert J., Uyttenboogaart, Maarten, Schonewille, Wouter J., van der Sluijs, P. Matthijs, Wolff, Lennard, van Voorst, Henk, Postma, Alida A., Roosendaal, Stefan D., van der Hoorn, Anouk, Emmer, Bart J., Krietemeijer, Menno G.M., van Doormaal, Pieter Jan, Roozenbeek, Bob, Goldhoorn, Robert Jan B., Staals, Julie, de Ridder, Inger R., van der Leij, Christiaan, Coutinho, Jonathan M., van der Worp, H. Bart, Lo, Rob T.H., Bokkers, Reinoud P.H., van Dijk, Ewoud I., Boogaarts, Hieronymus D., Wermer, Marieke J.H., van Es, Adriaan C.G.M., van Tuijl, Julia H., Kortman, Hans G.J., Gons, Rob A.R., Yo, Lonneke S.F., Vos, Jan Albert, de Laat, Karlijn F., van Dijk, Lukas C., van den Wijngaard, Ido R., Hofmeijer, Jeannette, Martens, Jasper M., Brouwers, Paul J.A.M., den Hertog, Heleen M., Lingsma, Hester F., van der Lugt, Aad, and Dippel, Diederik W.J.

Abstract

Background: Endovascular treatment for anterior circulation ischaemic stroke is effective and safe within a 6 h window. MR CLEAN-LATE aimed to assess efficacy and safety of endovascular treatment for patients treated in the late window (6–24 h from symptom onset or last seen well) selected on the basis of the presence of collateral flow on CT angiography (CTA). Methods: MR CLEAN-LATE was a multicentre, open-label, blinded-endpoint, randomised, controlled, phase 3 trial done in 18 stroke intervention centres in the Netherlands. Patients aged 18 years or older with ischaemic stroke, presenting in the late window with an anterior circulation large-vessel occlusion and collateral flow on CTA, and a neurological deficit score of at least 2 on the National Institutes of Health Stroke Scale were included. Patients who were eligible for late-window endovascular treatment were treated according to national guidelines (based on clinical and perfusion imaging criteria derived from the DAWN and DEFUSE-3 trials) and excluded from MR CLEAN-LATE enrolment. Patients were randomly assigned (1:1) to receive endovascular treatment or no endovascular treatment (control), in addition to best medical treatment. Randomisation was web based, with block sizes ranging from eight to 20, and stratified by centre. The primary outcome was the modified Rankin Scale (mRS) score at 90 days after randomisation. Safety outcomes included all-cause mortality at 90 days after randomisation and symptomatic intracranial haemorrhage. All randomly assigned patients who provided deferred consent or died before consent could be obtained comprised the modified intention-to-treat population, in which the primary and safety outcomes were assessed. Analyses were adjusted for predefined confounders. Treatment effect was estimated with ordinal logistic regression and reported as an adjusted common odds ratio (OR) with a 95% CI. This trial was registered with the ISRCTN, ISRCTN19922220. Findings: Between Feb 2, 2

Published
2023

23. Alternative Arterial Access Routes for Endovascular Thrombectomy in Patients with Acute Ischemic Stroke:A Study from the MR CLEAN Registry

Author

Collette, Sabine L., van de Ven, Elke A., Luijckx, Gert Jan R., Lingsma, Hester F., van Doormaal, Pieter Jan, van Es, Adriaan C.G.M., van den Wijngaard, Ido R., Goldhoorn, Robert Jan B., de Groot, Jan Cees, van Zwam, Wim H., Majoie, Charles B.L.M., Dippel, Diederik W.J., Bokkers, Reinoud P.H., Uyttenboogaart, Maarten, Collette, Sabine L., van de Ven, Elke A., Luijckx, Gert Jan R., Lingsma, Hester F., van Doormaal, Pieter Jan, van Es, Adriaan C.G.M., van den Wijngaard, Ido R., Goldhoorn, Robert Jan B., de Groot, Jan Cees, van Zwam, Wim H., Majoie, Charles B.L.M., Dippel, Diederik W.J., Bokkers, Reinoud P.H., and Uyttenboogaart, Maarten

Abstract

Background: Endovascular thrombectomy (EVT) through femoral access is difficult to perform in some patients with acute ischemic stroke due to challenging vasculature. We compared outcomes of EVT through femoral versus alternative arterial access. Methods: In this observational study, we included patients from the MR CLEAN Registry who underwent EVT for acute ischemic stroke in the anterior circulation between 2014 and 2019 in the Netherlands. Patients who underwent EVT through alternative and femoral access were matched on propensity scores in a 1:3 ratio. The primary endpoint was favorable functional outcome (modified Rankin Scale score ≤ 2) at 90 days. Secondary endpoints were early neurologic recovery, mortality, successful intracranial reperfusion and puncture related complications. Results: Of the 5197 included patients, 17 patients underwent EVT through alternative access and were matched to 48 patients who underwent EVT through femoral access. Alternative access was obtained through the common carotid artery (n = 15/17) and brachial artery (n = 2/17). Favorable functional outcome was less often observed after EVT through alternative than femoral access (18% versus 27%; aOR, 0.36; 95% CI, 0.05–2.74). The rate of successful intracranial reperfusion was higher for alternative than femoral access (88% versus 58%), although mortality (59% versus 31%) and puncture related complications (29% versus 0%) were more common after alternative access. Conclusions: EVT through alternative arterial access is rarely performed in the Netherlands and seems to be associated with worse outcomes than standard femoral access. A next step would be to compare the additional value of EVT through alternative arterial access after failure of femoral access.

Published
2023

24. Timing and causes of death after endovascular thrombectomy in patients with acute ischemic stroke

Author

Sluis, Wouter M., Hinsenveld, Wouter H., Goldhoorn, Robert Jan B., Potters, Lianne H., Bruggeman, Agnetha A.E., van der Hoorn, Anouk, Bot, Joseph C.J., van Oostenbrugge, Robert J., Lingsma, Hester F., Hofmeijer, Jeannette, van Zwam, Wim H., BLM Majoie, Charles, Bart van der Worp, H., Sluis, Wouter M., Hinsenveld, Wouter H., Goldhoorn, Robert Jan B., Potters, Lianne H., Bruggeman, Agnetha A.E., van der Hoorn, Anouk, Bot, Joseph C.J., van Oostenbrugge, Robert J., Lingsma, Hester F., Hofmeijer, Jeannette, van Zwam, Wim H., BLM Majoie, Charles, and Bart van der Worp, H.

Abstract

Introduction: Endovascular thrombectomy (EVT) increases the chance of good functional outcome after ischemic stroke caused by a large vessel occlusion, but the risk of death in the first 90 days is still considerable. We assessed the causes, timing and risk factors of death after EVT to aid future studies aiming to reduce mortality. Patients and methods: We used data from the MR CLEAN Registry, a prospective, multicenter, observational cohort study of patients treated with EVT in the Netherlands between March 2014, and November 2017. We assessed causes and timing of death and risk factors for death in the first 90 days after treatment. Causes and timing of death were determined by reviewing serious adverse event forms, discharge letters, or other written clinical information. Risk factors for death were determined with multivariable logistic regression. Results: Of 3180 patients treated with EVT, 863 (27.1%) died in the first 90 days. The most common causes of death were pneumonia (215 patients, 26.2%), intracranial hemorrhage (142 patients, 17.3%), withdrawal of life-sustaining treatment because of the initial stroke (110 patients, 13.4%) and space-occupying edema (101 patients, 12.3%). In total, 448 patients (52% of all deaths) died in the first week, with intracranial hemorrhage as most frequent cause. The strongest risk factors for death were hyperglycemia and functional dependency before the stroke and severe neurological deficit at 24–48 h after treatment. Discussion and conclusion: When EVT fails to decrease the initial neurological deficit, strategies to prevent complications like pneumonia and intracranial hemorrhage after EVT could improve survival, as these are often the cause of death.

Published
2023

25. Prognostic Value of Thrombus Volume and Interaction With First-Line Endovascular Treatment Device Choice

Author

Neurologen, Brain, Circulatory Health, Stroke, MS Radiologie, Van Voorst, Henk, Bruggeman, Agnetha A.E., Andriessen, Jurr, Hoving, Jan W., Konduri, Praneeta R., Yang, Wenjin, Kappelhof, Manon, Arrarte Terreros, Nerea, Roos, Yvo B.W.E.M., Van Zwam, Wim H., Van Der Lugt, Aad, Van Der Hoorn, Anouk, Boiten, Jelis, Roosendaal, Stefan, Jenniskens, Sjoerd, Caan, Matthan W.A., Marquering, Henk A., Emmer, Bart J., Majoie, Charles B.L.M., Dippel, Diederik W.J., Van Oostenbrugge, Robert J., Vos, Jan Albert, Jansen, Ivo G.H., Mulder, Maxim J.H.L., Goldhoorn, Robert Jan B., Compagne, Kars C.J., Brouwer, Josje, Den Hartog, Sanne J., Hinsenveld, Wouter H., Roozenbeek, Bob, Van Es, Adriaan C.G.M., Coutinho, Jonathan M., Schonewille, Wouter J., Wermer, Marieke J.H., Van Walderveen, Marianne A.A., Staals, Julie, Hofmeijer, Jeannette, Martens, Jasper M., Lycklama À Nijeholt, Geert 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 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., Sturm, Emiel J.C., Brouwers, Paul J.A.M., Sprengers, Marieke E.S., Van Den Berg, René, Yoo, Albert J., Beenen, Ludo F.M., Postma, Alida A., 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, Gerrits, Dick, Dinkelaar, Wouter, Appelman, Auke P.A., Hammer, Bas, Pegge, Sjoert, 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, Groot, Adrien E.D., Lecouffe, Natalie E., Prasetya, Haryadi, Ramos, Lucas A., Neurologen, Brain, Circulatory Health, Stroke, MS Radiologie, Van Voorst, Henk, Bruggeman, Agnetha A.E., Andriessen, Jurr, Hoving, Jan W., Konduri, Praneeta R., Yang, Wenjin, Kappelhof, Manon, Arrarte Terreros, Nerea, Roos, Yvo B.W.E.M., Van Zwam, Wim H., Van Der Lugt, Aad, Van Der Hoorn, Anouk, Boiten, Jelis, Roosendaal, Stefan, Jenniskens, Sjoerd, Caan, Matthan W.A., Marquering, Henk A., Emmer, Bart J., Majoie, Charles B.L.M., Dippel, Diederik W.J., Van Oostenbrugge, Robert J., Vos, Jan Albert, Jansen, Ivo G.H., Mulder, Maxim J.H.L., Goldhoorn, Robert Jan B., Compagne, Kars C.J., Brouwer, Josje, Den Hartog, Sanne J., Hinsenveld, Wouter H., Roozenbeek, Bob, Van Es, Adriaan C.G.M., Coutinho, Jonathan M., Schonewille, Wouter J., Wermer, Marieke J.H., Van Walderveen, Marianne A.A., Staals, Julie, Hofmeijer, Jeannette, Martens, Jasper M., Lycklama À Nijeholt, Geert 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 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., Sturm, Emiel J.C., Brouwers, Paul J.A.M., Sprengers, Marieke E.S., Van Den Berg, René, Yoo, Albert J., Beenen, Ludo F.M., Postma, Alida A., 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, Gerrits, Dick, Dinkelaar, Wouter, Appelman, Auke P.A., Hammer, Bas, Pegge, Sjoert, 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, Groot, Adrien E.D., Lecouffe, Natalie E., Prasetya, Haryadi, and Ramos, Lucas A.

Published
2023

26. Benefit of successful reperfusion achieved by endovascular thrombectomy for patients with ischemic stroke and moderate pre-stroke disability (mRS 3): results from the MR CLEAN Registry

Author

Benali, Faysal, Kappelhof, Manon, Ospel, Johanna, Ganesh, Aravind, McDonough, Rosalie V, Postma, Alida A, Goldhoorn, Robert-Jan Berend, Majoie, Charles B L M, van den Wijngaard, Ido, Lingsma, Hester F, Vos, Jan Albert, van Oostenbrugge, Robert J, van Zwam, Wim H, Goyal, Mayank, MR CLEAN Registry Investigators, Benali, Faysal, Kappelhof, Manon, Ospel, Johanna, Ganesh, Aravind, McDonough, Rosalie V, Postma, Alida A, Goldhoorn, Robert-Jan Berend, Majoie, Charles B L M, van den Wijngaard, Ido, Lingsma, Hester F, Vos, Jan Albert, van Oostenbrugge, Robert J, van Zwam, Wim H, Goyal, Mayank, and MR CLEAN Registry Investigators

Abstract

BACKGROUND: Pre-stroke dependent patients (modified Rankin Scale score (mRS) ≥3) were excluded from most trials on endovascular treatment (EVT) for acute ischemic stroke (AIS) in the anterior circulation. Therefore, little evidence exists for EVT in those patients. We aimed to investigate the safety and benefit of EVT in pre-stroke patients with mRS score 3.METHODS: We used data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic stroke in the Netherlands (MR CLEAN) Registry. All patients treated with EVT for anterior circulation AIS with pre-stroke mRS 3 were included. We assessed causes for dependence and compared patients with successful reperfusion (defined as expanded Thrombolysis in Cerebral Ischemia scale (eTICI) 2b-3) to patients without successful reperfusion. We used regression analyses with pre-specified adjustments. Our primary outcome was 90-day mRS 0-3 (functional improvement or return to baseline).RESULTS: A total of 192 patients were included, of whom 82 (43%) had eTICI <2b and 108 (56%) eTICI ≥2b. The median age was 80 years (IQR 73-87). Fifty-one of the 192 patients (27%) suffered from previous stroke and 36/192 (19%) had cardiopulmonary disease. Patients with eTICI ≥2b more often returned to their baseline functional state or improved (n=26 (26%) vs n=15 (19%); adjusted odds ratio (aOR) 2.91 (95% CI 1.08 to 7.82)) and had lower mortality rates (n=49 (49%) vs n=50 (64%); aOR 0.42 (95% CI 0.19 to 0.93)) compared with patients with eTICI <2b.CONCLUSIONS: Although patients with AIS with pre-stroke mRS 3 comprise a heterogenous group of disability causes, we observed improved outcomes when patients achieved successful reperfusion after EVT.

Published
2023

27. Alternative Arterial Access Routes for Endovascular Thrombectomy in Patients with Acute Ischemic Stroke: A Study from the MR CLEAN Registry

Author

Collette, Sabine L., van de Ven, Elke A., Luijckx, Gert Jan R., Lingsma, Hester F., van Doormaal, Pieter Jan, van Es, Adriaan C.G.M., van den Wijngaard, Ido R., Goldhoorn, Robert Jan B., de Groot, Jan Cees, van Zwam, Wim H., Majoie, Charles B.L.M., Dippel, Diederik W.J., Bokkers, Reinoud P.H., Uyttenboogaart, Maarten, Public Health, Radiology & Nuclear Medicine, and Neurology

Abstract

Background: Endovascular thrombectomy (EVT) through femoral access is difficult to perform in some patients with acute ischemic stroke due to challenging vasculature. We compared outcomes of EVT through femoral versus alternative arterial access. Methods: In this observational study, we included patients from the MR CLEAN Registry who underwent EVT for acute ischemic stroke in the anterior circulation between 2014 and 2019 in the Netherlands. Patients who underwent EVT through alternative and femoral access were matched on propensity scores in a 1:3 ratio. The primary endpoint was favorable functional outcome (modified Rankin Scale score ≤ 2) at 90 days. Secondary endpoints were early neurologic recovery, mortality, successful intracranial reperfusion and puncture related complications. Results: Of the 5197 included patients, 17 patients underwent EVT through alternative access and were matched to 48 patients who underwent EVT through femoral access. Alternative access was obtained through the common carotid artery (n = 15/17) and brachial artery (n = 2/17). Favorable functional outcome was less often observed after EVT through alternative than femoral access (18% versus 27%; aOR, 0.36; 95% CI, 0.05–2.74). The rate of successful intracranial reperfusion was higher for alternative than femoral access (88% versus 58%), although mortality (59% versus 31%) and puncture related complications (29% versus 0%) were more common after alternative access. Conclusions: EVT through alternative arterial access is rarely performed in the Netherlands and seems to be associated with worse outcomes than standard femoral access. A next step would be to compare the additional value of EVT through alternative arterial access after failure of femoral access.

Published
2023

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

Author

Hinsenveld, Wouter H., de Ridder, Inger R., van Oostenbrugge, Robert J., Vos, Jan A., Groot, Adrien E., Coutinho, Jonathan M., Lycklama à Nijeholt, Geert J., Boiten, Jelis, Schonewille, Wouter J., Dippel, Diederik W.J., van der Lugt, Aad, Majoie, Charles B.L.M., Roos, Yvo B.W.E.M., van Zwam, Wim H., Jansen, Ivo G.H., Mulder, Maxim J.H.L., Goldhoorn, Robert-Jan B., Compagne, Kars C.J., Kappelhof, Manon, Majoie, Charles B.L.M., Wermer, Marieke J.H., van Walderveen, Marianne A.A., Staals, Julie, van Zwam, Wim H., Hofmeijer, Jeannette, Martens, Jasper M., 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, René 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., Majoie, Charles B.L.M., van Zwam, Wim H., van der Lugt, Aad, van Walderveen, Marianne A.A., 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., van Es, Adriaan C.G.M., Emmer, Bart J., Martens, Jasper M., Yo, Lonneke S.F., Bot, Joost, van Doormaal, Pieter-Jan, Dippel, Diederik W.J., van der Lugt, Aad, Majoie, Charles B.L.M., Roos, Yvo B.W.E.M., van Zwam, Wim H., Hofmeijer, Jeannette, Martens, Jasper M., van der Worp, H. Bart, Lo, Rob H., Hofmeijer, Jeannette, Flach, H. Zwenneke, Lingsma, Hester F., el Ghannouti, Naziha, Sterrenberg, Martin, Puppels, Corina, Pellikaan, Wilma, Sprengers, Rita, Elfrink, Marjan, de Meris, Joke, Vermeulen, Tamara, Geerlings, Annet, van Vemde, Gina, Simons, Tiny, van Rijswijk, Cathelijn, Messchendorp, Gert, Bongenaar, Hester, Bodde, Karin, Kleijn, Sandra, Lodico, Jasmijn, Droste, Hanneke, Wollaert, M., Jeurrissen, D., Bos, Ernas, Drabbe, Yvonne, Aaldering, Nicoline, Zweedijk, Berber, Khalilzada, Mostafa, Venema, Esmee, Chalos, Vicky, Geuskens, Ralph R., van Straaten, Tim, Ergezen, Saliha, Harmsma, Roger R.M., Muijres, Daan, de Jong, Anouk, Berkhemer, Olvert A., Boersc, Anna M.M., Huguet, J., Groot, P.F.C., Mens, Marieke A., van Kranendonk, Katinka R., Treurniet, Kilian M., Tolhuijsen, Manon L., and Alves, Heitor

Published
2019
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29. Blood Pressure in the First 6 Hours Following Endovascular Treatment for Ischemic Stroke Is Associated with Outcome

Author

Samuels, Noor, van de Graaf, Rob A., van den Berg, Carlijn A. L., Venema, Simone M. Uniken, Bala, Kujtesa, van Doormaal, Pieter Jan, van der Steen, Wouter, Witvoet, Elbert, Boiten, Jelis, den Hertog, Heleen, Schonewille, Wouter J., Hofmeijer, Jeannette, Schreuder, Floris, Schreuder, Tobien A. H. C. M. L., van der Worp, H. Bart, Roos, Yvo B. W. E. M., Majoie, Charles B. L. M., Burke, James F., van Es, Adriaan C. G. M., van der Lugt, Aad, Roozenbeek, Bob, Lingsma, Hester F., Dippel, Diederik W. J., van Oostenbrugge, Robert Jan, van Zwam, Wim, Goldhoorn, Robert-Jan, Staals, Julie, Postma - Jacobi, Linda, Public Health, Neurology, Radiology & Nuclear Medicine, ACS - Atherosclerosis & ischemic syndromes, ANS - Neurovascular Disorders, Radiology and Nuclear Medicine, ACS - Microcirculation, MUMC+: Hersen en Zenuw Centrum (3), RS: Carim - B05 Cerebral small vessel disease, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, RS: Carim - B06 Imaging, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), MUMC+: MA AIOS Neurologie (9), MUMC+: MA Med Staf Spec Neurologie (9), RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, MUMC+: DA BV AIOS Radiologie (9), and MUMC+: DA BV AIOS Nucleaire Geneeskunde (9)

Subjects
Male, Original Contributions, MULTICENTER, THERAPY, law.invention, Randomized controlled trial, law, Modified Rankin Scale, Acute ischemic stroke, Stroke, Endovascular Procedures, blood pressure, THROMBECTOMY, Middle Aged, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], reperfusion, SAFETY, Hypertension, Cardiology, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, TRIAL, Female, Cardiology and Cardiovascular Medicine, Intracranial Hemorrhages, guideline, Adult, medicine.medical_specialty, Clinical and Population Sciences, All institutes and research themes of the Radboud University Medical Center, Internal medicine, SCORE, medicine, ischemic stroke, Humans, cardiovascular diseases, Endovascular treatment, Aged, Advanced and Specialized Nursing, cerebral hemorrhage, business.industry, Odds ratio, Recovery of Function, medicine.disease, Blood pressure, Ischemic stroke, Neurology (clinical), business
Abstract

Supplemental Digital Content is available in the text., Background and Purpose: Optimal blood pressure (BP) management in the acute phase of ischemic stroke remains an unresolved issue. It is uncertain whether guidelines for BP management during and after intravenous alteplase can be extrapolated to endovascular treatment (EVT) for stroke due to large artery occlusion in the anterior circulation. We evaluated the associations between systolic BP (SBP) in the first 6 hours following EVT and functional outcome as well as symptomatic intracranial hemorrhage. Methods: Patients of 8 MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry centers, with available data on SBP in the 6 hours following EVT, were analyzed. We evaluated maximum, minimum, and mean SBP. Study outcomes were functional outcome (modified Rankin Scale) at 90 days and symptomatic intracranial hemorrhage. We used multivariable ordinal and binary regression analysis to adjust for important prognostic factors and studied possible effect modification by successful reperfusion. Results: Post-EVT SBP data were available for 1161/1796 patients. Higher maximum SBP (per 10 mm Hg increments) was associated with worse functional outcome (adjusted common odds ratio, 0.93 [95% CI, 0.88–0.98]) and a higher rate of symptomatic intracranial hemorrhage (adjusted odds ratio, 1.17 [95% CI, 1.02–1.36]). The association between minimum SBP and functional outcome was nonlinear with an inflection point at 124 mm Hg. Minimum SBP lower and higher than the inflection point were associated with worse functional outcomes (adjusted common odds ratio, 0.85 per 10 mm Hg decrements [95% CI, 0.76–0.95] and adjusted common odds ratio, 0.81 per 10 mm Hg increments [95% CI, 0.71–0.92]). No association between mean SBP and functional outcome was observed. Successful reperfusion did not modify the relation of SBP with any of the outcomes. Conclusions: Maximum SBP in the first 6 hours following EVT is positively associated with worse functional outcome and an increased risk of symptomatic intracranial hemorrhage. Both lower and higher minimum SBP are associated with worse outcomes. A randomized trial to evaluate whether modifying post-intervention SBP results in better outcomes after EVT for ischemic stroke seems justified.

Published
2021
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30. Timing and causes of death after endovascular thrombectomy in patients with acute ischemic stroke

Author

Sluis, Wouter M, primary, Hinsenveld, Wouter H, additional, Goldhoorn, Robert-Jan B, additional, Potters, Lianne H, additional, Bruggeman, Agnetha AE, additional, van der Hoorn, Anouk, additional, Bot, Joseph CJ, additional, van Oostenbrugge, Robert J, additional, Lingsma, Hester F, additional, Hofmeijer, Jeannette, additional, van Zwam, Wim H, additional, BLM Majoie, Charles, additional, and Bart van der Worp, H, additional

Published
2022
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31. Effect of Intravenous Alteplase Treatment on First-Line Stent Retriever Versus Aspiration Alone During Endovascular Treatment

Author

Rinkel, Leon A., primary, Treurniet, Kilian M., additional, Nieboer, Daan, additional, Kappelhof, Manon, additional, LeCouffe, Natalie E., additional, Bruggeman, Agnetha A.E., additional, van Zwam, Wim H., additional, Lycklama à Nijeholt, Geert J., additional, Ghariq, Elyas, additional, Uyttenboogaart, Maarten, additional, Dippel, Diederik W.J., additional, Roos, Yvo B.W.E.M., additional, Coutinho, Jonathan M., additional, Majoie, Charles B.L.M., additional, Emmer, Bart J., additional, Roozenbeek, Bob, additional, van Es, Adriaan, additional, de Ridder, Inger, additional, van der Worp, Bart, additional, Lo, Rob, additional, Keizer, Koos, additional, Gons, Rob, additional, Yo, Lonneke, additional, Boiten, Jelis, additional, van den Wijngaard, Ido, additional, Hofmeijer, Jeanette, additional, Martens, Jasper, additional, Schonewille, Wouter, additional, Albert Vos, Jan, additional, Tuladhar, Anil, additional, Schreuder, Floris, additional, Boogaarts, Jeroen, additional, Jenniskens, Sjoerd, additional, de Laat, Karlijn, additional, van Dijk, Lukas, additional, den Hertog, Heleen, additional, van Hasselt, Boudewijn, additional, Brouwers, Paul, additional, Sturm, Emiel, additional, Bulut, Tomas, additional, Remmers, Michel, additional, van Norden, Anouk, additional, de Jong, Thijs, additional, Rozeman, Anouk, additional, Elgersma, Otto, additional, Bokkers, Reinoud, additional, van Tuijl, Julia, additional, Boukrab, Issam, additional, Kortman, Hans, additional, Costalat, Vincent, additional, Arquizan, Caroline, additional, Lemmens, Robin, additional, Demeestere, Jelle, additional, Desfontaines, Philippe, additional, Brisbois, Denis, additional, Clarençon, Frédéric, additional, Samson, Yves, additional, Brown, Martin, additional, White, Phil, additional, Gregson, John, additional, van Nuland, Rick, additional, van der Lugt, Aad, additional, Jacobi, Linda, additional, van den Berg, René, additional, Beenen, Ludo, additional, van Doormaal, Pieter-Jan, additional, Yoo, Albert, additional, Hammer, Bas, additional, Roosendaal, Stefan, additional, Meijer, Anton, additional, Krietemeijer, Menno, additional, van der Hoorn, Anouk, additional, Gerrits, Dick, additional, van Oostenbrugge, Robert, additional, Jansen, Ben, additional, Manschot, Sanne, additional, Kerkhof, Henk, additional, Koudstaal, Peter, additional, Lingsma, Hester, additional, Chalos, Vicky, additional, Berkhemer, Olvert, additional, Versteeg, Adriaan, additional, Wolff, Lennard, additional, Su, Jiahang, additional, Tolhuisen, Manon, additional, van Voorst, Henk, additional, ten Cate, Hugo, additional, de Maat, Moniek, additional, Donse-Donkel, Samantha, additional, van Beusekom, Heleen, additional, Taha, Aladdin, additional, van den Berg, Sophie, additional, van de Graaf, Rob, additional, Goldhoorn, Robert-Jan, additional, Hinsenveld, Wouter, additional, Pirson, Anne, additional, Sondag, Lotte, additional, Reinink, Rik, additional, Brouwer, Josje, additional, Collette, Sabine, additional, van der Steen, Wouter, additional, Sprengers, Rita, additional, Sterrenberg, Martin, additional, El Ghannouti, Naziha, additional, Verheesen, Sabrina, additional, Pellikaan, Wilma, additional, Blauwendraat, Kitty, additional, Drabbe, Yvonne, additional, de Meris, Joke, additional, Simons, Michelle, additional, Bongenaar, Hester, additional, van Loon, Anja, additional, Ponjee, Eva, additional, Eilander, Rieke, additional, Kooij, Suze, additional, de Jong, Marieke, additional, Santegoets, Esther, additional, Roodenburg, Suze, additional, van Ahee, Ayla, additional, Moynier, Marinette, additional, Devroye, Annemie, additional, Marcis, Evelyn, additional, Iezzi, Ingrid, additional, David, Annie, additional, Talbi, Atika, additional, Heiligers, Leontien, additional, and Martens, Yvonne, additional

Published
2022
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32. Time to Endovascular Treatment and Outcome in Acute Ischemic Stroke: MR CLEAN Registry Results

Author

Mulder, Maxim J.H.L., Jansen, Ivo G.H., Goldhoorn, Robert-Jan B., Venema, Esmee, Chalos, Vicky, Compagne, Kars C.J., Roozenbeek, Bob, Lingsma, Hester F., Schonewille, Wouter J., van den Wijngaard, Ido R., Boiten, Jelis, Albert Vos, Jan, Roos, Yvo B.W.EM., van Oostenbrugge, Robert J., van Zwam, Wim H., Majoie, Charles B.L.M., van der Lugt, Aad, Dippel, Diederik W.J., Vos, Jan Albert, Coutinho, Jonathan, Wermer, Marieke J.H., van Walderveen, Marianne A.A., Staals, Julie, Hofmeijer, Jeannette, Martens, Jasper, Lycklamà Nijeholt, Geert J., Emmer, Bart J., de Bruijn, Sebastiaan F., van Dijk, Lukas C., van der Worp, H. Bart, Lo, Rob H., van Dijk, Ewoud J., Boogaarts, Jeroen, de Kort, Paul L.M., Peluso, Jo, van den Berg, Jan S.P., van Hasselt, Boudewijn A.A.M., Aerden, Leo A.M., Dallinga, René J., Uyttenboogaart, Maarten, Eshghi, Omid, Schreuder, Tobien H.C.M.L., Heijboer, Roel J.J., Keizer, Koos, Yo, Lonneke, den Hertog, Heleen M., Sturm, Emiel J.C., Sprengers, Marieke E.S., Jenniskens, Sjoerd F.M., van den Berg, René, Yoo, Albert J., Beenen, Ludo F.M., Roosendaal, Stefan, van der Kallen, Bas, van den Wijngaard, Ido, van Es, Ad, Emmer, Bart, Bot, Joost, van Doormaal, Pieter-Jan, Martens, Jasper M., Flach, H. Zwenneke, Ghannouti, Naziha el, Sterrenberg, Martin, Puppels, Corina, Pellikaan, Wilma, Sprengers, Rita, Elfrink, Marjan, de Meris, Joke, Vermeulen, Tamara, Geerlings, Annet, van Vemde, Gina, Simons, Tiny, van Rijswijk, Cathelijn, Messchendorp, Gert, Bongenaar, Hester, Bodde, Karin, Kleijn, Sandra, Lodico, Jasmijn, Droste, Hanneke, Wollaert, Maureen, Ramakers, Daisy, Bos, Ernas, Drabbe, Yvonne, Zweedijk, Berber, Khalilzada, Mostafa, Geuskens, Ralph R., van Straaten, Tim, Ergezen, Saliha, Harmsma, Roger R.M., Muijres, Daan, de Jong, Anouk, Hinsenveld, Wouter, Berkhemer, Olvert A., Boers, Anna M.M., Huguet, J., Groot, P.F.C., Mens, Marieke A., van Kranendonk, Katinka R., Treurniet, Kilian M., Kappelhof, Manon, Tolhuijsen, Manon L., and Alves, Heitor

Published
2018
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34. Determinants of Symptomatic Intracranial Hemorrhage After Endovascular Stroke Treatment: A Retrospective Cohort Study

Author

van der Steen, Wouter, primary, van der Ende, Nadinda A.M., additional, van Kranendonk, Katinka R., additional, Chalos, Vicky, additional, van Oostenbrugge, Robert J., additional, van Zwam, Wim H., additional, Roos, Yvo B.W.E.M., additional, van Doormaal, Pieter J., additional, van Es, Adriaan C.G.M., additional, Lingsma, Hester F., additional, Majoie, Charles B.L.M., additional, van der Lugt, Aad, additional, Dippel, Diederik W.J., additional, Roozenbeek, Bob, additional, Boiten, Jelis, additional, Albert Vos, Jan, 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, 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 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, Bulut, Tomas, additional, Brouwers, Paul J.A.M., additional, Lycklama, Geert J., 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, Vos, Jan Albert, additional, Bot, Joost, additional, Meijer, Anton, additional, Ghariq, Elyas, additional, van Proosdij, Marc P., additional, Krietemeijer, G. Menno, additional, Lo, Rob, additional, Dinkelaar, Wouter, additional, 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, 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, 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, Ramos, Lucas A., additional, Brown, Martin M., additional, Liebig, Thomas, additional, van der Heijden, Esther, additional, Ghannouti, Naziha, additional, Fleitour, Nadine, additional, Hooijenga, Imke, additional, Puppels, Corina, additional, Geerling, Annet, additional, Lindl-Velema, Annemieke, additional, de Ridder, Ans, additional, Greebe, Paut, additional, de Bont- Stikkelbroeck, Jose, additional, Haaglanden, MC, additional, Janssen, Kirsten, additional, Licher, Silvan, additional, Boodt, Nikki, additional, Ros, Adriaan, additional, Slokkers, Ilse, additional, Ganpat, Raymie-Jayce, additional, Mulder, Maxim, additional, Saiedie, Nawid, additional, Heshmatollah, Alis, additional, Schipperen, Stefanie, additional, Vinken, Stefan, additional, van Boxtel, Tiemen, additional, Koets, Jeroen, additional, Boers, Merel, additional, Santos, Emilie, additional, Borst, Jordi, additional, Jansen, Ivo, additional, Lucas, Marit, additional, Geuskens, Ralph Renan, additional, and Sales Barros, Roeland, additional

Published
2022
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35. Etiology of Large Vessel Occlusion Posterior Circulation Stroke: Results of the MR CLEAN Registry

Author

Pirson, F.A.V. (Anne), primary, Boodt, Nikki, additional, Brouwer, Josje, additional, Bruggeman, Agnetha A.E., additional, Hinsenveld, Wouter H., additional, Staals, Julie, additional, van Zwam, Wim H., additional, van der Leij, Christiaan, additional, Brans, Rutger J.B., additional, Majoie, Charles B.L.M., additional, Dippel, Diederik W.J., additional, van der Lugt, Aad, additional, Schonewille, Wouter J., additional, van Oostenbrugge, Robert J., additional, Roos, Yvo B.W.E.M., additional, Boiten, Jelis, additional, Albert Vos, Jan, 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, den Hartog, Sanne J., additional, Roozenbeek, Bob, additional, Emmer, Bart J., additional, Coutinho, Jonathan M., additional, Vos, Jan Albert, additional, Wermer, Marieke J.H., additional, van Walderveen, Marianne A.A., additional, van Es, Adriaan C.G.M., additional, Hofmeijer, Jeannette, additional, Martens, Jasper M., additional, Lycklama à Nijeholt, Geert J., additional, de Bruijn, Sebastiaan F., additional, van Dijk, Lukas C., additional, Bart van der Worp, H., 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, 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, Menno Krietemeijer, G., 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, Cornelissen, Sandra, additional, Brans, Rutger, additional, Zwenneke Flach, H., additional, Lingsma, Hester F., 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, Ramos, Lucas A., additional, and Pirson, Anne F.A.V., additional

Published
2022
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36. Estimation of treatment effects in observational stroke care data: comparison of statistical approaches

Author

Amini, Marzyeh, van Leeuwen, Nikki, Eijkenaar, Frank, van de Graaf, Rob, Samuels, Noor, van Doormaal, Pieter Jan, Roozenbeek, Bob, Dippel, Diederik W.J., Lingsma, Hester F., van der Lugt, Aad, Vos, Jan Albert, Brouwer, Josje, den Hartog, Sanne J., Hinsenveld, Wouter H., Kappelhof, Manon, Compagne, Kars C.J., Goldhoorn, Robert Jan B., Mulder, Maxim J.H.L., Jansen, Ivo G.H., Emmer, Bart J., de Bruijn, Sebastiaan F., de Vries, J., Fransen, Puck, den Hertog, Heleen M., Brouwers, Paul, Jenniskens, Sjoerd F.M., Roosendaal, Stefan D., Ghariq, Elyas, Dinkelaar, Wouter, el Ghannouti, Naziha, Sterrenberg, Martin, Sprengers, Rita, Verheesen, Sabrina, Khalilzada, Mostafa, Venema, Esmee, Chalos, Vicky, Ergezen, Saliha, Harmsma, Roger R.M., Muijres, Daan, de Jong, Anouk, Berkhemer, Olvert A., Treurniet, Kilian M., LeCouffe, Natalie E., Radiology and nuclear medicine, ACS - Atherosclerosis & ischemic syndromes, ​Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Damage and Repair in Cancer Development and Cancer Treatment (DARE), MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, MUMC+: Hersen en Zenuw Centrum (3), RS: Carim - B05 Cerebral small vessel disease, Clinical Neurophysiology, TechMed Centre, Public Health, Health Systems and Insurance (HSI), Radiology & Nuclear Medicine, Neurology, Neurosciences, Erasmus School of Law, General Practice, Emergency Medicine, Intensive Care, Erasmus MC other, Medical Oncology, Amsterdam Neuroscience - Neurovascular Disorders, Radiology and Nuclear Medicine, and ACS - Microcirculation

Subjects
Epidemiology, Acute ischemic stroke, General anesthesia, Health Informatics, ADJUSTMENT, Intravenous thrombolysis, GENERAL-ANESTHESIA, Fibrinolytic Agents, CONSCIOUS SEDATION, Humans, Thrombolytic Therapy, ACUTE ISCHEMIC-STROKE, Unmeasured confounding, OUTCOMES, Confounding by indication, BINARY DATA, Fibrinolytic Agents/therapeutic use, Endovascular Procedures, Other Research Radboud Institute for Health Sciences [Radboudumc 0], THROMBECTOMY, INSTRUMENTAL VARIABLE METHODS, Stroke, Endovascular Procedures/methods, PROPENSITY SCORE, Instrumental variable, Treatment Outcome, ENDOVASCULAR TREATMENT, Statistical approaches, Ecological-analysis, Stroke/drug therapy
Abstract

Introduction Various statistical approaches can be used to deal with unmeasured confounding when estimating treatment effects in observational studies, each with its own pros and cons. This study aimed to compare treatment effects as estimated by different statistical approaches for two interventions in observational stroke care data. Patients and methods We used prospectively collected data from the MR CLEAN registry including all patients (n = 3279) with ischemic stroke who underwent endovascular treatment (EVT) from 2014 to 2017 in 17 Dutch hospitals. Treatment effects of two interventions – i.e., receiving an intravenous thrombolytic (IVT) and undergoing general anesthesia (GA) before EVT – on good functional outcome (modified Rankin Scale ≤2) were estimated. We used three statistical regression-based approaches that vary in assumptions regarding the source of unmeasured confounding: individual-level (two subtypes), ecological, and instrumental variable analyses. In the latter, the preference for using the interventions in each hospital was used as an instrument. Results Use of IVT (range 66–87%) and GA (range 0–93%) varied substantially between hospitals. For IVT, the individual-level (OR ~ 1.33) resulted in significant positive effect estimates whereas in instrumental variable analysis no significant treatment effect was found (OR 1.11; 95% CI 0.58–1.56). The ecological analysis indicated no statistically significant different likelihood (β = − 0.002%; P = 0.99) of good functional outcome at hospitals using IVT 1% more frequently. For GA, we found non-significant opposite directions of points estimates the treatment effect in the individual-level (ORs ~ 0.60) versus the instrumental variable approach (OR = 1.04). The ecological analysis also resulted in a non-significant negative association (0.03% lower probability). Discussion and conclusion Both magnitude and direction of the estimated treatment effects for both interventions depend strongly on the statistical approach and thus on the source of (unmeasured) confounding. These issues should be understood concerning the specific characteristics of data, before applying an approach and interpreting the results. Instrumental variable analysis might be considered when unobserved confounding and practice variation is expected in observational multicenter studies.

Published
2022
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37. Endovascular Treatment for Posterior Circulation Stroke in Routine Clinical Practice: Results of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry

Author

Pirson, F Anne V, Boodt, Nikki, Brouwer, Josje, Bruggeman, Agnetha A E, den Hartog, Sanne J, Goldhoorn, Robert-Jan B, Langezaal, Lucianne C M, Staals, Julie, van Zwam, Wim H, van der Leij, Christiaan, Brans, Rutger J B, Majoie, Charles B L M, Coutinho, Jonathan M, Emmer, Bart J, Dippel, Diederik W J, van der Lugt, Aad, Vos, Jan-Albert, van Oostenbrugge, Robert J, Schonewille, Wouter J, MR CLEAN Registry Investigators, Pirson, F Anne V, Boodt, Nikki, Brouwer, Josje, Bruggeman, Agnetha A E, den Hartog, Sanne J, Goldhoorn, Robert-Jan B, Langezaal, Lucianne C M, Staals, Julie, van Zwam, Wim H, van der Leij, Christiaan, Brans, Rutger J B, Majoie, Charles B L M, Coutinho, Jonathan M, Emmer, Bart J, Dippel, Diederik W J, van der Lugt, Aad, Vos, Jan-Albert, van Oostenbrugge, Robert J, Schonewille, Wouter J, and MR CLEAN Registry Investigators

Abstract

BACKGROUND AND PURPOSE: The benefit of endovascular treatment (EVT) for posterior circulation stroke (PCS) remains uncertain, and little is known on treatment outcomes in clinical practice. This study evaluates outcomes of a large PCS cohort treated with EVT in clinical practice. Simultaneous to this observational study, several intervention centers participated in the BASICS trial (Basilar Artery International Cooperation Study), which tested the efficacy of EVT for basilar artery occlusion in a randomized setting. We additionally compared characteristics and outcomes of patients treated outside BASICS in trial centers to those from nontrial centers.METHODS: We included patients with PCS from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry: a prospective, multicenter, observational study of patients who underwent EVT in the Netherlands between 2014 and 2018. Primary outcome was a score of 0 to 3 on the modified Rankin Scale at 90 days. Secondary outcomes included reperfusion status and symptomatic intracranial hemorrhage. For outcome comparison between patients treated in trial versus nontrial centers, we used ordinal logistic regression analysis.RESULTS: We included 264 patients of whom 135 (51%) had received intravenous thrombolysis. The basilar artery was most often involved (77%). Favorable outcome (modified Rankin Scale score 0-3) was observed in 115/252 (46%) patients, and 109/252 (43%) patients died. Successful reperfusion was achieved in 178/238 (75%), and symptomatic intracranial hemorrhage occurred in 9/264 (3%). The 154 nontrial patients receiving EVT in BASICS trial centers had similar characteristics and outcomes as the 110 patients treated in nontrial centers (modified Rankin Scale adjusted cOR: 0.77 [95% CI, 0.5-1.2]).CONCLUSIONS: Our study shows that high rates of favorable clinical outcome and successful reperfusion can be achieved with EVT for PCS, de

Published
2022

38. Aspiration Versus Stent Retriever Thrombectomy for Posterior Circulation Stroke

Author

Bernsen, Marie Louise E, Bruggeman, Agnetha A E, Brouwer, Josje, Emmer, Bart J, Majoie, Charles B L M, Coutinho, Jonathan M, Goldhoorn, Robert-Jan B, van Oostenbrugge, Robert J, van Zwam, Wim H, van der Leij, Christiaan, Schonewille, Wouter J, Martens, Jasper M, Hofmeijer, Jeannette, MR CLEAN Registry Investigators, Bernsen, Marie Louise E, Bruggeman, Agnetha A E, Brouwer, Josje, Emmer, Bart J, Majoie, Charles B L M, Coutinho, Jonathan M, Goldhoorn, Robert-Jan B, van Oostenbrugge, Robert J, van Zwam, Wim H, van der Leij, Christiaan, Schonewille, Wouter J, Martens, Jasper M, Hofmeijer, Jeannette, and MR CLEAN Registry Investigators

Abstract

Background and Purpose: Whereas a clear benefit of endovascular treatment for anterior circulation stroke has been established, randomized trials assessing the posterior circulation have failed to show efficacy. Previous studies in anterior circulation stroke suggest that advanced thrombectomy devices were of great importance in achieving clinical benefit. Little is known about the effect of thrombectomy techniques on outcomes in posterior circulation stroke. In this study, we compare first-line strategy of direct aspiration to stent retriever thrombectomy for posterior circulation stroke. Methods: We analyzed data of patients with a posterior circulation stroke who were included in the Multicentre Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry between March 2014 and December 2018, a prospective, nationwide study, in which data were collected from consecutive patients who underwent endovascular treatment for ischemic stroke in the Netherlands. We compared patients who underwent first-line aspiration versus stent retriever thrombectomy. Primary outcome was functional outcome according to the modified Rankin Scale. Secondary outcomes were reperfusion grade, complication rate, and procedure duration. Associations between thrombectomy technique and outcome measures were estimated with multivariable ordinal logistic regression analyses. Results: Overall, 71 of 205 patients (35%) were treated with aspiration, and 134 (65%) with stent retriever thrombectomy. Patients in the aspiration group had a lower pc-ASPECTS on baseline computed tomography, and general anesthesia was more often applied in this group. First-line aspiration was associated with better functional outcome compared with stent retriever thrombectomy (adjusted common odds ratio for a 1-point improvement on the modified Rankin Scale 1.94 [95% CI, 1.03-3.65]). Successful reperfusion (extended Thrombolysis in Cerebral Infarction ≥2B) was achieved more

Published
2022

39. Improvements in Endovascular Treatment for Acute Ischemic Stroke:A Longitudinal Study in the MR CLEAN Registry

Author

Compagne, Kars C.J., Kappelhof, Manon, Hinsenveld, Wouter H., Brouwer, Josje, Goldhoorn, Robert Jan B., Uyttenboogaart, Maarten, Bokkers, Reinoud P.H., Schonewille, Wouter J., Martens, Jasper M., Hofmeijer, Jeannette, van der Worp, H. Bart, Lo, Rob T.H., Keizer, Koos, Yo, Lonneke S.F., Lycklama À Nijeholt, Geert J., den Hertog, Heleen M., Sturm, Emiel J.C., Brouwers, Paul J.A.M., van Walderveen, Marianne A.A., Wermer, Marieke J.H., de Bruijn, Sebastiaan F., van Dijk, Lukas C., Boogaarts, Hieronymus D., van Dijk, Ewout J., van Tuijl, Julia H., Peluso, Jo P.P., de Kort, Paul L.M., van Hasselt, Boudewijn A.A.M., Fransen, Puck S., Schreuder, Tobien H.C.M.L., Heijboer, Roel J.J., Jenniskens, Sjoerd F.M., Sprengers, Marieke E.S., Ghariq, Elias, van den Wijngaard, Ido R., Roosendaal, Stefan D., Meijer, Anton F.J.A., Beenen, Ludo F.M., Postma, Alida A., van den Berg, René, Yoo, Albert J., van Doormaal, Pieter Jan, van Proosdij, Marc P., Krietemeijer, Menno G.M., Gerrits, Dick G., Vos, Jan Albert, Emmer, Bart J., Roozenbeek, Bob, Dippel, Diederik W.J., van der Lugt, Aad, Compagne, Kars C.J., Kappelhof, Manon, Hinsenveld, Wouter H., Brouwer, Josje, Goldhoorn, Robert Jan B., Uyttenboogaart, Maarten, Bokkers, Reinoud P.H., Schonewille, Wouter J., Martens, Jasper M., Hofmeijer, Jeannette, van der Worp, H. Bart, Lo, Rob T.H., Keizer, Koos, Yo, Lonneke S.F., Lycklama À Nijeholt, Geert J., den Hertog, Heleen M., Sturm, Emiel J.C., Brouwers, Paul J.A.M., van Walderveen, Marianne A.A., Wermer, Marieke J.H., de Bruijn, Sebastiaan F., van Dijk, Lukas C., Boogaarts, Hieronymus D., van Dijk, Ewout J., van Tuijl, Julia H., Peluso, Jo P.P., de Kort, Paul L.M., van Hasselt, Boudewijn A.A.M., Fransen, Puck S., Schreuder, Tobien H.C.M.L., Heijboer, Roel J.J., Jenniskens, Sjoerd F.M., Sprengers, Marieke E.S., Ghariq, Elias, van den Wijngaard, Ido R., Roosendaal, Stefan D., Meijer, Anton F.J.A., Beenen, Ludo F.M., Postma, Alida A., van den Berg, René, Yoo, Albert J., van Doormaal, Pieter Jan, van Proosdij, Marc P., Krietemeijer, Menno G.M., Gerrits, Dick G., Vos, Jan Albert, Emmer, Bart J., Roozenbeek, Bob, Dippel, Diederik W.J., and van der Lugt, Aad

Abstract

BACKGROUND: We evaluated data from all patients in the Netherlands who underwent endovascular treatment for acute ischemic stroke in the past 3.5 years, to identify nationwide trends in time to treatment and procedural success, and assess their effect on clinical outcomes. METHODS: We included patients with proximal occlusions of the anterior circulation from the second and first cohorts of the MR CLEAN (Multicenter Randomized Clinical trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry (March 2014 to June 2016; June 2016 to November 2017, respectively). We compared workflow times and rates of successful reperfusion (defined as an extended Thrombolysis in Cerebral Infarction score of 2B-3) between cohorts and chronological quartiles (all included patients stratified in chronological quartiles of intervention dates to create equally sized groups over the study period). Multivariable ordinal logistic regression was used to assess differences in the primary outcome (ordinal modified Rankin Scale at 90 days). RESULTS: Baseline characteristics were similar between cohorts (second cohort n=1692, first cohort n=1488) except for higher age, poorer collaterals, and less signs of early ischemia on computed tomography in the second cohort. Time from stroke onset to groin puncture and reperfusion were shorter in the second cohort (median 185 versus 210 minutes; P<0.001 and 236 versus 270 minutes; P<0.001, respectively). Successful reperfusion was achieved more often in the second than in the first cohort (72% versus 66%; P<0.001). Functional outcome significantly improved (adjusted common odds ratio 1.23 [95% CI, 1.07-1.40]). This effect was attenuated by adjustment for time from onset to reperfusion (adjusted common odds ratio, 1.12 [95% CI, 0.98-1.28]) and successful reperfusion (adjusted common odds ratio, 1.13 [95% CI, 0.99-1.30]). Outcomes were consistent in the analysis per chronological quartile. CONCLUSIONS: Clinical outcom

Published
2022

40. Endovascular Treatment for Posterior Circulation Stroke in Routine Clinical Practice:Results of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry

Author

Pirson, F Anne V, Boodt, Nikki, Brouwer, Josje, Bruggeman, Agnetha A E, den Hartog, Sanne J, Goldhoorn, Robert-Jan B, Langezaal, Lucianne C M, Staals, Julie, van Zwam, Wim H, van der Leij, Christiaan, Brans, Rutger J B, Majoie, Charles B L M, Coutinho, Jonathan M, Emmer, Bart J, Dippel, Diederik W J, van der Lugt, Aad, Vos, Jan-Albert, van Oostenbrugge, Robert J, Schonewille, Wouter J, Pirson, F Anne V, Boodt, Nikki, Brouwer, Josje, Bruggeman, Agnetha A E, den Hartog, Sanne J, Goldhoorn, Robert-Jan B, Langezaal, Lucianne C M, Staals, Julie, van Zwam, Wim H, van der Leij, Christiaan, Brans, Rutger J B, Majoie, Charles B L M, Coutinho, Jonathan M, Emmer, Bart J, Dippel, Diederik W J, van der Lugt, Aad, Vos, Jan-Albert, van Oostenbrugge, Robert J, and Schonewille, Wouter J

Abstract

BACKGROUND AND PURPOSE: The benefit of endovascular treatment (EVT) for posterior circulation stroke (PCS) remains uncertain, and little is known on treatment outcomes in clinical practice. This study evaluates outcomes of a large PCS cohort treated with EVT in clinical practice. Simultaneous to this observational study, several intervention centers participated in the BASICS trial (Basilar Artery International Cooperation Study), which tested the efficacy of EVT for basilar artery occlusion in a randomized setting. We additionally compared characteristics and outcomes of patients treated outside BASICS in trial centers to those from nontrial centers.METHODS: We included patients with PCS from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry: a prospective, multicenter, observational study of patients who underwent EVT in the Netherlands between 2014 and 2018. Primary outcome was a score of 0 to 3 on the modified Rankin Scale at 90 days. Secondary outcomes included reperfusion status and symptomatic intracranial hemorrhage. For outcome comparison between patients treated in trial versus nontrial centers, we used ordinal logistic regression analysis.RESULTS: We included 264 patients of whom 135 (51%) had received intravenous thrombolysis. The basilar artery was most often involved (77%). Favorable outcome (modified Rankin Scale score 0-3) was observed in 115/252 (46%) patients, and 109/252 (43%) patients died. Successful reperfusion was achieved in 178/238 (75%), and symptomatic intracranial hemorrhage occurred in 9/264 (3%). The 154 nontrial patients receiving EVT in BASICS trial centers had similar characteristics and outcomes as the 110 patients treated in nontrial centers (modified Rankin Scale adjusted cOR: 0.77 [95% CI, 0.5-1.2]).CONCLUSIONS: Our study shows that high rates of favorable clinical outcome and successful reperfusion can be achieved with EVT for PCS, de

Published
2022

41. Benefit of successful reperfusion achieved by endovascular thrombectomy for patients with ischemic stroke and moderate pre-stroke disability (mRS 3): results from the MR CLEAN Registry

Author

Benali, Faysal, primary, Kappelhof, Manon, additional, Ospel, Johanna, additional, Ganesh, Aravind, additional, McDonough, Rosalie V, additional, Postma, Alida A, additional, Goldhoorn, Robert-Jan Berend, additional, Majoie, Charles B L M, additional, van den Wijngaard, Ido, additional, Lingsma, Hester F, additional, Vos, Jan Albert, additional, van Oostenbrugge, Robert J, additional, van Zwam, Wim H, additional, and Goyal, Mayank, additional

Published
2022
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42. sj-pdf-1-eso-10.1177_23969873221143210 – Supplemental material for Timing and causes of death after endovascular thrombectomy in patients with acute ischemic stroke

Author

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

Subjects
FOS: Clinical medicine, Cardiology, Medicine, 110904 Neurology and Neuromuscular Diseases
Abstract

Supplemental material, sj-pdf-1-eso-10.1177_23969873221143210 for Timing and causes of death after endovascular thrombectomy in patients with acute ischemic stroke by Wouter M Sluis, Wouter H Hinsenveld, Robert-Jan B Goldhoorn, Lianne H Potters, Agnetha AE Bruggeman, Anouk van der Hoorn, Joseph CJ Bot, Robert J van Oostenbrugge, Hester F Lingsma, Jeannette Hofmeijer, Wim H van Zwam, Charles BLM Majoie and H Bart van der Worp in European Stroke Journal

Published
2022
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43. Relationship between primary stroke center volume and time to endovascular thrombectomy in acute ischemic stroke

Author

van Meenen, Laura C C, den Hartog, Sanne J, Groot, Adrien E, Emmer, Bart J, Smeekes, Martin D, Siegers, Arjen, Kommer, Geert Jan, Majoie, Charles B L M, Roos, Yvo B W E M, van Es, Adriaan C G M, Dippel, Diederik W, van der Worp, H Bart, Lingsma, Hester F, Roozenbeek, Bob, Coutinho, Jonathan M, van Oostenbrugge, Robert Jan, van Zwam, Wim, Hinsenveld, Wouter, Goldhoorn, Robert-Jan, Staals, Julie, Postma - Jacobi, Linda, MUMC+: Hersen en Zenuw Centrum (3), RS: Carim - B05 Cerebral small vessel disease, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, RS: Carim - B06 Imaging, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), MUMC+: MA Niet Med Staf Neurologie (9), MUMC+: MA AIOS Neurologie (9), MUMC+: MA Med Staf Spec Neurologie (9), RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, MUMC+: DA BV AIOS Radiologie (9), MUMC+: DA BV AIOS Nucleaire Geneeskunde (9), Radiology & Nuclear Medicine, Public Health, Neurology, Graduate School, ANS - Neurovascular Disorders, Radiology and Nuclear Medicine, ACS - Microcirculation, and ACS - Atherosclerosis & ischemic syndromes

Subjects
medicine.medical_specialty, Time Factors, Referral, IMPACT, workflow, medicine.medical_treatment, law.invention, Brain Ischemia, Randomized controlled trial, low-volume hospitals, Modified Rankin Scale, Interquartile range, law, Internal medicine, HOSPITAL CASE-VOLUME, medicine, ischemic stroke, Humans, Registries, Stroke, Aged, OUTCOMES, business.industry, MORTALITY, Endovascular Procedures, Thrombolysis, Odds ratio, medicine.disease, Confidence interval, Treatment Outcome, Neurology, thrombectomy, Cardiology, SURVIVAL, Neurology (clinical), THROMBOLYSIS VOLUME, high-volume hospitals, business
Abstract

Background and purposeWe investigated whether the annual volume of patients with acute ischemic stroke referred from a primary stroke center (PSC) for endovascular treatment (EVT) is associated with treatment times and functional outcome.MethodsWe used data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) registry (2014–2017). We included patients with acute ischemic stroke of the anterior circulation who were transferred from a PSC to a comprehensive stroke center (CSC) for EVT. We examined the association between EVT referral volume of PSCs and treatment times and functional outcome using multivariable regression modeling. The main outcomes were time from arrival at the PSC to groin puncture (PSC-door-to-groin time), adjusted for estimated ambulance travel times, time from arrival at the CSC to groin puncture (CSC-door-to-groin time), and modified Rankin Scale (mRS) score at 90 days after stroke.ResultsOf the 3637 patients in the registry, 1541 patients (42%) from 65 PSCs were included. Mean age was 71 years (SD ± 13.3), median National Institutes of Health Stroke Scale score was 16 (interquartile range [IQR]: 12–19), and median time from stroke onset to arrival at the PSC was 53 min (IQR: 38–90). Eighty-three percent had received intravenous thrombolysis. EVT referral volume was not associated with PSC-door-to-groin time (adjusted coefficient: −0.49 min/annual referral, 95% confidence interval [CI]: −1.27 to 0.29), CSC-door-to-groin time (adjusted coefficient: −0.34 min/annual referral, 95% CI: −0.69 to 0.01) or 90-day mRS score (adjusted common odds ratio: 0.99, 95% CI: 0.96–1.01).ConclusionsIn patients transferred from a PSC for EVT, higher PSC volumes do not seem to translate into better workflow metrics or patient outcome.

Published
2021

45. Endovascular treatment of acute ischemic stroke in clinical practice

Author

Goldhoorn, Robert-Jan, van Oostenbrugge, Robert Jan, van Zwam, Wim, Klinische Neurowetenschappen, and RS: Carim - B05 Cerebral small vessel disease

Subjects
endovascular treatment, stroke, clinical practice
Abstract

The dissertation describes that endovascular treatment for patients with a cerebral infarction by closure of a large cerebral artery is effective in clinical practice. The number of treatments performed in the Netherlands increased. In 2014, the treatment was carried out in 200 patients, in 2016 already in 1250 patients. As a result of national implementation, an additional 170 patients a year will be independent of care provided by others in the Netherlands. In addition to the described effect in the majority of patients, it appears that the endovascular treatment can also offer an advantage in patients with few symptoms or who were already dependent on health care beforehand. Moreover, the treatment is safe in patients who have already been treated for another condition with anticoagulant tablets. Successful results were achieved with the treatment techniques studied, promising for future practice.

Published
2021
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46. 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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47. White Matter Lesions and Outcomes After Endovascular Treatment for Acute Ischemic Stroke: MR CLEAN Registry Results

Author

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

Published
2021
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48. Assessment of Recurrent Stroke Risk in Patients With a Carotid Web

Author

Guglielmi, Valeria, Compagne, Kars C. J., Sarrami, Amir Hossein, Sluis, Wouter M., van den Berg, Lucie A., van der Sluijs, Pieter M., Mandell, Daniel M., van der Lugt, Aad, Roos, Yvo B. W. E. M., Majoie, Charles B. L. M., Dippel, Diederik W. J., Emmer, Bart J., van Es, Adriaan C. G. M., Coutinho, Jonathan M., MR CLEAN Trial MR CLEAN Registry, van Oostenbrugge, Robert Jan, van Zwam, Wim, Staals, Julie, Goldhoorn, Robert-Jan, Hinsenveld, Wouter, Guglielmi, Valeria, Compagne, Kars C. J., Sarrami, Amir Hossein, Sluis, Wouter M., van den Berg, Lucie A., van der Sluijs, Pieter M., Mandell, Daniel M., van der Lugt, Aad, Roos, Yvo B. W. E. M., Majoie, Charles B. L. M., Dippel, Diederik W. J., Emmer, Bart J., van Es, Adriaan C. G. M., Coutinho, Jonathan M., MR CLEAN Trial MR CLEAN Registry, van Oostenbrugge, Robert Jan, van Zwam, Wim, Staals, Julie, Goldhoorn, Robert-Jan, and Hinsenveld, Wouter

Abstract

IMPORTANCE A carotid web (CW) is a shelf-like lesion along the posterior wall of the internal carotid artery bulb and an underrecognized cause of young stroke. Several studies suggest that patients with symptomatic CW have a high risk of recurrent stroke, but high-quality data are lacking.OBJECTIVE To assess the 2-year risk of recurrent stroke in patients with a symptomatic CW.DESIGN, SETTING, AND PARTICIPANTS A comparative cohort study used data from the MR CLEAN trial (from 2010-2014) and MR CLEAN Registry (from 2014-2017). Data were analyzed in September 2020. The MR CLEAN trial and MR CLEAN Registry were nationwide prospective multicenter studies on endovascular treatment (EVT) of large vessel occlusion (LVO) stroke in the Netherlands. Baseline data were from 3439 consecutive adult patients with anterior circulation LVO stroke and available computed tomography (CT)-angiography of the carotid bulb. Two neuroradiologists reevaluated CT-angiography images for presence or absence of CW and identified 30 patients with CW ipsilateral to the index stroke. For these 30 eligible CW participants, detailed follow-up data regarding stroke recurrence within 2 years were acquired. These 30 patients with CW ipsilateral to the index stroke were compared with 168 patients without CW who participated in the MR CLEAN extended follow-up trial and who were randomized to the EVT arm.MAIN OUTCOMES AND MEASURES The primary outcome was recurrent stroke occurring within 2 years after the index stroke. Cox proportional hazards regression models were used to compare recurrent stroke rates within 2 years for patients with and without CW, adjusted for age and sex. The research question was formulated prior to data collection.RESULTS Of 3439 patients with baseline CT-angiography assessed, the median age was 72 years (interquartile range, 61-80 years) and 1813 (53%) were men. Patients with CW were younger (median age, 57 [interquartile range, 46-66] years vs 66 [

Published
2021

49. Prior antiplatelet therapy in patients undergoing endovascular treatment for acute ischemic stroke:Results from the MR CLEAN Registry

Author

van de Graaf, Rob A., Zinkstok, Sanne M., Chalos, Vicky, Goldhoorn, Robert Jan B., Majoie, Charles B.L.M., van Oostenbrugge, Robert J., van der Lugt, Aad, Dippel, Diederik W.J., Roos, Yvo B.W.E.M., Lingsma, Hester F., van Es, Adriaan C.G.M., Roozenbeek, Bob, van de Graaf, Rob A., Zinkstok, Sanne M., Chalos, Vicky, Goldhoorn, Robert Jan B., Majoie, Charles B.L.M., van Oostenbrugge, Robert J., van der Lugt, Aad, Dippel, Diederik W.J., Roos, Yvo B.W.E.M., Lingsma, Hester F., van Es, Adriaan C.G.M., and Roozenbeek, Bob

Abstract

Background: Antiplatelet therapy may increase the risk of symptomatic intracranial hemorrhage after endovascular treatment for ischemic stroke but may also have a beneficial effect on functional outcome. The aim of this study is to compare safety and efficacy outcomes after endovascular treatment in patients with and without prior antiplatelet therapy. Methods: We analyzed patients registered in the MR CLEAN Registry between March 2014 and November 2017, for whom data on antiplatelet therapy were available. We used propensity score nearest-neighbor matching with replacement to balance the probability of receiving prior antiplatelet therapy between the prior antiplatelet therapy and no prior antiplatelet therapy group and adjusted for baseline prognostic factors to compare these groups. Primary outcome was symptomatic intracranial hemorrhage. Secondary outcomes were 90-day functional outcome (modified Rankin Scale), successful reperfusion (extended thrombolysis in cerebral infarction score ≥2B) and 90-day mortality. Results: Thirty percent (n = 937) of the 3154 patients were on prior antiplatelet therapy, who were matched to 477 patients not on prior antiplatelet therapy. Symptomatic intracranial hemorrhage occurred in 74/937 (7.9%) patients on prior antiplatelet therapy and in 27/477 (5.6%) patients without prior antiplatelet therapy adjusted odds ratio 1.47, 95% confidence interval 0.86–2.49. No associations were found between prior antiplatelet therapy and functional outcome (adjusted common odds ratio 0.87, 95% confidence interval 0.65–1.16), successful reperfusion (adjusted odds ratio 1.23, 95% confidence interval 0.77–1.97), or 90-day mortality (adjusted odds ratio 1.15, 95% confidence interval 0.86–1.54). Conclusion: We found no evidence of an association of prior antiplatelet therapy with the risk of symptomatic intracranial hemorrhage after endovascular treatment, nor on functional outcome, reperfusion, or mortality. A substantial beneficial or detrimenta

Published
2021

50. Endovascular treatment in anterior circulation stroke beyond 6.5 hours after onset or time last seen well:Results from the MR CLEAN Registry

Author

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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