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165 results on '"Nederkoorn P.J."'

1. Early Intubation in Endovascular Therapy for Basilar Artery Occlusion: A Post Hoc Analysis of the BASICS Trial

Author

Barlinn, Kristian, Langezaal, Lucianne C.M., Dippel, Diederik W.J., van Zwam, Wim H., Roessler, Martin, Roos, Yvo B.W.E.M., Emmer, Bart J., van Oostenbrugge, Robert J., Gerber, Johannes C., Yoo, Albert J., Pontes-Neto, Octavio M., Mazighi, Mikael, Audebert, Heinrich J., Michel, Patrik, Schonewille, Wouter J., Puetz, Volker, Schonewille, W.J., Vos, J.A., van der Hoeven, E.J.R.J., van Leersum, M., van den Heuvel, D.A.F., van Strijen, M.J.L., Teunissen, L.L., van der Lugt, A., van Es, A. C.G.M., van Doormaal, P.J., Kappelle, L.J., Lo, T.H., van der Worp, H.B., Boiten, J., Lycklama à Nijeholt, G.J., Nederkoorn, P.J., Majoie, C.B.L.M., Coutinho, J., Staals, J., Hofmeijer, J., Martens, J., Bernsen, M.L., Wermer, M.J.H., van Walderveen, M.A.A., Remmers, M.J.M., de Laat, K.F., de Kort, P.L.M., Mont’Alverne, F.J., Carvalho, J.J.F., de Araújo Rocha, F., de Almeida Bandeira, D., Freitas de Lucena, A., Coelho Silva, H., Martins, S.O, Dias, F.A., Abud, D.G., Cerantola, R., Camilo, M., Alves, F. A., Martins, R.K., Nakiri, G., Castro-Afonso, L.H., Pallesen, L.P., Barlinn, J., Siepmann, T., Nolte, C.H., Erdur, H., Scheitz, J.F., Szabo, K., Schneider, H., Berlis, A., Maurer, C., Ertl, M., Zickler, P., Schneider, C., Rueckert, C., Piotin, M., Ben Maacha, M., Blanc, R., Desilles, J.P., Redjem, H., Escalard, S., Smajda, S., Ciccio, G., Maier, B., Devoye, F., Herbert, S., Zini, A., Vallone, S., Bigliardi, G., Dell’Acqua, M.L., Rosafio, F., Verganti, L., Zelent, G., Maffei, S., Meyer, I., and Herzig, R.

Published
2023
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2. Clinical Response to Procedural Stroke Following Carotid Endarterectomy: A Delphi Consensus Study

Author

Bonati, L.H., Brott, T.G., McCabe, D., Calvet, D., Engelter, S.T., Leira, E.C., Leys, D., Nederkoorn, P.J., Paciaroni, M., Petersson, J., Ringleb, P., Uyttenbogaart, M., Weimar, C., Antti Lindgren, J.M., Bastos Goncalves, F., Bjorck, M., Bismuth, J., Debus, S., Eckstein, H., Glovizcki, P., Halliday, A., Kakkos, S.K., Koncar, I., Naylor, A.R., Radak, D., Schermerhorn, M.L., Sillesen, H., Tolva, V., Vega de Ceniga, M., Vermassen, F., Zeebregts, C.J., Meershoek, Armelle J.A., de Waard, Djurre D., Trappenburg, Jaap, Zeebregts, Clark J., Bulbulia, Richard, Kappelle, Jaap L.J., and de Borst, Gert J.

Published
2021
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3. Management of extracranial carotid artery stenosis during endovascular treatment for acute ischaemic stroke:results from the MR CLEAN Registry

Author

Collette, S.L., Rodgers, M.P., Walderveen, M.A.A. van, Compagne, K.C.J., Nederkoorn, P.J., Hofmeijer, J., Martens, J.M., Borst, G.J. de, Luijckx, G.J.R., Majoie, C.B.L.M., Lugt, A. van der, Bokkers, R.P.H., Uyttenboogaart, M., and MR CLEAN Registry Investigators

Subjects
Stroke, Stents, Carotid Stenosis, Neurology (clinical), Cardiology and Cardiovascular Medicine, Atherosclerosis, Thrombectomy
Abstract

BackgroundThe optimal management of ipsilateral extracranial internal carotid artery (ICA) stenosis during endovascular treatment (EVT) is unclear. We compared the outcomes of two different strategies: EVT with vs without carotid artery stenting (CAS).MethodsIn this observational study, we included patients who had an acute ischaemic stroke undergoing EVT and a concomitant ipsilateral extracranial ICA stenosis of ≥50% or occlusion of presumed atherosclerotic origin, from the Dutch Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry (2014–2017). The primary endpoint was a good functional outcome at 90 days, defined as a modified Rankin Scale score ≤2. Secondary endpoints were successful intracranial reperfusion, new clot in a different vascular territory, symptomatic intracranial haemorrhage, recurrent ischaemic stroke and any serious adverse event.ResultsOf the 433 included patients, 169 (39%) underwent EVT with CAS. In 123/168 (73%) patients, CAS was performed before intracranial thrombectomy. In 42/224 (19%) patients who underwent EVT without CAS, a deferred carotid endarterectomy or CAS was performed. EVT with and without CAS were associated with similar proportions of good functional outcome (47% vs 42%, respectively; adjusted OR (aOR), 0.90; 95% CI, 0.50 to 1.62). There were no major differences between the groups in any of the secondary endpoints, except for the increased odds of a new clot in a different vascular territory in the EVT with CAS group (aOR, 2.96; 95% CI, 1.07 to 8.21).ConclusionsFunctional outcomes were comparable after EVT with and without CAS. CAS during EVT might be a feasible option to treat the extracranial ICA stenosis but randomised studies are warranted to prove non-inferiority or superiority.

Published
2023
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4. The course of post-stroke apathy in relation to cognitive functioning: a prospective longitudinal cohort study.

Author

Lammers, N.A., Wanrooij, L.L. van, Dalen, J.W. van, Gool, W.A. van, Schmand, B., l van Charante, E.P. Mol, Haan, E.H.F. de, Beek, D van, Nederkoorn, P.J., Richard, E., Lammers, N.A., Wanrooij, L.L. van, Dalen, J.W. van, Gool, W.A. van, Schmand, B., l van Charante, E.P. Mol, Haan, E.H.F. de, Beek, D van, Nederkoorn, P.J., and Richard, E.

Abstract

01 januari 2023, Item does not contain fulltext, Apathy is common after stroke and has been associated with cognitive impairment. However, causality between post-stroke apathy and cognitive impairment remains unclear. We assessed the course of apathy in relation to changes in cognitive functioning in stroke survivors. Using the Apathy Scale (AS) and cognitive tests on memory, processing speed and executive functioning at six- and 15 months post-stroke we tested for associations between (1) AS-scores and (change in) cognitive scores; (2) apathy course (persistent/incident/resolved) and cognitive change scores. Of 117 included participants, 29% had persistent apathy, 13% apathy resolving over time and 10% apathy emerging between 6-15 months post-stroke. Higher AS-scores were cross-sectionally and longitudinally associated with lower cognitive scores. Relations between apathy and cognitive change scores were ambiguous. These inconsistent relations between apathy and changes in cognition over time suggest that post-stroke apathy does not directly impact cognitive performance. Both these sequelae of stroke require separate attention.

Published
2023

5. Trigger Factors for Stroke in Young Adults: A Case-Crossover Study

Author

Ekker, M.S., Verhoeven, J.I., Rensink, K.M.L., Schellekens, M.M.I., Boot, E.M., Alebeek, M.E. van, Brouwers, P., Arntz, R.M., Dijk, G.W. van, Gons, R.A., Uden, I.W.M. van, Heijer, T., Kort, P.L. de, Laat, K.F. de, Norden, A.G.W. van, Vermeer, S.E., Zagten, M. van, Oostenbrugge, R.J. van, Wermer, M.J., Nederkoorn, P.J., Kerkhoff, H., Rooyer, F., Rooij, F.G. van, Wijngaard, I.R. van den, Klijn, C.J.M., Tuladhar, A.M., Leeuw, F.E. de, Ekker, M.S., Verhoeven, J.I., Rensink, K.M.L., Schellekens, M.M.I., Boot, E.M., Alebeek, M.E. van, Brouwers, P., Arntz, R.M., Dijk, G.W. van, Gons, R.A., Uden, I.W.M. van, Heijer, T., Kort, P.L. de, Laat, K.F. de, Norden, A.G.W. van, Vermeer, S.E., Zagten, M. van, Oostenbrugge, R.J. van, Wermer, M.J., Nederkoorn, P.J., Kerkhoff, H., Rooyer, F., Rooij, F.G. van, Wijngaard, I.R. van den, Klijn, C.J.M., Tuladhar, A.M., and Leeuw, F.E. de

Abstract

Item does not contain fulltext, BACKGROUND AND OBJECTIVES: Causes of stroke in young adults differ from those in the elderly individuals, and in a larger percentage, no cause can be determined. To gain more insight into the etiology of (cryptogenic) stroke in the young population, we investigated whether trigger factors, such as short-lasting exposure to toxins or infection, may play a role. METHODS: Patients aged 18-49 years with a first-ever ischemic stroke or intracerebral hemorrhage (ICH) in 17 participating centers in the Netherlands completed a questionnaire about exposure to 9 potential trigger factors in hazard periods and on a regular yearly basis. A case-crossover design was used to assess relative risks (RRs) with 95% confidence intervals (95% CIs) by the Mantel-Haenszel case-crossover method, for any stroke (ischemic stroke and ICH combined) and for different etiologic subgroups of ischemic stroke. RESULTS: One thousand one hundred forty-six patients completed the questionnaire (1,043 patients with an ischemic stroke and 103 with an ICH, median age 44.0 years, 52.6% men). For any stroke, an increased risk emerged within 1 hour of cola consumption (RR 2.0, 95% CI 1.5-2.8) and vigorous physical exercise (RR 2.6, 95% CI 2.2-3.0), within 2 hours after sexual activity (RR 2.4, 95% CI 1.6-3.5), within 4 hours after illicit drug use (RR 2.8, 95% CI 1.7-4.9), and within 24 hours after fever or flu-like disease (RR 14.1, 95% CI 10.5-31.2; RR 13.9, 95% CI 8.9-21.9). Four trigger factors increased the risk of other determined and cryptogenic ischemic stroke, 3 that of cardioembolic stroke, 2 that of large vessel atherosclerosis and likely atherothrombotic stroke combined and stroke with multiple causes, and none that of stroke due to small vessel disease. DISCUSSION: We identified cola consumption, vigorous physical exercise, sexual activity, illicit drug use, fever, and flu-like disease as potential trigger factors for stroke in the young population and found differences in the type and number o

Published
2023

6. Subacute cognitive impairment after first-ever transient ischemic attack or ischemic stroke in young adults: The ODYSSEY study

Author

Schellekens, M.M.I., Boot, E.M., Verhoeven, J.I., Ekker, M.S., Alebeek, M.E. van, Brouwers, P.J.A.M., Arntz, R.M., Dijk, G.W. van, Gons, R.A.R., Uden, I.W.M. van, Heijer, T. den, Kort, P.L.M. de, Laat, K.F. de, Norden, A.G.W. van, Vermeer, S.E., Zagten, M.S.G. van, Oostenbrugge, R.J. van, Wermer, M.J.H., Nederkoorn, P.J., Rooij, F.G. van, Wijngaard, I.R. van den, Leeuw, H.F. de, Kessels, R.P.C., Tuladhar, A.M., Schellekens, M.M.I., Boot, E.M., Verhoeven, J.I., Ekker, M.S., Alebeek, M.E. van, Brouwers, P.J.A.M., Arntz, R.M., Dijk, G.W. van, Gons, R.A.R., Uden, I.W.M. van, Heijer, T. den, Kort, P.L.M. de, Laat, K.F. de, Norden, A.G.W. van, Vermeer, S.E., Zagten, M.S.G. van, Oostenbrugge, R.J. van, Wermer, M.J.H., Nederkoorn, P.J., Rooij, F.G. van, Wijngaard, I.R. van den, Leeuw, H.F. de, Kessels, R.P.C., and Tuladhar, A.M.

Abstract

Contains fulltext : 284228.pdf (Publisher’s version ) (Open Access), Introduction: We aimed to investigate the prevalence of cognitive impairment in the subacute phase after transient ischemic attack (TIA) and ischemic stroke (IS), factors associated with a vascular cognitive disorder, and the prevalence of subjective cognitive complaints and their relation with objective cognitive performance.Patients and methods: In this multicenter prospective cohort study, we recruited patients with first-ever TIA and IS, aged 18-49 years, between 2013 and 2021 for cognitive assessment up to 6 months after index event. We calculated composite Z-scores for seven cognitive domains. We defined cognitive impairment as a composite Z-score < -1.5. We defined major vascular cognitive disorder as a Z-score < -2.0 in one or more cognitive domains. Results: Fifty three TIA and 545 IS patients completed cognitive assessment with mean time to assessment of 89.7 (SD 40.7) days. The median NIHSS at admission was 3 (interquartile range, 1-5). Cognitive impairment was common in five domains (up to 37%), with similar proportion in TIA and IS patients. Patients with major vascular cognitive disorder had a lower education level, higher NIHSS scores and more frequent lesions in the left frontotemporal lobe than without vascular cognitive disorder (p < 0.05 FDR-corrected). Subjective memory and executive cognitive complaints were present in about two-thirds of the patients, but were weakly associated with objective cognitive performance (ß: -0.32 and -0.21, respectively). Discussion and conclusion: In the subacute phase after TIA or stroke in young adults, cognitive impairment and subjective cognitive complaints are prevalent, but they are weakly associated with each other.

Published
2023

7. Changes in intra- and extracranial carotid plaque calcification: a 2-year follow-up study

Author

Zadi, T., Dam-Nolen, D.H.K. Van, Aizaz, M., Kolk, A.G. van der, Nederkoorn, P.J., Hendrikse, J., Kooi, M.E., Lugt, A. van der, Bos, D., Zadi, T., Dam-Nolen, D.H.K. Van, Aizaz, M., Kolk, A.G. van der, Nederkoorn, P.J., Hendrikse, J., Kooi, M.E., Lugt, A. van der, and Bos, D.

Abstract

Contains fulltext : 294702.pdf (Publisher’s version ) (Open Access), Extra- and intracranial carotid plaque calcification might have plaque-stabilizing effects, yet information on changes in plaque calcification remains scarce. We evaluated changes in carotid plaque calcification over 2 years follow-up in patients with symptomatic carotid artery disease. This study is based on the PARISK-study, a multicenter cohort study, with TIA/minor stroke patients with ipsilateral mild-to-moderate carotid artery stenosis (< 70%). We included 79 patients (25% female, mean age 66 years) who underwent CTA imaging with 2 year interval. We assessed the volume of extra- and intracranial carotid artery calcification (ECAC and ICAC) and calculated the difference between baseline and follow-up ECAC and ICAC volume. We performed multivariable regression analyses to investigate the association between change of ECAC or ICAC with cardiovascular determinants. ECAC. We found increase (46.2%) and decrease (34%) in ECAC volume during 2 year follow-up, both significantly correlation with baseline ECAC volume (OR = 0.72, 95% CI 0.58-0.90 respectively OR = 2.24, 95% CI 1.60-3.13).We found significant correlation for change in ECAC volume with diabetes (beta = 0.46, 95% CI 0.03-0.89) and baseline ECAC volume (beta = 0.81, 95% CI 0.73-0.88). ICAC. We found increase (45.0%) and decrease (25.0%) in ICAC volume. The ICAC decrease was significantly correlated with baseline ICAC volume (OR = 2.17, 95% CI 1.48-3.16), age (OR = 2.00, 95% CI 1.19-3.38) and use of antihypertensive drugs (OR = 3.79, 95% CI 1.20-11.96]).The overall change of ICAC volume was also significantly correlated with diabetes (beta = 0.92, 95% CI 1.59-7.02), use of oral hypoglycemic drugs (beta = 0.86, 95% CI 0.12-1.59) and baseline ICAC volume (beta = 0.71, 95% CI 0.55-0.87). We provide novel insights into the dynamics of carotid plaque calcification in symptomatic stroke patients.

Published
2023

8. Impact of Cerebral Microbleeds in Stroke Patients with Atrial Fibrillation.

Author

Soo, Y., Zietz, A., Yiu, B., Mok, V.C.T., Polymeris, A.A., Seiffge, D., Ambler, G., Wilson, D., Leung, T.W.H., Tsang, S.F., Chu, W., Abrigo, J., Cheng, C., Lee, K.J., Lim, J.S., Shiozawa, M., Koga, M., Chabriat, H., Hennerici, M., Wong, Y.K., Mak, H., Collet, R., Inamura, S., Yoshifuji, K., Arsava, E.M., Horstmann, S., Purrucker, J., Lam, B.Y.K., Wong, A., Kim, Y.D., Song, T.J., Lemmens, R., Eppinger, S., Gattringer, T., Uysal, E., Demirelli, D.S., Bornstein, N.M., Assayag, E.B., Hallevi, H., Molad, J., Nishihara, M., Tanaka, J., Coutts, S.B., Kappelle, L.J., Al-Shahi Salman, R., Jager, Rolf, Lip, G.Y.H., Goeldlin, M.B., Panos, L.D., Mas, J.L., Legrand, Laurence, Karayiannis, C., Phan, T., Bellut, M., Chappell, F., Makin, S., Hayden, D., Williams, D., Dam-Nolen, D.H.K. Van, Nederkoorn, P.J., Barbato, C., Browning, S., Wiegertjes, K., Tuladhar, A.M., Mendyk, A.M., Köhler, S., Oostenburgge, R. van, Zhou, Ying, Xu, Chao, Hilal, S., Gyanwali, B., Chen, C, Lou, M., Staals, J., Bordet, R., Kandiah, N., Leeuw, F.E. de, Simister, R., Hendrikse, Jeroen, Wardlaw, J., Kelly, P., Fluri, F., Srikanth, V., Calvet, D., Jung, S., Kwa, V.I.H., Smith, E.E., Hara, H., Yakushiji, Y., Orken, D.N., Fazekas, F., Thijs, V., Heo, J.H., Veltkamp, R., Ay, H., Imaizumi, T., Lau, K.K., Jouvent, E., Toyoda, K., Yoshimura, S., Bae, H.J., Martí-Fàbregas, J., Prats-Sánchez, L., Lyrer, P., Best, J. de, Werring, D., Engelter, S.T., Peters, Nils, Soo, Y., Zietz, A., Yiu, B., Mok, V.C.T., Polymeris, A.A., Seiffge, D., Ambler, G., Wilson, D., Leung, T.W.H., Tsang, S.F., Chu, W., Abrigo, J., Cheng, C., Lee, K.J., Lim, J.S., Shiozawa, M., Koga, M., Chabriat, H., Hennerici, M., Wong, Y.K., Mak, H., Collet, R., Inamura, S., Yoshifuji, K., Arsava, E.M., Horstmann, S., Purrucker, J., Lam, B.Y.K., Wong, A., Kim, Y.D., Song, T.J., Lemmens, R., Eppinger, S., Gattringer, T., Uysal, E., Demirelli, D.S., Bornstein, N.M., Assayag, E.B., Hallevi, H., Molad, J., Nishihara, M., Tanaka, J., Coutts, S.B., Kappelle, L.J., Al-Shahi Salman, R., Jager, Rolf, Lip, G.Y.H., Goeldlin, M.B., Panos, L.D., Mas, J.L., Legrand, Laurence, Karayiannis, C., Phan, T., Bellut, M., Chappell, F., Makin, S., Hayden, D., Williams, D., Dam-Nolen, D.H.K. Van, Nederkoorn, P.J., Barbato, C., Browning, S., Wiegertjes, K., Tuladhar, A.M., Mendyk, A.M., Köhler, S., Oostenburgge, R. van, Zhou, Ying, Xu, Chao, Hilal, S., Gyanwali, B., Chen, C, Lou, M., Staals, J., Bordet, R., Kandiah, N., Leeuw, F.E. de, Simister, R., Hendrikse, Jeroen, Wardlaw, J., Kelly, P., Fluri, F., Srikanth, V., Calvet, D., Jung, S., Kwa, V.I.H., Smith, E.E., Hara, H., Yakushiji, Y., Orken, D.N., Fazekas, F., Thijs, V., Heo, J.H., Veltkamp, R., Ay, H., Imaizumi, T., Lau, K.K., Jouvent, E., Toyoda, K., Yoshimura, S., Bae, H.J., Martí-Fàbregas, J., Prats-Sánchez, L., Lyrer, P., Best, J. de, Werring, D., Engelter, S.T., and Peters, Nils

Abstract

01 juli 2023, Contains fulltext : 294348.pdf (Publisher’s version ) (Open Access), OBJECTIVES: Cerebral microbleeds are associated with the risks of ischemic stroke and intracranial hemorrhage, causing clinical dilemmas for antithrombotic treatment decisions. We aimed to evaluate the risks of intracranial hemorrhage and ischemic stroke associated with microbleeds in patients with atrial fibrillation treated with vitamin K antagonists, direct oral anticoagulants, antiplatelets, and combination therapy (i.e. concurrent oral anticoagulant and antiplatelet). METHODS: We included patients with documented atrial fibrillation from the pooled individual patient data analysis by the Microbleeds International Collaborative Network. Risks of subsequent intracranial hemorrhage and ischemic stroke were compared between patients with and without microbleeds, stratified by antithrombotic use. RESULTS: A total of 7,839 patients were included. The presence of microbleeds was associated with an increased relative risk of intracranial hemorrhage (adjusted hazard ratio [aHR] = 2.74, 95% confidence interval = 1.76-4.26) and ischemic stroke (aHR = 1.29, 95% confidence interval = 1.04-1.59). For the entire cohort, the absolute incidence of ischemic stroke was higher than intracranial hemorrhage regardless of microbleed burden. However, for the subgroup of patients taking combination of anticoagulant and antiplatelet therapy, the absolute risk of intracranial hemorrhage exceeded that of ischemic stroke in those with 2 to 4 microbleeds (25 vs 12 per 1,000 patient-years) and ≥ 11 microbleeds (94 vs 48 per 1,000 patient-years). INTERPRETATION: Patients with atrial fibrillation and high burden of microbleeds receiving combination therapy have a tendency of higher rate of intracranial hemorrhage than ischemic stroke, with potential for net harm. Further studies are needed to help optimize stroke preventive strategies in this high-risk group. ANN NEUROL 2023;94:61-74.

Published
2023

9. Endovascular Therapy for Stroke Due to Basilar-Artery Occlusion

Author

Langezaal, L.C.M., Hoeven, E.J.R.J. van der, Mont'Alverne, F.J.A., Carvalho, J.J.F. de, Lima, F.O., Dippel, D.W.J., Lugt, A. van der, R.T.H. lo, Boiten, J., Nijeholt, G.J.L.A., Staals, J., Zwam, W.H. van, Nederkoorn, P.J., Majoie, C.B.L.M., Gerber, J.C., Mazighi, M., Piotin, M., Zini, A., Vallone, S., Hofmeijer, J., Martins, S.O., Nolte, C.H., Szabo, K., Dias, F.A., Abud, D.G., Wermer, M.J.H., Remmers, M.J.M., Schneider, H., Rueckert, C.M., Laat, K.F. de, Yoo, A.J., Doormaal, P.J. van, Es, A.C.G.M. van, Emmer, B.J., Michel, P., Puetz, V., Audebert, H.J., Pontes-Neto, O.M., Vos, J.A., Kappelle, L.J., Algra, A., Schonewille, W.J., BASICS Study Grp, Klinische Neurowetenschappen, MUMC+: MA Med Staf Spec Neurologie (9), RS: Carim - B05 Cerebral small vessel disease, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: Carim - B06 Imaging, TechMed Centre, Clinical Neurophysiology, Neurology, ACS - Atherosclerosis & ischemic syndromes, ANS - Neurovascular Disorders, Radiology and Nuclear Medicine, ACS - Microcirculation, and Radiology & Nuclear Medicine

Subjects
medicine.medical_specialty, Endovascular therapy, law.invention, Randomized controlled trial, law, Internal medicine, Severity of illness, Occlusion, medicine, In patient, ddc:610, cardiovascular diseases, Stroke, Intention-to-treat analysis, business.industry, Basilar artery occlusion, General Medicine, THROMBECTOMY, medicine.disease, ISCHEMIC-STROKE, RESULTADO DE TRATAMENTO, cardiovascular system, Cardiology, INTRAARTERIAL, TRIAL, business
Abstract

Background The effectiveness of endovascular therapy in patients with stroke caused by basilar-artery occlusion has not been well studied.Methods We randomly assigned patients within 6 hours after the estimated time of onset of a stroke due to basilar-artery occlusion, in a 1:1 ratio, to receive endovascular therapy or standard medical care. The primary outcome was a favorable functional outcome, defined as a score of 0 to 3 on the modified Rankin scale (range, 0 to 6, with 0 indicating no disability, 3 indicating moderate disability, and 6 indicating death) at 90 days. The primary safety outcomes were symptomatic intracranial hemorrhage within 3 days after the initiation of treatment and mortality at 90 days.Results A total of 300 patients were enrolled (154 in the endovascular therapy group and 146 in the medical care group). Intravenous thrombolysis was used in 78.6% of the patients in the endovascular group and in 79.5% of those in the medical group. Endovascular treatment was initiated at a median of 4.4 hours after stroke onset. A favorable functional outcome occurred in 68 of 154 patients (44.2%) in the endovascular group and 55 of 146 patients (37.7%) in the medical care group (risk ratio, 1.18; 95% confidence interval [CI], 0.92 to 1.50). Symptomatic intracranial hemorrhage occurred in 4.5% of the patients after endovascular therapy and in 0.7% of those after medical therapy (risk ratio, 6.9; 95% CI, 0.9 to 53.0); mortality at 90 days was 38.3% and 43.2%, respectively (risk ratio, 0.87; 95% CI, 0.68 to 1.12).Conclusions Among patients with stroke from basilar-artery occlusion, endovascular therapy and medical therapy did not differ significantly with respect to a favorable functional outcome, but, as reflected by the wide confidence interval for the primary outcome, the results of this trial may not exclude a substantial benefit of endovascular therapy. Larger trials are needed to determine the efficacy and safety of endovascular therapy for basilar-artery occlusion. (Funded by the Dutch Heart Foundation and others; BASICS ClinicalTrials.gov number, NCT01717755; Netherlands Trial Register number, NL2500.)Endovascular Therapy for Basilar-Artery Stroke In a randomized trial involving 300 patients with basilar-artery stroke, endovascular thrombectomy was not significantly different from medical therapy with respect to a favorable functional outcome (modified Rankin scale score of 0 to 3) at 90 days, but a clinically significant benefit could not be excluded.

Published
2021
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11. The 2nd European Carotid Surgery Trial (ECST-2): rationale and protocol for a randomised clinical trial comparing immediate revascularisation versus optimised medical therapy alone in patients with symptomatic and asymptomatic carotid stenosis at low to intermediate risk of stroke

Author

Cheng, S.F., van Velzen, T.J., Gregson, J., Richards, T., Jager, H.R., Simister, R., Kooi, M.E., de Borst, G.J., Pizzini, F.B., Nederkoorn, P.J., Brown, M.M., Bonati, L.H., Beeldvorming, MUMC+: DA BV Klinisch Fysicus (9), and RS: Carim - B06 Imaging

Subjects
Randomised controlled trial, ENDARTERECTOMY, PROGRESSION, Plaque imaging, ATORVASTATIN, PREVENTION, Risk prediction, EVENTS, Carotid stenting, INDIVIDUALS, HEMORRHAGE, Magnetic resonance imaging, Carotid endarterectomy, VERTEBRAL ARTERY, Carotid stenosis, RECURRENCE, Ischaemic stroke, METAANALYSIS
Abstract

Background: Carotid endarterectomy is currently recommended for patients with recently symptomatic carotid stenosis >= 50%, based on randomised trials conducted 30 years ago. Several factors such as carotid plaque ulceration, age and associated comorbidities might influence the risk-benefit ratio of carotid revascularisation. A model developed in previous trials that calculates the future risk of stroke based on these features can be used to stratify patients into low, intermediate or high risk. Since the original trials, medical treatment has improved significantly. Our hypothesis is that patients with carotid stenosis >= 50% associated with a low to intermediate risk of stroke will not benefit from additional carotid revascularisation when treated with optimised medical therapy. We also hypothesise that prediction of future risk of stroke in individual patients with carotid stenosis can be improved using the results of magnetic resonance imaging (MRI) of the carotid plaque.Methods: Patients are randomised between immediate revascularisation plus OMT versus OMT alone. Suitable patients are those with asymptomatic or symptomatic carotid stenosis >= 50% with an estimated 5-year risk of stroke of

Published
2022

12. Sex Differences in Plaque Composition and Morphology Among Symptomatic Patients With Mild-to-Moderate Carotid Artery Stenosis.

Author

Dam-Nolen, Dianne H.K. van, Egmond, Nina C.M. van, Dilba, Kristine, Nies, Kelly, Kolk, A.G. van der, Liem, M.I., Kooi, M.E., Hendrikse, J., Nederkoorn, P.J., Koudstaal, P.J., Lugt, A. van der, Bos, D., Dam-Nolen, Dianne H.K. van, Egmond, Nina C.M. van, Dilba, Kristine, Nies, Kelly, Kolk, A.G. van der, Liem, M.I., Kooi, M.E., Hendrikse, J., Nederkoorn, P.J., Koudstaal, P.J., Lugt, A. van der, and Bos, D.

Abstract

Item does not contain fulltext

Published
2022

13. Subacute cognitive impairment after first-ever transient ischemic attack or ischemic stroke in young adults: The ODYSSEY study

Author

Schellekens, M.M.I., Boot, E.M., Verhoeven, J.I., Ekker, M.S., Alebeek, M.E. van, Brouwers, P.J.A.M., Arntz, R.M., Dijk, G.W. van, Gons, R.A.R., Uden, I.W.M. van, Heijer, T. den, Kort, P.L.M. de, Laat, K.F. de, Norden, A.G.W. van, Vermeer, S.E., Zagten, M.S.G. van, Oostenbrugge, R.J. van, Wermer, M.J.H., Nederkoorn, P.J., Rooij, F.G. van, Wijngaard, I.R. van den, Leeuw, H.F. de, Kessels, R.P.C., Tuladhar, A.M., Schellekens, M.M.I., Boot, E.M., Verhoeven, J.I., Ekker, M.S., Alebeek, M.E. van, Brouwers, P.J.A.M., Arntz, R.M., Dijk, G.W. van, Gons, R.A.R., Uden, I.W.M. van, Heijer, T. den, Kort, P.L.M. de, Laat, K.F. de, Norden, A.G.W. van, Vermeer, S.E., Zagten, M.S.G. van, Oostenbrugge, R.J. van, Wermer, M.J.H., Nederkoorn, P.J., Rooij, F.G. van, Wijngaard, I.R. van den, Leeuw, H.F. de, Kessels, R.P.C., and Tuladhar, A.M.

Abstract

31 oktober 2022, Contains fulltext : 284228.pdf (Publisher’s version ) (Open Access), Introduction: We aimed to investigate the prevalence of cognitive impairment in the subacute phase after transient ischemic attack (TIA) and ischemic stroke (IS), factors associated with a vascular cognitive disorder, and the prevalence of subjective cognitive complaints and their relation with objective cognitive performance.Patients and methods: In this multicenter prospective cohort study, we recruited patients with first-ever TIA and IS, aged 18-49 years, between 2013 and 2021 for cognitive assessment up to 6 months after index event. We calculated composite Z-scores for seven cognitive domains. We defined cognitive impairment as a composite Z-score < -1.5. We defined major vascular cognitive disorder as a Z-score < -2.0 in one or more cognitive domains. Results: Fifty three TIA and 545 IS patients completed cognitive assessment with mean time to assessment of 89.7 (SD 40.7) days. The median NIHSS at admission was 3 (interquartile range, 1-5). Cognitive impairment was common in five domains (up to 37%), with similar proportion in TIA and IS patients. Patients with major vascular cognitive disorder had a lower education level, higher NIHSS scores and more frequent lesions in the left frontotemporal lobe than without vascular cognitive disorder (p < 0.05 FDR-corrected). Subjective memory and executive cognitive complaints were present in about two-thirds of the patients, but were weakly associated with objective cognitive performance (ß: -0.32 and -0.21, respectively). Discussion and conclusion: In the subacute phase after TIA or stroke in young adults, cognitive impairment and subjective cognitive complaints are prevalent, but they are weakly associated with each other.

Published
2022

14. 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

Berg, S.A. van den, Venema, S.M. Uniken, Reinink, H., Hofmeijer, J., Schonewille, W.J., Miedema, I., Fransen, P.S., Pruissen, D.M.O., Raaijmakers, T.W.M., Dijk, G.W. van, Leeuw, F.E. de, Vliet, Jorien A. van der, Kwa, V.I.H., Kerkhoff, H., Net, A. van 't, Boomars, R., Siegers, A., Lok, T., Caminada, K., Cuevas, L.M. Esteve, Visser, M.C, Zwetsloot, C.P., Boomsma, J.M.F., Schipper, M.H., Eijkelenburg, R.P.J. van, Berkhemer, O.A., Nieboer, D., Lingsma, H.F., Emmer, B.J., Oostenbrugge, R.J. van, Lugt, A. van der, Roos, Y., Majoie, C., Dippel, D.W., Nederkoorn, P.J., Worp, H.B. van der, Berg, S.A. van den, Venema, S.M. Uniken, Reinink, H., Hofmeijer, J., Schonewille, W.J., Miedema, I., Fransen, P.S., Pruissen, D.M.O., Raaijmakers, T.W.M., Dijk, G.W. van, Leeuw, F.E. de, Vliet, Jorien A. van der, Kwa, V.I.H., Kerkhoff, H., Net, A. van 't, Boomars, R., Siegers, A., Lok, T., Caminada, K., Cuevas, L.M. Esteve, Visser, M.C, Zwetsloot, C.P., Boomsma, J.M.F., Schipper, M.H., Eijkelenburg, R.P.J. van, Berkhemer, O.A., Nieboer, D., Lingsma, H.F., Emmer, B.J., Oostenbrugge, R.J. van, Lugt, A. van der, Roos, Y., Majoie, C., Dippel, D.W., Nederkoorn, P.J., and Worp, H.B. van der

Abstract

Item does not contain fulltext, BACKGROUND: Pooled analyses of previous randomised studies have suggested that very early treatment with glyceryl trinitrate (also known as nitroglycerin) improves functional outcome in patients with acute ischaemic stroke or intracerebral haemorrhage, but this finding was not confirmed in a more recent trial (RIGHT-2). We aimed to assess whether patients with presumed acute stroke benefit from glyceryl tr initrate started within 3 h after symptom onset. METHODS: MR ASAP was a phase 3, randomised, open-label, blinded endpoint trial done at six ambulance services serving 18 hospitals in the Netherlands. Eligible participants (aged ≥18 years) had a probable diagnosis of acute stroke (as assessed by a paramedic), a face-arm-speech-time test score of 2 or 3, systolic blood pressure of at least 140 mm Hg, and could start treatment within 3 h of symptom onset. Participants were randomly assigned (1:1) by ambulance personnel, using a secure web-based electronic application with random block sizes stratified by ambulance service, to receive either transdermal glyceryl trinitrate 5 mg/day for 24 h plus standard care (glyceryl trinitrate group) or to standard care alone (control group) in the prehospital setting. Informed consent was deferred until after arrival at the hospital. The primary outcome was functional outcome assessed with the modified Rankin Scale (mRS) at 90 days. Safety outcomes included death within 7 days, death within 90 days, and serious adverse events. Analyses were based on modified intention to treat, and treatment effects were expressed as odds ratios (ORs) or common ORs, with adjustment for baseline prognostic factors. We separately analysed the total population and the target population (ie, patients with intracerebral haemorrhage, ischaemic stroke, or transient ischaemic attack). The target sample size was 1400 patients. The trial is registered as ISRCTN99503308. FINDINGS: On June 24, 2021, the MR ASAP trial was prematurely terminated on the advice o

Published
2022

15. Association between plaque vulnerability and neutrophil extracellular traps (NETs) levels: The Plaque At RISK study

Author

Vries, J.J.J. de, Autar, A.S.A., Dam-Nolen, D.H.K. Van, Donkel, S.J., Kassem, M., Kolk, A.G. van der, Velzen, T.J. van, Kooi, M.Eline, Hendrikse, J., Nederkoorn, P.J., Bos, D., Lugt, A. van der, Maat, M.P. de, Beusekom, H.M. van, Vries, J.J.J. de, Autar, A.S.A., Dam-Nolen, D.H.K. Van, Donkel, S.J., Kassem, M., Kolk, A.G. van der, Velzen, T.J. van, Kooi, M.Eline, Hendrikse, J., Nederkoorn, P.J., Bos, D., Lugt, A. van der, Maat, M.P. de, and Beusekom, H.M. van

Abstract

Contains fulltext : 283306.pdf (Publisher’s version ) (Open Access), Carotid atherosclerotic plaque rupture and its sequelae are among the leading causes of acute ischemic stroke. The risk of rupture and subsequent thrombosis is, among others, determined by vulnerable plaque characteristics and linked to activation of the immune system, in which neutrophil extracellular traps (NETs) potentially play a role. The aim of this study was to investigate how plaque vulnerability is associated with NETs levels. We included 182 patients from the Plaque At RISK (PARISK) study in whom carotid imaging was performed to measure plaque ulceration, fibrous cap integrity, intraplaque hemorrhage, lipid-rich necrotic core, calcifications and plaque volume. Principal component analysis generated a 'vulnerability index' comprising all plaque characteristics. Levels of the NETs marker myeloperoxidase-DNA complex were measured in patient plasma. The association between the vulnerability index and low or high NETs levels (dependent variable) was assessed by logistic regression. No significant association between the vulnerability index and NETs levels was detected in the total population (odds ratio 1.28, 95% confidence interval 0.90-1.83, p = 0.18). However, in the subgroup of patients naive to statins or antithrombotic medication prior to the index event, this association was statistically significant (odds ratio 2.08, 95% confidence interval 1.04-4.17, p = 0.04). Further analyses revealed that this positive association was mainly driven by intraplaque hemorrhage, lipid-rich necrotic core and ulceration. In conclusion, plaque vulnerability is positively associated with plasma levels of NETs, but only in patients naive to statins or antithrombotic medication prior to the index event.

Published
2022

17. Proximal Region of Carotid Atherosclerotic Plaque Shows More Intraplaque Hemorrhage: The Plaque at Risk Study

Author

Crombag, G.A.J.C., primary, Aizaz, M., additional, Schreuder, F.H.B.M., additional, Benali, F., additional, van Dam-Nolen, D.H.K., additional, Liem, M.I., additional, Lucci, C., additional, van der Steen, A.F., additional, Daemen, M.J.A.P., additional, Mess, W.H., additional, van der Lugt, A., additional, Nederkoorn, P.J., additional, Hendrikse, J., additional, Hofman, P.A.M., additional, van Oostenbrugge, R.J., additional, Wildberger, J.E., additional, and Kooi, M.E., additional

Published
2022
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18. Clinical and Imaging Markers Associated With Hemorrhagic Transformation in Patients With Acute Ischemic Stroke

Author

Kranendonk, K.R. van, Treumiet, K.M., Boers, A.M.M., Berkhemer, O.A., Berg, L.A. van den, Chalos, V., Lingsma, H.F., Zwam, W.H. van, Lugt, A. van der, Oostenbrugge, R.J. van, Dippel, D.W.J., Roos, Y.B.W.E.M., Marquering, H.A., Majoie, C.B.L.M., Fransen, P.S.S., Beumer, D., Yoo, A.J., Schonewille, W.J., Vos, J.A., Nederkoorn, P.J., Wenner, M.J.H., Walderveen, M.A.A. van, Staals, J., Hofmeijer, J., Oostayen, J.A. van, Nijeholt, G.J.L.A., Boiten, J., Brouwer, P.A., Emmet, B.J., Bruijn, S.F. de, Dijk, L.C. van, Kappelle, L.J., R.H. lo, Dijk, E.J. van, Vries, J. de, Kort, P.L.M. de, Rooij, W.J.J. van, Berg, J.S.P. van den, Hassell, B.A.A.M. van, Aerden, L.A.M., Dallinga, R.J., Visser, M.C., Bot, J.C.J., Vroomen, P.C., Eshghi, O., Schreuder, T.H.C.M.L., Heijboer, R.J.J., Keizer, K., Tielbeek, A.V., Hertog, H.M. den, Gerrits, D.G., Berg-Vos, R.M. van den, Karas, G.B., Steyerberg, E.W., Flach, H.Z., Sprengers, M.E.S., Jenniskens, S.F.M., Beenen, L.F.M., Berg, R. van den, Koudstaal, P.J., MR CLEAN Investigators, RS: Carim - B05 Cerebral small vessel disease, RS: CARIM - R3.03 - Cerebral small vessel disease, RS: Carim - B06 Imaging, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: CARIM - R3.11 - Imaging, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, MUMC+: MA AIOS Neurologie (9), MUMC+: MA Med Staf Spec Neurologie (9), Graduate School, Radiology and Nuclear Medicine, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, ANS - Neurovascular Disorders, Neurology, Radiology and nuclear medicine, VU University medical center, Amsterdam Neuroscience - Neurovascular Disorders, Radiology & Nuclear Medicine, Orthopedics and Sports Medicine, and Public Health

Subjects
medicine.medical_specialty, Population, infarction, intracranial hemorrhages, Infarction, BLOOD-PRESSURE, Tissue plasminogen activator, All institutes and research themes of the Radboud University Medical Center, Hematoma, Internal medicine, medicine, risk factors, atrial fibrillation, education, Stroke, TISSUE-PLASMINOGEN ACTIVATOR, Advanced and Specialized Nursing, HEALTH-CARE PROFESSIONALS, education.field_of_study, business.industry, INTRAVENOUS ALTEPLASE, Other Research Radboud Institute for Health Sciences [Radboudumc 0], blood pressure, Atrial fibrillation, SYMPTOMATIC INTRACRANIAL HEMORRHAGE, Odds ratio, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], medicine.disease, stroke, n/a OA procedure, reperfusion, Blood pressure, THROMBOLYTIC THERAPY, ENDOVASCULAR TREATMENT, Cardiology, RISK-FACTORS, TRIAL, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, medicine.drug, INTRAARTERIAL TREATMENT
Abstract

Background and Purpose— Hemorrhagic transformation (HT) after acute ischemic stroke may cause severe neurological deterioration and affects functional outcome. Identifying patients most likely to suffer from this complication could potentially be used for future treatment selection. Reperfusion after endovascular therapy could be associated with different risk factors for HT than intravenous thrombolytics as these treatments largely differ. In this study, we aimed to identify clinical and imaging markers that are associated with HT subtypes in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) population. Methods— In this post hoc analysis, all patients with follow-up imaging were included. HT was classified according to ECASS II (European Cooperative Acute Stroke Study). Variables with an association of P Results— Of the 478 out of 500 included patients in this subanalysis, 46% had HT (n=222). Of these, 66% had hemorrhagic infarction (n=147) and 34% PH (n=75). Symptomatic intracranial hemorrhage was observed in 7.3% (n=35) of all patients. Baseline National Institutes of Health Stroke Scale (odds ratio [OR], 1.05,95% CI, 1.01–1.09 per point) and absent/poor collaterals (OR, 1.90; 95% CI, 1.05–3.42) were significantly associated with hemorrhagic infarction. Increased systolic blood pressure (OR, 1.17; 95% CI, 1.05–1.31 per 10 mm Hg) and atrial fibrillation (OR, 1.94; 95% CI, 1.08–3.48) were associated with PH. Increased systolic blood pressure (OR, 1.28; 95% CI, 1.12–1.48) and antiplatelet use (OR, 2.6; 95% CI, 1.08–6.3) were associated with symptomatic intracranial hemorrhage. Conclusions— Clinical and imaging stroke severity parameters were associated with HT, both in hemorrhagic infarction and PH, whereas baseline patients characteristics like systolic blood pressure, atrial fibrillation, and antiplatelet use were only associated with PH or symptomatic intracranial hemorrhage. Clinical Trial Registration— URL: http://www.controlled-trials.com . Unique identifier: ISRCTN10888758.

Published
2019
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19. Clinical Response to Procedural Stroke Following Carotid Endarterectomy: A Delphi Consensus Study

Author

Meershoek, Armelle J.A., primary, de Waard, Djurre D., additional, Trappenburg, Jaap, additional, Zeebregts, Clark J., additional, Bulbulia, Richard, additional, Kappelle, Jaap L.J., additional, de Borst, Gert J., additional, Bonati, L.H., additional, Brott, T.G., additional, McCabe, D., additional, Calvet, D., additional, Engelter, S.T., additional, Leira, E.C., additional, Leys, D., additional, Nederkoorn, P.J., additional, Paciaroni, M., additional, Petersson, J., additional, Ringleb, P., additional, Uyttenbogaart, M., additional, Weimar, C., additional, Antti Lindgren, J.M., additional, Bastos Goncalves, F., additional, Bjorck, M., additional, Bismuth, J., additional, Debus, S., additional, Eckstein, H., additional, Glovizcki, P., additional, Halliday, A., additional, Kakkos, S.K., additional, Koncar, I., additional, Naylor, A.R., additional, Radak, D., additional, Schermerhorn, M.L., additional, Sillesen, H., additional, Tolva, V., additional, Vega de Ceniga, M., additional, Vermassen, F., additional, and Zeebregts, C.J., additional

Published
2021
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21. Predictors of Acute and Persisting Ischemic Brain Lesions in Patients Randomized to Carotid Stenting or Endarterectomy

Author

Rostamzadeh, Ayda, Zumbrunn, Thomas, Jongen, Lisa M., Nederkoorn, Paul J., Macdonald, Sumaira, Lyrer, Philippe A., Kappelle, L. Jaap, Mali, Willem P. Th. M., Brown, Martin M., van der Worp, H. Bart, Engelter, Stefan T., Bonati, Leo H., de Borst, G.J., de Kort, G.A.P., Jongen, L.M., Kappelle, L.J., Lo, T.H., Mali, W.P.Th.M., Moll, F.L., van der Worp, H.B., Bonati, L.H., Engelter, S.T., Fluri, F., Haller, S., Jacob, A.L., Kirsch, E., Lyrer, P.A., Radue, E.-W., Stierli, P., Wasner, M., Wetzel, S.G., Flach, H.Z., Hendriks, J.M., Koudstaal, P.J., Pattynama, P.M.T., van Dijk, L.C., van Sambeek, M.R.H.M., van der Lugt, A., van Urk, H., Verhagen, H.J.M., Clarke, M., Davis, M., Dixit, A.K., Dorman, P., Dyker, A., Ford, G., Golkar, A., Jackson, R., Jayakrishnan, V., Lambert, D., Lees, T., Louw, S., Macdonald, S., Mendelow, D., Rodgers, H., Rose, J., Stansby, G., Wyatt, M., Koelemaij, M.J.W., Majoie, C.B.L.M., Nederkoorn, P.J., Reekers, J.A.A., Roos, Y.B.W.E.M., Adiseshiah, M., Bishop, C., Brew, S., Brookes, J., Brown, M.M., Jäger, H.R., Kitchen, N., Beard, J., Cleveland, T., Dodd, D., Gaines, P.A., Lonsdale, R., Nair, R., Nassef, A., Nawaz, S., and Venables, G.

Published
2014
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22. Confounding adjustment performance of ordinal analysis methods in stroke studies

Author

Zonneveld, T.P., Aigner, A., Groenwold, R.H.H., Algra, A., Nederkoorn, P.J., Grittner, U., Kruyt, N.D., and Siegerink, B.

Abstract

BackgroundIn stroke studies, ordinal logistic regression (OLR) is often used to analyze outcome on the modified Rankin Scale (mRS), whereas the non-parametric Mann-Whitney measure of superiority (MWS) has also been suggested. It is unclear how these perform comparatively when confounding adjustment is warranted.AimsOur aim is to quantify the performance of OLR and MWS in different confounding variable settings.MethodsWe set up a simulation study with three different scenarios; (1) dichotomous confounding variables, (2) continuous confounding variables, and (3) confounding variable settings mimicking a study on functional outcome after stroke. We compared adjusted ordinal logistic regression (aOLR) and stratified Mann-Whitney measure of superiority (sMWS), and also used propensity scores to stratify the MWS (psMWS). For comparability, OLR estimates were transformed to a MWS. We report bias, the percentage of runs that produced a point estimate deviating by more than 0.05 points (point estimate variation), and the coverage probability.ResultsIn scenario 1, there was no bias in both sMWS and aOLR, with similar point estimate variation and coverage probabilities. In scenario 2, sMWS resulted in more bias (0.04 versus 0.00), and higher point estimate variation (41.6% versus 3.3%), whereas coverage probabilities were similar. In scenario 3, there was no bias in both methods, point estimate variation was higher in the sMWS (6.7%) versus aOLR (1.1%), and coverage probabilities were 0.98 (sMWS) versus 0.95 (aOLR). With psMWS, bias remained 0.00, with less point estimate variation (1.5%) and a coverage probability of 0.95.ConclusionsThe bias of both adjustment methods was similar in our stroke simulation scenario, and the higher point estimate variation in the MWS improved with propensity score based stratification. The stratified MWS is a valid alternative for adjusted OLR only when the ratio of number of strata versus number of observations is relatively low, but propensity score based stratification extends the application range of the MWS.

Published
2020

23. Development of imaging-based risk scores for prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotic therapy after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies

Author

Best, J.G., Ambler, G., Wilson, D., Lee, K.J., Lim, J.S., Shiozawa, M., Koga, M., Li, L, Lovelock, C., Chabriat, H., Hennerici, M., Wong, Y.K., Mak, H.K.F., Prats-Sanchez, L., Martínez-Domeño, A., Inamura, S., Yoshifuji, K., Arsava, E.M., Horstmann, S., Purrucker, J., Lam, B.Y.K., Wong, A., Kim, Y.D., Song, T.J., Lemmens, R., Eppinger, S., Gattringer, T., Uysal, E., Tanriverdi, Z., Bornstein, N.M., Assayag, E. Ben, Hallevi, H., Molad, J., Nishihara, M., Tanaka, J., Coutts, S.B., Polymeris, A., Wagner, B., Seiffge, D.J., Lyrer, P., Algra, A., Kappelle, L.J., Al-Shahi Salman, R., Jäger, H.R., Lip, G.Y.H., Fischer, U., El-Koussy, M., Mas, J.L., Legrand, Laurence, Karayiannis, C., Phan, T., Gunkel, S., Christ, N., Abrigo, J., Leung, T., Chu, W., Chappell, F., Makin, S., Hayden, D., Williams, D.J., Mess, W.H., Nederkoorn, P.J., Barbato, C., Browning, S., Wiegertjes, K., Tuladhar, A.M., Maaijwee, N., Guevarra, A.C., Yatawara, C., Mendyk, A.M., Delmaire, C., Köhler, S., Oostenbrugge, R van, Zhou, Y, Xu, Chao, Hilal, S., Gyanwali, B., Chen, C, Lou, M., Staals, J., Bordet, R., Kandiah, N., Leeuw, F.E. de, Simister, R., Hendrikse, Jeroen, Kelly, P.J., Wardlaw, J., Soo, Y., Fluri, F., Srikanth, V., Calvet, D., Jung, S., Kwa, V.I.H., Engelter, S.T., Peters, Nils, Smith, E.E., Hara, H., Yakushiji, Y., Orken, D.N., Best, J.G., Ambler, G., Wilson, D., Lee, K.J., Lim, J.S., Shiozawa, M., Koga, M., Li, L, Lovelock, C., Chabriat, H., Hennerici, M., Wong, Y.K., Mak, H.K.F., Prats-Sanchez, L., Martínez-Domeño, A., Inamura, S., Yoshifuji, K., Arsava, E.M., Horstmann, S., Purrucker, J., Lam, B.Y.K., Wong, A., Kim, Y.D., Song, T.J., Lemmens, R., Eppinger, S., Gattringer, T., Uysal, E., Tanriverdi, Z., Bornstein, N.M., Assayag, E. Ben, Hallevi, H., Molad, J., Nishihara, M., Tanaka, J., Coutts, S.B., Polymeris, A., Wagner, B., Seiffge, D.J., Lyrer, P., Algra, A., Kappelle, L.J., Al-Shahi Salman, R., Jäger, H.R., Lip, G.Y.H., Fischer, U., El-Koussy, M., Mas, J.L., Legrand, Laurence, Karayiannis, C., Phan, T., Gunkel, S., Christ, N., Abrigo, J., Leung, T., Chu, W., Chappell, F., Makin, S., Hayden, D., Williams, D.J., Mess, W.H., Nederkoorn, P.J., Barbato, C., Browning, S., Wiegertjes, K., Tuladhar, A.M., Maaijwee, N., Guevarra, A.C., Yatawara, C., Mendyk, A.M., Delmaire, C., Köhler, S., Oostenbrugge, R van, Zhou, Y, Xu, Chao, Hilal, S., Gyanwali, B., Chen, C, Lou, M., Staals, J., Bordet, R., Kandiah, N., Leeuw, F.E. de, Simister, R., Hendrikse, Jeroen, Kelly, P.J., Wardlaw, J., Soo, Y., Fluri, F., Srikanth, V., Calvet, D., Jung, S., Kwa, V.I.H., Engelter, S.T., Peters, Nils, Smith, E.E., Hara, H., Yakushiji, Y., and Orken, D.N.

Abstract

Item does not contain fulltext, BACKGROUND: Balancing the risks of recurrent ischaemic stroke and intracranial haemorrhage is important for patients treated with antithrombotic therapy after ischaemic stroke or transient ischaemic attack. However, existing predictive models offer insufficient performance, particularly for assessing the risk of intracranial haemorrhage. We aimed to develop new risk scores incorporating clinical variables and cerebral microbleeds, an MRI biomarker of intracranial haemorrhage and ischaemic stroke risk. METHODS: We did a pooled analysis of individual-patient data from the Microbleeds International Collaborative Network (MICON), which includes 38 hospital-based prospective cohort studies from 18 countries. All studies recruited participants with previous ischaemic stroke or transient ischaemic attack, acquired baseline MRI allowing quantification of cerebral microbleeds, and followed-up participants for ischaemic stroke and intracranial haemorrhage. Participants not taking antithrombotic drugs were excluded. We developed Cox regression models to predict the 5-year risks of intracranial haemorrhage and ischaemic stroke, selecting candidate predictors on biological relevance and simplifying models using backward elimination. We derived integer risk scores for clinical use. We assessed model performance in internal validation, adjusted for optimism using bootstrapping. The study is registered on PROSPERO, CRD42016036602. FINDINGS: The included studies recruited participants between Aug 28, 2001, and Feb 4, 2018. 15 766 participants had follow-up for intracranial haemorrhage, and 15 784 for ischaemic stroke. Over a median follow-up of 2 years, 184 intracranial haemorrhages and 1048 ischaemic strokes were reported. The risk models we developed included cerebral microbleed burden and simple clinical variables. Optimism-adjusted c indices were 0·73 (95% CI 0·69-0·77) with a calibration slope of 0·94 (0·81-1·06) for the intracranial haemorrhage model and 0·63 (0·62-0·65) with

Published
2021

24. Plaque composition as a predictor of plaque ulceration in carotid artery atherosclerosis: The plaque at RISK study

Author

Dilba, K. (K.), van Dam-Nolen, D.H.K. (D. H.K.), Nouwens- van Dijk, A.C. (Anouk), Kassem, M. (M.), van der Steen, A.F.W. (A. F.W.), Koudstaal, P.J. (P. J.), Nederkoorn, P.J. (Paul), Hendrikse, J. (Jeroen), Kooi, M.E. (M. Eline), Wentzel, J.J. (Jolanda), Lugt, A. (Aad) van der, Dilba, K. (K.), van Dam-Nolen, D.H.K. (D. H.K.), Nouwens- van Dijk, A.C. (Anouk), Kassem, M. (M.), van der Steen, A.F.W. (A. F.W.), Koudstaal, P.J. (P. J.), Nederkoorn, P.J. (Paul), Hendrikse, J. (Jeroen), Kooi, M.E. (M. Eline), Wentzel, J.J. (Jolanda), and Lugt, A. (Aad) van der

Abstract

BACKGROUND AND PURPOSE: Plaque ulceration is a marker of previous plaque rupture. We studied the association between atherosclerotic plaque composition at baseline and plaque ulceration at baseline and follow-up. MATERIALS AND METHODS: We included symptomatic patients with a carotid stenosis of ,70% who underwent MDCTA and MR imaging at baseline (n=180). MDCTA was repeated at 2 years (n=73). We assessed the presence of ulceration using MDCTA. Baseline MR imaging was used to assess the vessel wall volume and the presence and volume of plaque components (intraplaque hemorrhage, lipid-rich necrotic core, and calcifications) and the fibrous cap status. Associations at baseline were evaluated with binary logistic regression and reported with an OR and its 95% CI. Simple statistical testing was performed in the follow-up analysis. RESULTS: At baseline, the prevalence of plaque ulceration was 27% (49/180). Increased wall volume (OR = 12.1; 95% CI, 3.5-42.0), higher relative lipid-rich necrotic core (OR= 1.7; 95% CI, 1.3-2.2), higher relative intraplaque hemorrhage volume (OR= 1.7; 95% CI, 1.3-2.2), and a thin-or-ruptured fibrous cap (OR = 3.4; 95% CI, 1.7-6.7) were associated with the presence of ulcerations at baseline. In 8% (6/73) of the patients, a new ulcer developed. Plaques with a new ulceration at follow-up had at baseline a larger wall volume (1.04 cm3 [IQR, 0.97-1.16 cm3] versus 0.86 cm3 [IQR, 0.73-1.00 cm3]; P=.029), a larger relative lipid-rich necrotic core volume (23% [IQR, 13-31%] versus 2% [IQR, 0-14%]; P=.002), and a larger relative intraplaque hemorrhage volume (14% [IQR, 8-24%] versus 0% [IQR, 0-5%]; P<.001). CONCLUSIONS: Large atherosclerotic plaques and plaques with intraplaque hemorrhage and lipid-rich necrotic cores were associated with plaque ulcerations at baseline and follow-up.

Published
2021
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25. Development of imaging-based risk scores for prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotic therapy after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies.

Author

Best J.G., Ambler G., Wilson D., Lee K.-J., Lim J.-S., Shiozawa M., Koga M., Li L., Lovelock C., Chabriat H., Hennerici M., Wong Y.K., Mak H.K.F., Prats-Sanchez L., Martinez-Domeno A., Inamura S., Yoshifuji K., Arsava E.M., Horstmann S., Purrucker J., Lam B.Y.K., Wong A., Kim Y.D., Song T.-J., Lemmens R., Eppinger S., Gattringer T., Uysal E., Tanriverdi Z., Bornstein N.M., Ben Assayag E., Hallevi H., Molad J., Nishihara M., Tanaka J., Coutts S.B., Polymeris A., Wagner B., Seiffge D.J., Lyrer P., Algra A., Kappelle L.J., Al-Shahi Salman R., Jager H.R., Lip G.Y.H., Fischer U., El-Koussy M., Mas J.-L., Legrand L., Karayiannis C., Phan T., Gunkel S., Christ N., Abrigo J., Leung T., Chu W., Chappell F., Makin S., Hayden D., Williams D.J., Mess W.H., Nederkoorn P.J., Barbato C., Browning S., Wiegertjes K., Tuladhar A.M., Maaijwee N., Guevarra A.C., Yatawara C., Mendyk A.-M., Delmaire C., Kohler S., van Oostenbrugge R., Zhou Y., Xu C., Hilal S., Gyanwali B., Chen C., Lou M., Staals J., Bordet R., Kandiah N., de Leeuw F.-E., Simister R., Hendrikse J., Kelly P.J., Wardlaw J., Soo Y., Fluri F., Srikanth V., Calvet D., Jung S., Kwa V.I.H., Engelter S.T., Peters N., Smith E.E., Hara H., Yakushiji Y., Orken D.N., Fazekas F., Thijs V., Heo J.H., Mok V., Veltkamp R., Ay H., Imaizumi T., Gomez-Anson B., Lau K.K., Jouvent E., Rothwell P.M., Toyoda K., Bae H.-J., Marti-Fabregas J., Werring D.J., Harkness K., Shaw L., Sword J., Mohd Nor A., Sharma P., Kelly D., Harrington F., Randall M., Smith M., Mahawish K., Elmarim A., Esisi B., Cullen C., Nallasivam A., Price C., Barry A., Roffe C., Coyle J., Hassan A., Birns J., Cohen D., Sekaran L., Parry-Jones A., Parry A., Hargroves D., Proschel H., Datta P., Darawil K., Manoj A., Burn M., Patterson C., Giallombardo E., Smyth N., Mansoor S., Anwar I., Marsh R., Ispoglou S., Chadha D., Prabhakaran M., Meenakishundaram S., O'Connell J., Scott J., Krishnamurthy V., Aghoram P., McCormick M., Sprigg N., O'Mahony P., Cooper M., Choy L., Wilkinson P., Leach S., Caine S., Burger I., Gunathilagan G., Guyler P., Emsley H., Davis M., Manawadu D., Pasco K., Mamun M., Luder R., Sajid M., Okwera J., Warburton E., Saastamoinen K., England T., Putterill J., Flossman E., Power M., Dani K., Mangion D., Suman A., Corrigan J., Lawrence E., Vahidassr D., Shakeshaft C., Brown M., Charidimou A., Cohen H., Banerjee G., Houlden H., White M., Yousry T., Flossmann E., Muir K., Gratz P., Mattle H., Panos L., Korczyn A., Kliper E., Maeder P., Gass A., Pachai C., Bracoub L., Douste-Blazy M.-Y., Fratacci M.D., Vicaut E., Sato S., Miwa K., Fujita K., Ide T., Ma H., Ly J., Singhal S., Chandra R., Slater L.-A., Soufan C., Moran C., Traenka C., Thilemann S., Fladt J., Gensicke H., Bonati L., Kim B.J., Han M.-K., Kang J., Ko E., Yang M.H., Jang M.S., Murphy S., Carty F., Akijian L., Thornton J., Schembri M., Douven E., Delgado-Mederos R., Marin R., Camps-Renom P., Guisado-Alonso D., Nunez F., Medrano-Martorell S., Merino E., Iida K., Ikeda S., Irie H., Demirelli D.S., Medanta J.M., Zerna C., Hernandez M.V., Armitage P., Heye A., Munoz-Maniega S., Sakka E., Thrippleton M., Dennis M., Beigneux Y., Silva M., Venketasubramanian N., Ho S.L., Cheung R.T.F., Chan K.H., Teo K.C., Hui E., Kwan J.S.K., Chang R., Tse M.Y., Hoi C.P., Chan C.Y., Chan O.L., Cheung R.H.K., Wong E.K.M., Leung K.T., Tsang S.F., Ip H.L., Ma S.H., Ma K., Fong W.C., Li S.H., Li R., Ng P.W., Wong K.K., Liu W., Wong L., Ramos L., De Schryver E., Jobsis J., van der Sande J., Brouwers P., Roos Y., Stam J., Bakker S., Verbiest H., Schoonewille W., Linn C., Hertzberger L., van Gemert M., Berntsen P., Van Dam-Nolen D., Kooi M.E., Van der Lugt A., Koudstaal P., Leff A., Ward N., Nachev P., Perry R., Ozkan H., Mitchell J., Best J.G., Ambler G., Wilson D., Lee K.-J., Lim J.-S., Shiozawa M., Koga M., Li L., Lovelock C., Chabriat H., Hennerici M., Wong Y.K., Mak H.K.F., Prats-Sanchez L., Martinez-Domeno A., Inamura S., Yoshifuji K., Arsava E.M., Horstmann S., Purrucker J., Lam B.Y.K., Wong A., Kim Y.D., Song T.-J., Lemmens R., Eppinger S., Gattringer T., Uysal E., Tanriverdi Z., Bornstein N.M., Ben Assayag E., Hallevi H., Molad J., Nishihara M., Tanaka J., Coutts S.B., Polymeris A., Wagner B., Seiffge D.J., Lyrer P., Algra A., Kappelle L.J., Al-Shahi Salman R., Jager H.R., Lip G.Y.H., Fischer U., El-Koussy M., Mas J.-L., Legrand L., Karayiannis C., Phan T., Gunkel S., Christ N., Abrigo J., Leung T., Chu W., Chappell F., Makin S., Hayden D., Williams D.J., Mess W.H., Nederkoorn P.J., Barbato C., Browning S., Wiegertjes K., Tuladhar A.M., Maaijwee N., Guevarra A.C., Yatawara C., Mendyk A.-M., Delmaire C., Kohler S., van Oostenbrugge R., Zhou Y., Xu C., Hilal S., Gyanwali B., Chen C., Lou M., Staals J., Bordet R., Kandiah N., de Leeuw F.-E., Simister R., Hendrikse J., Kelly P.J., Wardlaw J., Soo Y., Fluri F., Srikanth V., Calvet D., Jung S., Kwa V.I.H., Engelter S.T., Peters N., Smith E.E., Hara H., Yakushiji Y., Orken D.N., Fazekas F., Thijs V., Heo J.H., Mok V., Veltkamp R., Ay H., Imaizumi T., Gomez-Anson B., Lau K.K., Jouvent E., Rothwell P.M., Toyoda K., Bae H.-J., Marti-Fabregas J., Werring D.J., Harkness K., Shaw L., Sword J., Mohd Nor A., Sharma P., Kelly D., Harrington F., Randall M., Smith M., Mahawish K., Elmarim A., Esisi B., Cullen C., Nallasivam A., Price C., Barry A., Roffe C., Coyle J., Hassan A., Birns J., Cohen D., Sekaran L., Parry-Jones A., Parry A., Hargroves D., Proschel H., Datta P., Darawil K., Manoj A., Burn M., Patterson C., Giallombardo E., Smyth N., Mansoor S., Anwar I., Marsh R., Ispoglou S., Chadha D., Prabhakaran M., Meenakishundaram S., O'Connell J., Scott J., Krishnamurthy V., Aghoram P., McCormick M., Sprigg N., O'Mahony P., Cooper M., Choy L., Wilkinson P., Leach S., Caine S., Burger I., Gunathilagan G., Guyler P., Emsley H., Davis M., Manawadu D., Pasco K., Mamun M., Luder R., Sajid M., Okwera J., Warburton E., Saastamoinen K., England T., Putterill J., Flossman E., Power M., Dani K., Mangion D., Suman A., Corrigan J., Lawrence E., Vahidassr D., Shakeshaft C., Brown M., Charidimou A., Cohen H., Banerjee G., Houlden H., White M., Yousry T., Flossmann E., Muir K., Gratz P., Mattle H., Panos L., Korczyn A., Kliper E., Maeder P., Gass A., Pachai C., Bracoub L., Douste-Blazy M.-Y., Fratacci M.D., Vicaut E., Sato S., Miwa K., Fujita K., Ide T., Ma H., Ly J., Singhal S., Chandra R., Slater L.-A., Soufan C., Moran C., Traenka C., Thilemann S., Fladt J., Gensicke H., Bonati L., Kim B.J., Han M.-K., Kang J., Ko E., Yang M.H., Jang M.S., Murphy S., Carty F., Akijian L., Thornton J., Schembri M., Douven E., Delgado-Mederos R., Marin R., Camps-Renom P., Guisado-Alonso D., Nunez F., Medrano-Martorell S., Merino E., Iida K., Ikeda S., Irie H., Demirelli D.S., Medanta J.M., Zerna C., Hernandez M.V., Armitage P., Heye A., Munoz-Maniega S., Sakka E., Thrippleton M., Dennis M., Beigneux Y., Silva M., Venketasubramanian N., Ho S.L., Cheung R.T.F., Chan K.H., Teo K.C., Hui E., Kwan J.S.K., Chang R., Tse M.Y., Hoi C.P., Chan C.Y., Chan O.L., Cheung R.H.K., Wong E.K.M., Leung K.T., Tsang S.F., Ip H.L., Ma S.H., Ma K., Fong W.C., Li S.H., Li R., Ng P.W., Wong K.K., Liu W., Wong L., Ramos L., De Schryver E., Jobsis J., van der Sande J., Brouwers P., Roos Y., Stam J., Bakker S., Verbiest H., Schoonewille W., Linn C., Hertzberger L., van Gemert M., Berntsen P., Van Dam-Nolen D., Kooi M.E., Van der Lugt A., Koudstaal P., Leff A., Ward N., Nachev P., Perry R., Ozkan H., and Mitchell J.

Abstract

Background: Balancing the risks of recurrent ischaemic stroke and intracranial haemorrhage is important for patients treated with antithrombotic therapy after ischaemic stroke or transient ischaemic attack. However, existing predictive models offer insufficient performance, particularly for assessing the risk of intracranial haemorrhage. We aimed to develop new risk scores incorporating clinical variables and cerebral microbleeds, an MRI biomarker of intracranial haemorrhage and ischaemic stroke risk. Method(s): We did a pooled analysis of individual-patient data from the Microbleeds International Collaborative Network (MICON), which includes 38 hospital-based prospective cohort studies from 18 countries. All studies recruited participants with previous ischaemic stroke or transient ischaemic attack, acquired baseline MRI allowing quantification of cerebral microbleeds, and followed-up participants for ischaemic stroke and intracranial haemorrhage. Participants not taking antithrombotic drugs were excluded. We developed Cox regression models to predict the 5-year risks of intracranial haemorrhage and ischaemic stroke, selecting candidate predictors on biological relevance and simplifying models using backward elimination. We derived integer risk scores for clinical use. We assessed model performance in internal validation, adjusted for optimism using bootstrapping. The study is registered on PROSPERO, CRD42016036602. Finding(s): The included studies recruited participants between Aug 28, 2001, and Feb 4, 2018. 15 766 participants had follow-up for intracranial haemorrhage, and 15 784 for ischaemic stroke. Over a median follow-up of 2 years, 184 intracranial haemorrhages and 1048 ischaemic strokes were reported. The risk models we developed included cerebral microbleed burden and simple clinical variables. Optimism-adjusted c indices were 0.73 (95% CI 0.69-0.77) with a calibration slope of 0.94 (0.81-1.06) for the intracranial haemorrhage model and 0.63 (0.62-0.65) w

Published
2021

26. A history of loss of consciousness or post-traumatic amnesia in minor head injury: 'conditio sine qua non' or one of the risk factors?

Author

Smits, M., Hunink, M.G.M., Nederkoorn, P.J., Dekker, H.M., Vos, P.E., Kool, D.R., Hofman, P.A.M., Twijnstra, A., de Haan, G.G., Tanghe, H.L.J., and Dippel, D.W.J.

Subjects
Loss of consciousness -- Risk factors, Head injuries -- Complications and side effects, Head injuries -- Care and treatment, Amnesia -- Risk factors, Amnesia -- Diagnosis, Health, Psychology and mental health
Published
2007

28. Distribution of Cardioembolic Stroke: A Cohort Study

Author

Pierik, R., Algra, A., Dijk, E. van, Erasmus, M.E., Gelder, I.C. van, Koudstaal, P.J., Luijckx, G.J.R., Nederkoorn, P.J., Oostenbrugge, R.J. van, Ruigrok, Y.M., Scheeren, T.W.L., Uyttenboogaart, M., Visser, M.C., Wermer, M.J.H., Bergh, W.M. van den, Parelsnoer Inst-Cerebrovasc Accid, Neurology, Cardiovascular Centre (CVC), Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), ​Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Groningen Institute for Organ Transplantation (GIOT), ACS - Atherosclerosis & ischemic syndromes, ANS - Neurovascular Disorders, MUMC+: Hersen en Zenuw Centrum (3), RS: Carim - B05 Cerebral small vessel disease, MUMC+: MA Neurologie (3), and Klinische Neurowetenschappen

Subjects
Male, Thromboembolic stroke, SUBCLINICAL ATRIAL-FIBRILLATION, 030204 cardiovascular system & hematology, Brain Ischemia, Coronary artery disease, 0302 clinical medicine, Risk Factors, Prospective Studies, Registries, Child, Stroke, Netherlands, Aged, 80 and over, RISK, Middle Aged, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], Cardiovascular diseases, Neurology, Cerebrovascular Circulation, Child, Preschool, symbols, Cardiology, Female, Cardiology and Cardiovascular Medicine, Cohort study, Adult, medicine.medical_specialty, Adolescent, Heart Diseases, Clinical Neurology, Risk Assessment, CLASSIFICATION, 03 medical and health sciences, symbols.namesake, Young Adult, All institutes and research themes of the Radboud University Medical Center, Internal medicine, Thromboembolism, Journal Article, medicine, Humans, Poisson regression, cardiovascular diseases, Aged, business.industry, Infant, Newborn, Infant, medicine.disease, Posterior circulation brain infarction, Intracranial embolism and thrombosis, Relative risk, Etiology, Observational study, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

Background: A cardiac origin in ischemic stroke is more frequent than previously assumed, but it is not clear which patients benefit from cardiac work-up if obvious cardiac pathology is absent. We hypothesized that thromboembolic stroke with a cardiac source occurs more frequently in the posterior circulation compared with thromboembolic stroke of another etiology. Methods: We performed a multicenter observational study in 3,311 consecutive patients with ischemic stroke who were enrolled in an ongoing prospective stroke registry of 8 University hospitals between September 2009 and November 2014 in The Netherlands. In this initiative, the so-called Parelsnoer Institute-Cerebrovascular Accident Study Group, clinical data, imaging, and biomaterials of patients with stroke are prospectively and uniformly collected. We compared the proportions of posterior stroke location in patients with a cardiac stroke source with those with another stroke etiology and calculated risk ratios (RR) with corresponding 95% CI with Poisson regression analyses. To assess which patient or disease characteristics were most strongly associated with a cardiac etiology in patients with ischemic stroke, we performed a stepwise backward regression analysis. Results: For the primary aim, 1,428 patients were eligible for analyses. The proportion of patients with a posterior stroke location among patients with a cardiac origin of their stroke (28%) did not differ statistically significant to those with another origin (25%), age and sex adjusted RR 1.16; 95% CI 0.96–1.41. For the secondary aim, 1,955 patients were eligible for analyses. No recent history of smoking, no hyperlipidemia, coronary artery disease, a higher age, and a higher National Institutes of Health Stroke Scale (NIHSS) score were associated with a cardiac etiology of ischemic stroke. Conclusions: We could not confirm our hypothesis that thromboembolic stroke localized in the posterior circulation is associated with a cardioembolic source of ischemic stroke, and therefore posterior stroke localization on itself does not necessitate additional cardiac examination. The lack of determinants of atherosclerosis, for example, no recent history of smoking and no hyperlipidemia, coronary artery disease, a higher age, and a higher NIHSS score are stronger risk factors for a cardiac source of ischemic stroke.

Published
2020
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30. Admission Blood Pressure in Relation to Clinical Outcomes and Successful Reperfusion After Endovascular Stroke Treatment

Author

Berg, S.A. van den, Venema, S.M. Uniken, Mulder, M., Treurniet, K.M., Samuels, N., Lingsma, H.F., Goldhoorn, R.B., Jansen, I.G., Coutinho, J.M., Roozenbeek, B., Dippel, D.W., Roos, Y., Dijk, E.J. van, Boogaarts, H.D., Jenniskens, S.F.M., Meijer, A., Worp, H.B. van der, Nederkoorn, P.J., Berg, S.A. van den, Venema, S.M. Uniken, Mulder, M., Treurniet, K.M., Samuels, N., Lingsma, H.F., Goldhoorn, R.B., Jansen, I.G., Coutinho, J.M., Roozenbeek, B., Dippel, D.W., Roos, Y., Dijk, E.J. van, Boogaarts, H.D., Jenniskens, S.F.M., Meijer, A., Worp, H.B. van der, and Nederkoorn, P.J.

Abstract

Contains fulltext : 229554.pdf (Publisher’s version ) (Open Access), BACKGROUND AND PURPOSE: Optimal blood pressure (BP) targets before endovascular treatment (EVT) for acute ischemic stroke are unknown. We aimed to assess the relation between admission BP and clinical outcomes and successful reperfusion after EVT. METHODS: We used data from the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry, an observational, prospective, nationwide cohort study of patients with ischemic stroke treated with EVT in routine clinical practice in the Netherlands. Baseline systolic BP (SBP) and diastolic BP (DBP) were recorded on admission. The primary outcome was the score on the modified Rankin Scale at 90 days. Secondary outcomes included successful reperfusion (extended Thrombolysis in Cerebral Infarction score 2B-3), symptomatic intracranial hemorrhage, and 90-day mortality. Multivariable logistic and linear regression were used to assess the associations of SBP and DBP with outcomes. The relations between BPs and outcomes were tested for nonlinearity. Parameter estimates were calculated per 10 mm Hg increase or decrease in BP. RESULTS: We included 3180 patients treated with EVT between March 2014 and November 2017. The relations between admission SBP and DBP with 90-day modified Rankin Scale scores and mortality were J-shaped, with inflection points around 150 and 81 mm Hg, respectively. An increase in SBP above 150 mm Hg was associated with poor functional outcome (adjusted common odds ratio, 1.09 [95% CI, 1.04-1.15]) and mortality at 90 days (adjusted odds ratio, 1.09 [95% CI, 1.03-1.16]). Following linear relationships, higher SBP was associated with a lower probability of successful reperfusion (adjusted odds ratio, 0.97 [95% CI, 0.94-0.99]) and with the occurrence of symptomatic intracranial hemorrhage (adjusted odds ratio, 1.06 [95% CI, 0.99-1.13]). Results for DBP were largely similar. CONCLUSIONS: In patients with acute ischemic stroke treated with EVT, high

Published
2020

31. Dutch parelsnoer institute-cerebrovascular accident (CVA) study: A large multicenter clinical biobank with stan

Author

van Os, H.J.A. (H. J.A.), Ruigrok, Y.M. (Ynte), Mannien, J. (Judith), Dijk, E.J. (Ewoud) van, Koudstaal, P.J. (Peter), Luijckx, G.-J. (Gert-Jan), Nederkoorn, P.J. (Paul), Oostenbrugge, R.J. (Robert) van, Visser, M.C. (Marieke), Kappelle, L.J. (Jaap), Verspaget, H.W., Algra, A. (Ale), Wermer, M.J.H. (Marieke), van Os, H.J.A. (H. J.A.), Ruigrok, Y.M. (Ynte), Mannien, J. (Judith), Dijk, E.J. (Ewoud) van, Koudstaal, P.J. (Peter), Luijckx, G.-J. (Gert-Jan), Nederkoorn, P.J. (Paul), Oostenbrugge, R.J. (Robert) van, Visser, M.C. (Marieke), Kappelle, L.J. (Jaap), Verspaget, H.W., Algra, A. (Ale), and Wermer, M.J.H. (Marieke)

Abstract

The Dutch Parelsnoer Institute-Cerebrovascular accident (CVA) Study is part of the Parelsnoer Institute (PSI), initiated in 2007 by the Netherlands Federation of University Medical Centers (NFU). PSI is a cooperation of all eight Dutch University Medical Centers (UMCs) and aims at building large prospectively collected datasets with uniformly and standardized storage of biomaterials for complex diseases. Currently, PSI covers 18 disease-specific cohorts called 'Pearls', and this number is still growing. One of these cohorts is the Stroke or CVA Pearl. For each of the cohorts, PSI offers the UMCs an infrastructure and standard procedures for storing the specific biomaterials in their certified biobanks. Clinical data are stored in a central database after being pseudonymized to ensure patient privacy. For the Parelsnoer Institute-CVA Study, blood for genetic analysis, serum and plasma are collected according to nationally agreed standards. Currently (November 2017) the Stroke Pearl has stored blood samples with prospectively obtained clinical data of around 6000 patients in all UMCs combined. Blood samples and data are available for all researchers with a methodologically valid research proposal.

Published
2020
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32. Association between Intraplaque Hemorrhage and Vascular Remodeling in Carotid Arteries: The Plaque at RISK (PARISK) Study

Author

Dilba, K. (Kristine), Nouwens- van Dijk, A.C. (Anouk), Crombag, G.A.J.C. (Genevieve), Steen, A.F.W. (Ton) van der, Daemen, M.J.A.P. (Mat), Koudstaal, P.J. (Peter), Nederkoorn, P.J. (Paul), Hendrikse, J. (Jeroen), Kooi, M.E. (M. Eline), Lugt, A. (Aad) van der, Wentzel, J.J. (Jolanda), Dilba, K. (Kristine), Nouwens- van Dijk, A.C. (Anouk), Crombag, G.A.J.C. (Genevieve), Steen, A.F.W. (Ton) van der, Daemen, M.J.A.P. (Mat), Koudstaal, P.J. (Peter), Nederkoorn, P.J. (Paul), Hendrikse, J. (Jeroen), Kooi, M.E. (M. Eline), Lugt, A. (Aad) van der, and Wentzel, J.J. (Jolanda)

Abstract

Introduction: Vascular remodeling is a compensatory enlargement of the vessel wall in response to atherosclerotic plaque growth. We aimed to investigate the association between intraplaque hemorrhage (IPH), vascular remodeling, and luminal dimensions in recently symptomatic patients with mild to moderate carotid artery stenosis in which the differences in plaque size were taken into account. Materials and Methods: We assessed vessel dimensions on MRI of the symptomatic carotid artery in 164 patients from the Plaque At RISK study. This study

Published
2020
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33. Prevalence and risk factors of symptomatic carotid stenosis in patients with recent transient ischaemic attack or ischaemic stroke in the Netherlands

Author

den Brok, M.G.H.E. (Melina GHE), Kuhrij, L.S. (Laurien S), Roozenbeek, B. (Bob), Lugt, A. (Aad) van der, Hilkens, P.H.E. (Pieter HE), Dippel, D.W.J. (Diederik WJ), Nederkoorn, P.J. (Paul), den Brok, M.G.H.E. (Melina GHE), Kuhrij, L.S. (Laurien S), Roozenbeek, B. (Bob), Lugt, A. (Aad) van der, Hilkens, P.H.E. (Pieter HE), Dippel, D.W.J. (Diederik WJ), and Nederkoorn, P.J. (Paul)

Abstract

Introduction: Literature on prevalence of symptomatic internal carotid artery stenosis is scarce and heterogeneous. Prevalence may have decreased in recent years due to improved management of cardiovascular risk factors. We aim to estimate current prevalence and identify risk factors of ipsilateral internal carotid artery stenosis in patients with recent hemispheric transient ischaemic attack or ischa

Published
2020
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34. Distribution of Cardioembolic Stroke: A Cohort Study

Author

Pierik, R. (Ramon), Algra, A. (Ale), Dijk, E.J. (Ewoud) van, Erasmus, M.E. (Michiel E.), Van Gelder, I.C. (Isabella C.), Koudstaal, P.J. (Peter J.), Luijckx, G.-J. (Gert-Jan), Nederkoorn, P.J. (Paul), Oostenbrugge, R.J. (Robert) van, Ruigrok, Y.M. (Ynte), Scheeren, T.W.L. (Thomas W.L.), Uyttenboogaart, M. (Maarten), Visser, M.C. (Marieke C.), Wermer, M.J.H. (Marieke), Van Den Bergh, H. (Huub), Pierik, R. (Ramon), Algra, A. (Ale), Dijk, E.J. (Ewoud) van, Erasmus, M.E. (Michiel E.), Van Gelder, I.C. (Isabella C.), Koudstaal, P.J. (Peter J.), Luijckx, G.-J. (Gert-Jan), Nederkoorn, P.J. (Paul), Oostenbrugge, R.J. (Robert) van, Ruigrok, Y.M. (Ynte), Scheeren, T.W.L. (Thomas W.L.), Uyttenboogaart, M. (Maarten), Visser, M.C. (Marieke C.), Wermer, M.J.H. (Marieke), and Van Den Bergh, H. (Huub)

Abstract

Background: A cardiac origin in ischemic stroke is more frequent than previously assumed, but it is not clear which patients benefit from cardiac work-up if obvious cardiac pathology is absent. We hypothesized that thromboembolic stroke with a cardiac source occurs more frequently in the posterior circulation compared with thromboembolic stroke of another etiology. Methods: We performed a multicenter observational study in 3,311 consecutive patients with ischemic stroke who were enrolled in an ongoing prospective stroke registry of 8 University hospitals between September 2009 and November 2014 in The Netherlands. In this

Published
2020
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36. Intracranial Carotid Artery Calcification and Effect of Endovascular Stroke Treatment MR CLEAN Subgroup Analysis

Author

Compagne, K.C.J., Clephas, P.R.D., Majoie, C.B.L.M., Roos, Y.B.W.E.M., Berkhemer, O.A., Oostenbrugge, R.J. van, Zwam, W.H. van, Es, A.C.G.M. van, Dippel, D.W.J., Lugt, A. van der, Bos, D., Fransen, P.S.S., Beumer, D., Berg, L.A. van den, Schonewille, W.J., Vos, J.A., Nederkoorn, P.J., Wermer, M.J.H., Walderveen, M.A.A. van, Staals, J., Hofmeijer, E., Oostayen, J.A. van, Nijeholt, G.J.L.A., Boiten, J., Brouwer, P.A., Emmer, B.J., Bruijn, S.F. de, Dijk, L.C. van, Kappelle, L.J., R.H. lo, Dijk, E.J. van, Vries, J. de, Kort, P.L.M. de, Berg, J.S.P. van den, Rooij, W.J.J. van, Hasselt, B.A.A.M. van, Aerden, L.A.M., Dallinga, R.J., Visser, M.C., Bot, J.C.J., Vroomen, P.C., Eshghi, O., Schreuder, T.H.C.M.L., Heijboer, R.J.J., Keizer, K., Tielbeek, A.V., Hertog, H.M. den, Gerrits, D.G., Berg-Vos, R.M. van den, Karas, G.B., Marquering, H.A., Beenen, L.F., Sprengers, M.E.S., Jenniskens, S.F.M., Berg, R. van den, Yoo, A.J., Koudstaal, P.J., Flach, H.Z., Steyerberg, E.W., Lingsma, H.F., MR CLEAN Investigators, Radiology and nuclear medicine, VU University medical center, Neurology, Amsterdam Neuroscience - Neurovascular Disorders, ACS - Atherosclerosis & ischemic syndromes, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, RS: CARIM - R3.03 - Cerebral small vessel disease, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: CARIM - R3.11 - Imaging, Beeldvorming, MUMC+: MA AIOS Neurologie (9), and MUMC+: MA Med Staf Spec Neurologie (9)

Subjects
Tunica media, medicine.medical_specialty, IMPACT, medicine.medical_treatment, RECANALIZATION, Subgroup analysis, 030204 cardiovascular system & hematology, tomography, Revascularization, DISEASE, 03 medical and health sciences, 0302 clinical medicine, carotid arteries, Modified Rankin Scale, Internal medicine, medicine, ACUTE ISCHEMIC-STROKE, Stroke, Advanced and Specialized Nursing, business.industry, MECHANICAL THROMBECTOMY, Odds ratio, medicine.disease, Tunica intima, stroke, medicine.anatomical_structure, thrombectomy, tunica media, Cardiology, REVASCULARIZATION, TRIAL, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery, Calcification
Abstract

Background and Purpose— Previous studies suggest that intracranial carotid artery calcification (ICAC) volume might influence the clinical outcome of patients after endovascular treatment (EVT) for acute ischemic stroke. Importantly, ICAC can be subtyped into a medial or intimal pattern that may differentially influence the effect of EVT in patients with acute ischemic stroke. Methods— All 500 patients included in the MR CLEAN (Multicenter Randomized Clinical trial of Endovascular treatment for acute ischemic stroke in the Netherlands) were evaluated. Volume (mm 3 ) and location pattern (tunica intima or tunica media) of ICAC could be determined on baseline noncontrast computed tomography in 344 patients. Functional outcome at 90 days was assessed with the modified Rankin Scale. Next, we investigated the association of ICAC volume and pattern with functional outcome using adjusted ordinal logistic regression models. Effect modification by EVT was assessed with an interaction term between treatment allocation and ICAC aspect. Results— We found evidence for treatment effect modification by ICAC pattern ( P interaction=0.04). Patients with predominantly medial calcification had better functional outcome with EVT than without this treatment (adjusted common odds ratio, 2.32; 95% CI, 1.23–4.39), but we observed no effect of EVT in patients with predominantly intimal calcifications (adjusted common odds ratio, 0.82; 95% CI, 0.40–1.68). We did not find an association of ICAC volume with functional outcome (adjusted common odds ratio per unit increase ICAC volume 1.01 (95% CI, 0.89–1.13). Moreover, we found no evidence for effect modification by ICAC volume ( P interaction=0.61). Conclusions— The benefit of EVT in acute ischemic stroke patients with a medial calcification pattern is larger than the benefit in patients with an intimal calcification pattern. Clinical Trial Registration— URL: http://www.trialregister.nl . Unique identifier: NTR1804. URL: http://www.isrctn.com . Unique identifier: ISRCTN10888758.

Published
2018
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39. Serum biomarkers in patients suspected of transient ischaemic attack in primary care: a diagnostic accuracy study

Author

Dolmans, L.Servaas, Rutten, F., Bartelink, M.E.L., Dijk, E.J. van, Nederkoorn, P.J., Kappelle, J., Hoes, A.W., Dolmans, L.Servaas, Rutten, F., Bartelink, M.E.L., Dijk, E.J. van, Nederkoorn, P.J., Kappelle, J., and Hoes, A.W.

Abstract

Contains fulltext : 215523.pdf (publisher's version ) (Open Access), OBJECTIVE: The diagnosis of transient ischaemic attack (TIA) based on symptoms and signs can be challenging and would greatly benefit from a rapid serum biomarker of brain ischaemia. We aimed to quantify the added diagnostic value of serum biomarkers in patients suspected of TIA beyond symptoms and signs. METHODS: This is a cross-sectional diagnostic accuracy study with a 6-month follow-up period. Participants were patients suspected of TIA by the general practitioner (GP) in whom a blood sample could be collected within 72 hours from symptom onset. A research nurse visited the participant for the blood sample and a standardised interview. The GP referred participants to the regional TIA service. An expert panel of three neurologists classified cases as TIA, minor stroke or any other diagnosis, based on all available diagnostic information including the GP's and neurologist's correspondence and the follow-up period. We used multivariable logistic regression analyses to quantify the diagnostic accuracy of clinical predictors and the improvement of accuracy by seven biomarkers (NR2, NR2 antibodies, PARK7, NDKA, UFD1, B-FABP and H-FABP). RESULTS: 206 patients suspected of TIA participated, of whom 126 (61.2%) were diagnosed with TIA (n=104) or minor stroke (n=22) by the expert panel. The median time from symptom onset to the blood sample collection was 48.0 (IQR 28.3-56.8) hours. None of the seven biomarkers had discriminative value in the diagnosis of TIA, with C-statistics ranging from 0.45 to 0.58. The final multivariable model (C-statistic 0.83 (0.78-0.89)) consisted of eight clinical predictors of TIA/minor stroke: increasing age, a history of coronary artery disease, sudden onset of symptoms, occurrence of symptoms in full intensity, dysarthria, no history of migraine, absence of loss of consciousness and absence of headache. Addition of the individual biomarkers did not further increase the C-statistics. CONCLUSIONS: Currently available blood biomarkers have no

Published
2019

40. Cerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies

Author

Wilson, D. (Duncan), Ambler, G. (Gareth), Lee, K.-J. (Keon-Joo), Lim, J.-S. (Jae-Sung), Shiozawa, M. (Masayuki), Koga, M. (Masatoshi), Li, L. (Linxin), Lovelock, C. (Caroline), Chabriat, H. (Hugues), Hennerici, M.G. (Michael), Wong, Y.K. (Yuen Kwun), Mak, H.K.F. (Henry Ka Fung), Prats-Sánchez, L. (Luis), Martínez-Domeño, A. (Alejandro), Inamura, S. (Shigeru), Yoshifuji, K. (Kazuhisa), Arsava, E.M. (Ethem Murat), Horstmann, S. (Solveig), Purrucker, J. (Jan), Lam, B.Y.K. (Bonnie Yin Ka), Wong, A. (Adrian), Kim, Y.D. (Young Dae), Song, T.-J. (Tae-Jin), Schrooten, M. (Maarten), Lemmens, R. (Robin), Eppinger, S. (Sebastian), Gattringer, T. (Thomas), Uysal, E. (Ender), Tanriverdi, Z. (Zeynep), Bornstein, S.R. (Stefan), Assayag, E.B. (Einor Ben), Hallevi, H. (Hen), Tanaka, J. (Jun), Hara, H. (Hideo), Coutts, S.B. (Shelagh B), Hert, L. (Lisa), Polymeris, A. (Alexandros), Seiffge, D.J. (David J), Lyrer, P.A. (Philippe), Algra, A. (Ale), Kappelle, L.J. (Jaap), Al-Shahi Salman, R. (Rustam), Jäger, H.R. (Rolf), Lip, G.Y.H. (Gregory Y H), Mattle, H., Panos, L.D. (Leonidas D), Mas, J.L. (J.), Legrand, L. (Laurence), Karayiannis, C. (Christopher), Phan, T.G. (Thanh), Gunkel, S. (Sarah), Christ, N. (Nicolas), Abrigo, J. (Jill), Leung, T. (Thomas), Chu, W. (Winnie), Chappell, F. (Francesca), Makin, S. (Stephen), Hayden, D. (Derek), Williams, D.J. (David J), Kooi, M.E. (M. Eline), van Dam-Nolen, D.H.K. (Dianne H K), Barbato, C. (Carmen), Browning, S. (Simone), Wiegertjes, K. (Kim), Tuladhar, A.M. (Anil M.), Maaijwee, N. (Noortje), Guevarra, C. (Christine), Yatawara, C. (Chathuri), Mendyk, A.-M. (Anne-Marie), Delmaire, C. (Christine), Köhler, S. (Sebastian), Oostenbrugge, R.J. (Robert) van, Zhou, Y. (Ying), Xu, C. (Chao), Hilal, S. (Saima), Gyanwali, B. (Bibek), Chen, C. (Christopher), Lou, M. (Min), Staals, J. (Julie), Bordet, R. (Régis), Kandiah, N. (Nagaendran), Leeuw, H.F. (Frank) de, Simister, R. (Robert), Lugt, A. (Aad) van der, Kelly, P.J. (Peter J), Wardlaw, J.M. (J.), Soo, Y. (Yannie), Fluri, F. (Felix), Srikanth, V. (Velandai), Calvet, D. (David), Jung, S. (Simon), Kwa, V.I.H., Engelter, S.T. (Stefan), Peters, N. (Nils), Smith, E.E. (Eric), Yakushiji, Y. (Yusuke), Orken, D.N. (Dilek Necioglu), Fazekas, F. (Franz), Thijs, V. (Vincent), Heo, J.H. (Ji Hoe), Mok, V. (Vincent), Veltkamp, R. (Roland), Ay, H. (Hakan), Imaizumi, T. (Toshio), Gomez-Anson, B. (Beatriz), Lau, K.K. (Kui Kai), Jouvent, E. (Eric), Rothwell, P.M. (Peter), Toyoda, K. (Kazunori), Bae, H.-J. (Hee-Joon), Marti-Fabregas, J. (Joan), Werring, D.J. (David), Harkness, K. (Kirsty), Shaw, L. (Louise), Sword, J. (Jane), Mohd Nor, A. (Azlisham), Sharma, P. (Pankaj), Kelly, D. (Deborah), Harrington, F. (Frances), Randall, M. (Marc), Smith, M. (Matthew), Mahawish, K. (Karim), Elmarim, A. (Abduelbaset), Esisi, B. (Bernard), Cullen, C. (Claire), Nallasivam, A. (Arumug), Price, C. (Christopher), Barry, A. (Adrian), Roffe, C. (Christine), Coyle, J. (John), Hassan, A. (Ahamad), Birns, J. (Jonathan), Cohen, D. (David), Sekaran, L. (Lakshmanan), Parry-Jones, A. (Adrian), Parry, A. (Anthea), Hargroves, D. (David), Proschel, H. (Harald), Datta, P. (Prabel), Darawil, K. (Khaled), Manoj, A. (Aravindakshan), Burn, M. (Mathew), Patterson, C. (Chris), Giallombardo, E. (Elio), Smyth, N. (Nigel), Mansoor, S. (Syed), Anwar, I. (Ijaz), Marsh, R. (Rachel), Ispoglou, S. (Sissi), Chadha, D. (Dinesh), Prabhakaran, M. (Mathuri), Meenakishundaram, S. (Sanjeevikumar), O'Connell, J. (Janice), Scott, J. (Jon), Krishnamurthy, V. (Vinodh), Aghoram, P. (Prasanna), McCormick, M. (Michael), Sprigg, N. (Nikola), O'Mahony, P. (Paul), Cooper, M. (Martin), Choy, L. (Lillian), Wilkinson, P. (Peter), Leach, S. (Simon), Caine, S. (Sarah), Burger, I. (Ilse), Gunathilagan, G. (Gunaratam), Guyler, P. (Paul), Emsley, H. (Hedley), Davis, M. (Michelle), Manawadu, D. (Dulka), Pasco, K. (Kath), Mamun, M. (Maam), Luder, R. (Robert), Sajid, M. (Mahmud), Okwera, J. (James), Warburton, E. (Elizabeth), Saastamoinen, K. (Kari), England, T. (Timothy), Putterill, J. (Janet), Flossman, E. (Enrico), Power, M. (Michael), Dani, K. (Krishna), Mangion, D. (David), Suman, A. (Appu), Corrigan, J. (John), Lawrence, E. (Enas), Vahidassr, D. (Djamil), Shakeshaft, C. (Clare), Brown, M. (Martin), Charidimou, A. (Andreas), Cohen, H. (Hannah), Banerjee, G. (Gargi), Houlden, H. (Henry), White, M. (Mark), Yousry, T. (Tarek), Flossmann, E. (Enrico), Muir, K. (Keith), El-Koussy, M. (Marwan), Gratz, P. (Pascal), Molad, J. (Jeremy), Korczyn, A.D. (A.), Kliper, E. (Efrat), Maeder, P. (Philippe), Gass, A. (Achim), Pachai, C. (Chahin), Bracoub, L. (Luc), Douste-Blazy, M.-Y. (Marie-Yvonne), Fratacci, M.D. (Marie Dominique), Vicaut, E. (Eric), Sato, S. (Shoichiro), Miwa, K. (Kaori), Fujita, K. (Kyohei), Ide, T. (Toshihiro), Ma, H. (Henry), Ly, J. (John), Singhal, S. (Shahoo), Chandra, R. (Ronil), Slater, L.-A. (Lee-Anne), Soufan, C. (Cathy), Moran, C. (Christopher), Traenka, C. (Christopher), Thilemann, S. (Sebastian), Fladt, J. (Joachim), Gensicke, H. (Henrik), Bonati, L. (Leo), Kim, B.J. (Beom Joon), Han, M.-K. (Moon-Ku), Kang, J. (Jihoon), Ko, E. (Eunbin), Yang, M.H. (Mi Hwa), Jang, M.S. (Myung Suk), Murphy, S. (Sean), Carty, F. (Fiona), Akijian, L. (Layan), Thornton, J. (John), Schembri, M. (Mark), Douven, E. (Elles), Delgado-Mederos;, R. (Raquel), Marín, R. (Rebeca), Camps-Renom, P. (Pol), Guisado-Alonso, D. (Daniel), Nuñez, F. (Fidel), Medrano-Martorell, S. (Santiago), Merino, E. (Elisa), Iida, K. (Kotaro), Ikeda, S. (Syuhei), Nishihara, M. (Masashi), Irie, H. (Hiroyuki), Demirelli, D.S. (Derya Selcuk), Medanta, J.M. (Jayesh Modi), Zerna, C. (Charlotte), Hernández, M.V. (Maria Valdés), Armitage, P. (Paul), Heye, A. (Anna), Muñoz Maniega, S. (Susana), Sakka, E. (Eleni), Thrippleton, M. (Michael), Dennis, M.S. (M.), Beigneux, Y. (Ysoline), Silva, M. (Mauro), Venketasubramanian, N. (Narayanaswamy), Ho, S.L. (Shu Leung), Cheung, R.T.F. (Raymond Tak Fai), Chan, K.H. (Koon Ho), Teo, K.C. (Kay Cheong), Hui, E. (Edward), Kwan, J.S.K. (Joseph Shiu Kwong), Chang, R. (Richard), Tse, M.Y. (Man Yu), Hoi, C.P. (Chu Peng), Chan, C.Y. (Chung Yan), Chan, O.L. (Oi Ling), Cheung, R.H.K. (Ryan Hoi Kit), Wong, E.K.M. (Edmund Ka Ming), Leung, K.T. (Kam Tat), Tsang, S.F. (Suk Fung), Ip, H.L. (Hing Lung), Ma, S.H. (Sze Ho), Ma, K. (Karen), Fong, W.C. (Wing Chi), Li, S.H. (Siu Hung), Li, R. (Richard), Ng, P.W. (Ping Wing), Wong, K.K. (Kwok Kui), Liu, W. (Wenyan), Wong, L. (Lawrence), Ramos, L. (Lino), Schryver, E.L.L.M. (Els) de, Jöbsis, J. (Joost), van der Sande, J. (Jaap), Brouwers, P.J. (Paul), Roos, Y.B.W.E.M. (Yvo), Stam, J. (Jan), Bakker, S.L.M. (Stef), Verbiest, H. (Henk), Schoonewille, W. (Wouter), Linn, C. (Cisca), Hertzberger, L., Gemert, M. (Maarten) van, Berntsen, P. (Paul), Hendrikse, J. (Jeroen), Nederkoorn, P.J. (Paul), Mess, W.H. (Werner), Koudstaal, P.J. (Peter), Leff, A. (Alexander), Ward, N. (Nicholas), Nachev, P. (Parashkev), Perry, R. (Richard), Ozkan, H. (Hatice), Mitchell, J. (John), Wilson, D. (Duncan), Ambler, G. (Gareth), Lee, K.-J. (Keon-Joo), Lim, J.-S. (Jae-Sung), Shiozawa, M. (Masayuki), Koga, M. (Masatoshi), Li, L. (Linxin), Lovelock, C. (Caroline), Chabriat, H. (Hugues), Hennerici, M.G. (Michael), Wong, Y.K. (Yuen Kwun), Mak, H.K.F. (Henry Ka Fung), Prats-Sánchez, L. (Luis), Martínez-Domeño, A. (Alejandro), Inamura, S. (Shigeru), Yoshifuji, K. (Kazuhisa), Arsava, E.M. (Ethem Murat), Horstmann, S. (Solveig), Purrucker, J. (Jan), Lam, B.Y.K. (Bonnie Yin Ka), Wong, A. (Adrian), Kim, Y.D. (Young Dae), Song, T.-J. (Tae-Jin), Schrooten, M. (Maarten), Lemmens, R. (Robin), Eppinger, S. (Sebastian), Gattringer, T. (Thomas), Uysal, E. (Ender), Tanriverdi, Z. (Zeynep), Bornstein, S.R. (Stefan), Assayag, E.B. (Einor Ben), Hallevi, H. (Hen), Tanaka, J. (Jun), Hara, H. (Hideo), Coutts, S.B. (Shelagh B), Hert, L. (Lisa), Polymeris, A. (Alexandros), Seiffge, D.J. (David J), Lyrer, P.A. (Philippe), Algra, A. (Ale), Kappelle, L.J. (Jaap), Al-Shahi Salman, R. (Rustam), Jäger, H.R. (Rolf), Lip, G.Y.H. (Gregory Y H), Mattle, H., Panos, L.D. (Leonidas D), Mas, J.L. (J.), Legrand, L. (Laurence), Karayiannis, C. (Christopher), Phan, T.G. (Thanh), Gunkel, S. (Sarah), Christ, N. (Nicolas), Abrigo, J. (Jill), Leung, T. (Thomas), Chu, W. (Winnie), Chappell, F. (Francesca), Makin, S. (Stephen), Hayden, D. (Derek), Williams, D.J. (David J), Kooi, M.E. (M. Eline), van Dam-Nolen, D.H.K. (Dianne H K), Barbato, C. (Carmen), Browning, S. (Simone), Wiegertjes, K. (Kim), Tuladhar, A.M. (Anil M.), Maaijwee, N. (Noortje), Guevarra, C. (Christine), Yatawara, C. (Chathuri), Mendyk, A.-M. (Anne-Marie), Delmaire, C. (Christine), Köhler, S. (Sebastian), Oostenbrugge, R.J. (Robert) van, Zhou, Y. (Ying), Xu, C. (Chao), Hilal, S. (Saima), Gyanwali, B. (Bibek), Chen, C. (Christopher), Lou, M. (Min), Staals, J. (Julie), Bordet, R. (Régis), Kandiah, N. (Nagaendran), Leeuw, H.F. (Frank) de, Simister, R. (Robert), Lugt, A. (Aad) van der, Kelly, P.J. (Peter J), Wardlaw, J.M. (J.), Soo, Y. (Yannie), Fluri, F. (Felix), Srikanth, V. (Velandai), Calvet, D. (David), Jung, S. (Simon), Kwa, V.I.H., Engelter, S.T. (Stefan), Peters, N. (Nils), Smith, E.E. (Eric), Yakushiji, Y. (Yusuke), Orken, D.N. (Dilek Necioglu), Fazekas, F. (Franz), Thijs, V. (Vincent), Heo, J.H. (Ji Hoe), Mok, V. (Vincent), Veltkamp, R. (Roland), Ay, H. (Hakan), Imaizumi, T. (Toshio), Gomez-Anson, B. (Beatriz), Lau, K.K. (Kui Kai), Jouvent, E. (Eric), Rothwell, P.M. (Peter), Toyoda, K. (Kazunori), Bae, H.-J. (Hee-Joon), Marti-Fabregas, J. (Joan), Werring, D.J. (David), Harkness, K. (Kirsty), Shaw, L. (Louise), Sword, J. (Jane), Mohd Nor, A. (Azlisham), Sharma, P. (Pankaj), Kelly, D. (Deborah), Harrington, F. (Frances), Randall, M. (Marc), Smith, M. (Matthew), Mahawish, K. (Karim), Elmarim, A. (Abduelbaset), Esisi, B. (Bernard), Cullen, C. (Claire), Nallasivam, A. (Arumug), Price, C. (Christopher), Barry, A. (Adrian), Roffe, C. (Christine), Coyle, J. (John), Hassan, A. (Ahamad), Birns, J. (Jonathan), Cohen, D. (David), Sekaran, L. (Lakshmanan), Parry-Jones, A. (Adrian), Parry, A. (Anthea), Hargroves, D. (David), Proschel, H. (Harald), Datta, P. (Prabel), Darawil, K. (Khaled), Manoj, A. (Aravindakshan), Burn, M. (Mathew), Patterson, C. (Chris), Giallombardo, E. (Elio), Smyth, N. (Nigel), Mansoor, S. (Syed), Anwar, I. (Ijaz), Marsh, R. (Rachel), Ispoglou, S. (Sissi), Chadha, D. (Dinesh), Prabhakaran, M. (Mathuri), Meenakishundaram, S. (Sanjeevikumar), O'Connell, J. (Janice), Scott, J. (Jon), Krishnamurthy, V. (Vinodh), Aghoram, P. (Prasanna), McCormick, M. (Michael), Sprigg, N. (Nikola), O'Mahony, P. (Paul), Cooper, M. (Martin), Choy, L. (Lillian), Wilkinson, P. (Peter), Leach, S. (Simon), Caine, S. (Sarah), Burger, I. (Ilse), Gunathilagan, G. (Gunaratam), Guyler, P. (Paul), Emsley, H. (Hedley), Davis, M. (Michelle), Manawadu, D. (Dulka), Pasco, K. (Kath), Mamun, M. (Maam), Luder, R. (Robert), Sajid, M. (Mahmud), Okwera, J. (James), Warburton, E. (Elizabeth), Saastamoinen, K. (Kari), England, T. (Timothy), Putterill, J. (Janet), Flossman, E. (Enrico), Power, M. (Michael), Dani, K. (Krishna), Mangion, D. (David), Suman, A. (Appu), Corrigan, J. (John), Lawrence, E. (Enas), Vahidassr, D. (Djamil), Shakeshaft, C. (Clare), Brown, M. (Martin), Charidimou, A. (Andreas), Cohen, H. (Hannah), Banerjee, G. (Gargi), Houlden, H. (Henry), White, M. (Mark), Yousry, T. (Tarek), Flossmann, E. (Enrico), Muir, K. (Keith), El-Koussy, M. (Marwan), Gratz, P. (Pascal), Molad, J. (Jeremy), Korczyn, A.D. (A.), Kliper, E. (Efrat), Maeder, P. (Philippe), Gass, A. (Achim), Pachai, C. (Chahin), Bracoub, L. (Luc), Douste-Blazy, M.-Y. (Marie-Yvonne), Fratacci, M.D. (Marie Dominique), Vicaut, E. (Eric), Sato, S. (Shoichiro), Miwa, K. (Kaori), Fujita, K. (Kyohei), Ide, T. (Toshihiro), Ma, H. (Henry), Ly, J. (John), Singhal, S. (Shahoo), Chandra, R. (Ronil), Slater, L.-A. (Lee-Anne), Soufan, C. (Cathy), Moran, C. (Christopher), Traenka, C. (Christopher), Thilemann, S. (Sebastian), Fladt, J. (Joachim), Gensicke, H. (Henrik), Bonati, L. (Leo), Kim, B.J. (Beom Joon), Han, M.-K. (Moon-Ku), Kang, J. (Jihoon), Ko, E. (Eunbin), Yang, M.H. (Mi Hwa), Jang, M.S. (Myung Suk), Murphy, S. (Sean), Carty, F. (Fiona), Akijian, L. (Layan), Thornton, J. (John), Schembri, M. (Mark), Douven, E. (Elles), Delgado-Mederos;, R. (Raquel), Marín, R. (Rebeca), Camps-Renom, P. (Pol), Guisado-Alonso, D. (Daniel), Nuñez, F. (Fidel), Medrano-Martorell, S. (Santiago), Merino, E. (Elisa), Iida, K. (Kotaro), Ikeda, S. (Syuhei), Nishihara, M. (Masashi), Irie, H. (Hiroyuki), Demirelli, D.S. (Derya Selcuk), Medanta, J.M. (Jayesh Modi), Zerna, C. (Charlotte), Hernández, M.V. (Maria Valdés), Armitage, P. (Paul), Heye, A. (Anna), Muñoz Maniega, S. (Susana), Sakka, E. (Eleni), Thrippleton, M. (Michael), Dennis, M.S. (M.), Beigneux, Y. (Ysoline), Silva, M. (Mauro), Venketasubramanian, N. (Narayanaswamy), Ho, S.L. (Shu Leung), Cheung, R.T.F. (Raymond Tak Fai), Chan, K.H. (Koon Ho), Teo, K.C. (Kay Cheong), Hui, E. (Edward), Kwan, J.S.K. (Joseph Shiu Kwong), Chang, R. (Richard), Tse, M.Y. (Man Yu), Hoi, C.P. (Chu Peng), Chan, C.Y. (Chung Yan), Chan, O.L. (Oi Ling), Cheung, R.H.K. (Ryan Hoi Kit), Wong, E.K.M. (Edmund Ka Ming), Leung, K.T. (Kam Tat), Tsang, S.F. (Suk Fung), Ip, H.L. (Hing Lung), Ma, S.H. (Sze Ho), Ma, K. (Karen), Fong, W.C. (Wing Chi), Li, S.H. (Siu Hung), Li, R. (Richard), Ng, P.W. (Ping Wing), Wong, K.K. (Kwok Kui), Liu, W. (Wenyan), Wong, L. (Lawrence), Ramos, L. (Lino), Schryver, E.L.L.M. (Els) de, Jöbsis, J. (Joost), van der Sande, J. (Jaap), Brouwers, P.J. (Paul), Roos, Y.B.W.E.M. (Yvo), Stam, J. (Jan), Bakker, S.L.M. (Stef), Verbiest, H. (Henk), Schoonewille, W. (Wouter), Linn, C. (Cisca), Hertzberger, L., Gemert, M. (Maarten) van, Berntsen, P. (Paul), Hendrikse, J. (Jeroen), Nederkoorn, P.J. (Paul), Mess, W.H. (Werner), Koudstaal, P.J. (Peter), Leff, A. (Alexander), Ward, N. (Nicholas), Nachev, P. (Parashkev), Perry, R. (Richard), Ozkan, H. (Hatice), and Mitchell, J. (John)

Abstract

Background: Cerebral microbleeds are a neuroimaging biomarker of stroke risk. A crucial clinical question is whether cerebral microbleeds indicate patients with recent ischaemic stroke or transient ischaemic attack in whom the rate of future intracranial haemorrhage is likely to exceed that of recurrent ischaemic stroke when treated with antithrombotic drugs. We therefore aimed to establish whether a large burden of cerebral microbleeds or particular anatomical patterns of cerebral microbleeds can identify ischaemic stroke or transient ischaemic attack patients at higher absolute risk of intracranial haemorrhage than ischaemic stroke. Methods: We did a pooled analysis of individual patient data from cohort studies in adults with recent ischaemic stroke or transient ischaemic attack. Cohorts were eligible for inclusion if they prospectively recruited adult participants with ischaemic stroke or

Published
2019
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41. Multicentre Randomised trial of Acute Stroke treatment in the Ambulance with a nitroglycerin Patch (MR ASAP): study protocol for a randomised controlled trial

Author

van den Berg, S.A. (Sophie A.), Dippel, D.W.J. (Diederik), Hofmeijer, J., Fransen, P.S.S. (Puck), Caminada, K. (Klaartje), Siegers, A. (Arjen), Kruyt, N.D. (Nyika), Kerkhoff, H. (Henk), Leeuw, H.F. (Frank) de, Nederkoorn, P.J. (Paul), Worp, H.B. (Bart) van der, van den Berg, S.A. (Sophie A.), Dippel, D.W.J. (Diederik), Hofmeijer, J., Fransen, P.S.S. (Puck), Caminada, K. (Klaartje), Siegers, A. (Arjen), Kruyt, N.D. (Nyika), Kerkhoff, H. (Henk), Leeuw, H.F. (Frank) de, Nederkoorn, P.J. (Paul), and Worp, H.B. (Bart) van der

Abstract

BACKGROUND: Some studies have suggested that transdermal administration of glyceryl trinitrate (GTN; nitroglycerin) in the first few hours after symptom onset increases the chance of a favourable outcome after ischaemic stroke or intracerebral haemorrhage, possibly through an increase in intracranial collateral blood flow and a reduction in blood pressure. The Multicentre Randomised trial of Acute Stroke treatment in the Ambulance with a nitroglycerin Patch (MR ASAP) aims to assess the effect of transdermal GTN, started within 3 h after stroke onset in the prehospital setting, on functional outcome at 90 days in patients with acute ischaemic stroke or intracerebral haemorrhage. METHODS: MR ASAP is a phase III, multicentre, randomised, open-label clinical trial with a blinded outcome assessment. A total of 1400 adult patients with suspected stroke and a systolic blood pressure ≥ 140 mmHg will be randomised to transdermal GTN (5 mg/day), administered as a transdermal patch by paramedics in the prehospital setting within 3 h of stroke onset and continued for 24 h or to standard care. The primary outcome is the score on the modified Rankin Scale (mRS) at 90 days, analysed with ordinal logistic regression. Secondary outcomes include blood pressure and collateral circulation at hospital admission, neurological deficit measured with the National Institutes of Health Stroke Scale at 24 h, and mortality and poor outcome (mRS score 3 to 6) at 90 days. This trial will be conducted in the Netherlands and will use a deferred consent procedure. The trial is part of the Collaboration for New Treatments of Acute Stro

Published
2019
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42. A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke

Author

Berkhemer, O.A., Fransen, P.S.S., Beumer, D., Berg, L.A. van den, Lingsma, H.F., Yoo, A.J., Schonewille, W.J., Vos, J.A., Nederkoorn, P.J., Wermer, M.J.H., Walderveen, M.A.A. van, Staals, J., Hofmeijer, J., Oostayen, J.A. van, Nijeholt, G.J.L.A., Boiten, J., Brouwer, P.A., Emmer, B.J., Bruijn, S.F. de, Dijk, L.C. van, Kappelle, L.J., R.H. lo, Dijk, E.J. van, Vries, J. de, Kort, P.L.M. de, Rooij, W.J.J. van, Berg, J.S.P. van den, Hasselt, B.A.A.M. van, Aerden, L.A.M., Dallinga, R.J., Visser, M.C., Bot, J.C.J., Vroomen, P.C., Eshghi, O., Schreuder, T.H.C.M.L., Heijboer, R.J.J., Keizer, K., Tielbeek, A.V., Hertog, H.M. den, Gerrits, D.G., Berg-Vos, R.M. van den, Karas, G.B., Steyerberg, E.W., Flach, H.Z., Marquering, H.A., Sprengers, M.E.S., Jenniskens, S.F.M., Beenen, L.F.M., Berg, R. van den, Koudstaal, P.J., Zwam, W.H. van, Roos, Y.B.W.E.M., Lugt, A. van der, Oostenbrugge, R.J. van, Majoie, C.B.L.M., Dippel, D.W.J., MR CLEAN Investigators, Clinical Neurophysiology, Faculty of Science and Technology, ACS - Amsterdam Cardiovascular Sciences, ANS - Amsterdam Neuroscience, Radiology and Nuclear Medicine, Graduate School, Neurology, Biomedical Engineering and Physics, Other Research, Other departments, Radiology and nuclear medicine, NCA - neurodegeneration, Public Health, Radiology & Nuclear Medicine, RS: CARIM - R3 - Vascular biology, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, MUMC+: MA AIOS Neurologie (9), Interne Geneeskunde, Klinische Neurowetenschappen, MUMC+: MA Med Staf Spec Neurologie (9), MUMC+: MA Arts Assistenten Obstetrie Gynaecologie (9), Huisartsgeneeskunde, NUTRIM, and MUMC+: DA BV Medisch Specialisten Radiologie (9)

Subjects
medicine.medical_specialty, Solitaire Cryptographic Algorithm, Randomization, RECANALIZATION, THERAPY, law.invention, Randomized controlled trial, Modified Rankin Scale, law, SCORE, medicine, OCCLUSIONS, IR-98132, Intracerebral hemorrhage, business.industry, Other Research Radboud Institute for Health Sciences [Radboudumc 0], General Medicine, Odds ratio, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], medicine.disease, Confidence interval, Surgery, Clinical trial, Anesthesia, ENDOVASCULAR TREATMENT, METIS-313119, CEREBRAL INFARCT, business
Abstract

Contains fulltext : 153000.pdf (Publisher’s version ) (Open Access) BACKGROUND: In patients with acute ischemic stroke caused by a proximal intracranial arterial occlusion, intraarterial treatment is highly effective for emergency revascularization. However, proof of a beneficial effect on functional outcome is lacking. METHODS: We randomly assigned eligible patients to either intraarterial treatment plus usual care or usual care alone. Eligible patients had a proximal arterial occlusion in the anterior cerebral circulation that was confirmed on vessel imaging and that could be treated intraarterially within 6 hours after symptom onset. The primary outcome was the modified Rankin scale score at 90 days; this categorical scale measures functional outcome, with scores ranging from 0 (no symptoms) to 6 (death). The treatment effect was estimated with ordinal logistic regression as a common odds ratio, adjusted for prespecified prognostic factors. The adjusted common odds ratio measured the likelihood that intraarterial treatment would lead to lower modified Rankin scores, as compared with usual care alone (shift analysis). RESULTS: We enrolled 500 patients at 16 medical centers in The Netherlands (233 assigned to intraarterial treatment and 267 to usual care alone). The mean age was 65 years (range, 23 to 96), and 445 patients (89.0%) were treated with intravenous alteplase before randomization. Retrievable stents were used in 190 of the 233 patients (81.5%) assigned to intraarterial treatment. The adjusted common odds ratio was 1.67 (95% confidence interval [CI], 1.21 to 2.30). There was an absolute difference of 13.5 percentage points (95% CI, 5.9 to 21.2) in the rate of functional independence (modified Rankin score, 0 to 2) in favor of the intervention (32.6% vs. 19.1%). There were no significant differences in mortality or the occurrence of symptomatic intracerebral hemorrhage. CONCLUSIONS: In patients with acute ischemic stroke caused by a proximal intracranial occlusion of the anterior circulation, intraarterial treatment administered within 6 hours after stroke onset was effective and safe. (Funded by the Dutch Heart Foundation and others; MR CLEAN Netherlands Trial Registry number, NTR1804, and Current Controlled Trials number, ISRCTN10888758.).

Published
2015
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43. No Association between Thrombin Generation and Intra-Plaque Haemorrhage in Symptomatic Carotid Atherosclerotic Plaques: The Plaque at RISK (PARISK) Study

Author

Crombag, G., Spronk, H.M., Nelemans, P., Schreuder, F.H.B.M., Truijman, M.T., Dijk, A.C. van, Rotte, A.A. de, Liem, M.I., Daemen, M., Steen, A.F. van der, Mess, W.H., Nederkoorn, P.J., Hendrikse, J., Lugt, A. van der, Wildberger, J.E., Cate, H. ten, Oostenbrugge, R.J. van, Kooi, M.E., Crombag, G., Spronk, H.M., Nelemans, P., Schreuder, F.H.B.M., Truijman, M.T., Dijk, A.C. van, Rotte, A.A. de, Liem, M.I., Daemen, M., Steen, A.F. van der, Mess, W.H., Nederkoorn, P.J., Hendrikse, J., Lugt, A. van der, Wildberger, J.E., Cate, H. ten, Oostenbrugge, R.J. van, and Kooi, M.E.

Abstract

Item does not contain fulltext, BACKGROUND: Carotid atherosclerosis is an important cause of stroke. Intra-plaque haemorrhage (IPH) on magnetic resonance imaging (MRI) increases stroke risk. Development of IPH is only partly understood. Thrombin is an essential enzyme in haemostasis. Experimental animal studies have shown conflicting results on the relation between thrombin and plaque vulnerability. We hypothesize that decreased thrombin generation (TG) is associated with IPH and plaque vulnerability. OBJECTIVE: This article investigates whether TG is associated with IPH and other features of plaque vulnerability in stroke patients. METHODS: Recently symptomatic stroke patients underwent carotid MRI and blood sampling. MRI plaque features include plaque burden, presence of IPH, amount of lipid-rich necrotic core (LRNC), calcified tissue and fibrous tissue (% of total wall volume). TG was assessed in platelet-poor plasma and expressed as: peak height (PH) and endogenous thrombin potential (ETP). MR images could be analysed in 224 patients. Blood samples were available in 161 of 224 patients. Binary multivariate logistic and linear regression were used to investigate the association between TG and MRI plaque features. RESULTS: IPH and LRNC were present in 65 (40%) and 102 (63%) of plaques. There were no significant associations between TG and IPH; PH odds ratio (OR) = 1, 95% confidence interval (CI): 0.76 to 1.45 and ETP OR = 1, 95% CI: 0.73 to 1.37. After correction for age, sex and hypercholesterolaemia, the association was weak but non-significant; PH: OR = 0.76, 95% CI: 0.52 to 1.10 and ETP: OR = 0.73, 95% CI: 0.53 to 1.37. CONCLUSION: Features of carotid plaque on MRI show no significant association with TG in stroke patients. Systemic TG does not seem to be an important factor in IPH development.

Published
2018

44. Blood pressure-lowering treatment for preventing recurrent stroke, major vascular events, and dementia in patients with a history of stroke or transient ischaemic attack

Author

Zonneveld, T.P., Richard, E., Vergouwen, M.D., Nederkoorn, P.J., Haan, R. den, Roos, Y.B., Kruyt, N.D., Zonneveld, T.P., Richard, E., Vergouwen, M.D., Nederkoorn, P.J., Haan, R. den, Roos, Y.B., and Kruyt, N.D.

Abstract

Item does not contain fulltext, BACKGROUND: Stroke is an important cause of death and disability worldwide. Since high blood pressure is an important risk factor for stroke and stroke recurrence, drugs that lower blood pressure might play an important role in secondary stroke prevention. OBJECTIVES: To investigate whether blood pressure-lowering drugs (BPLDs) started at least 48 hours after the index event are effective for the prevention of recurrent stroke, major vascular events, and dementia in people with stroke or transient ischaemic attack (TIA). Secondary objectives were to identify subgroups of people in which BPLDs are effective, and to investigate the optimum systolic blood pressure target after stroke or TIA for preventing recurrent stroke, major vascular events, and dementia. SEARCH METHODS: In August 2017, we searched the Trials Registers of the Cochrane Stroke Group and the Cochrane Hypertension Group, the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 8), MEDLINE Ovid (1946 to August 2017), Embase Ovid (1974 to August 2017), ClinicalTrials.gov, the ISRCTN Registry, Stroke Trials Registry, Trials Central, and the World Health Organization (WHO) International Clinical Trials Registry Platform Portal. SELECTION CRITERIA: Randomised controlled trials (RCTs) of BPLDs started at least 48 hours after stroke or TIA. DATA COLLECTION AND ANALYSIS: Two review authors independently screened all titles and abstracts, selected eligible trials, extracted the data, assessed risk of bias, and used GRADE to assess the quality of the evidence. If necessary, we contacted the principal investigators or corresponding authors for additional data. MAIN RESULTS: We included 11 studies involving a total of 38,742 participants: eight studies compared BPLDs versus placebo or no treatment (35,110 participants), and three studies compared different systolic blood pressure targets (3632 participants). The risk of bias varied greatly between included studies. The pooled risk ratios (RRs) of B

Published
2018

47. Development and validation of the Dutch Stroke Score for predicting disability and functional outcome after ischemic stroke: A tool to support efficient discharge planning

Author

Ridder, I.R. (Inger) de, Dijkland, S.A. (Simone), Scheele, M. (Maaike), Hertog, H.M. (Heleen) den, Dirks, M. (Maaike), Westendorp, W.F. (Willeke), Nederkoorn, P.J. (Paul), Beek, D. (Diederik) van de, Ribbers, G.M. (Gerard), Steyerberg, E.W. (Ewout), Lingsma, H.F. (Hester), Dippel, D.W.J. (Diederik), Ridder, I.R. (Inger) de, Dijkland, S.A. (Simone), Scheele, M. (Maaike), Hertog, H.M. (Heleen) den, Dirks, M. (Maaike), Westendorp, W.F. (Willeke), Nederkoorn, P.J. (Paul), Beek, D. (Diederik) van de, Ribbers, G.M. (Gerard), Steyerberg, E.W. (Ewout), Lingsma, H.F. (Hester), and Dippel, D.W.J. (Diederik)

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

Author

Fransen, P.S.S., Berkhemer, O.A., Lingsma, H.F., Beumer, D., Berg, L.A. van den, Yoo, A.J., Schonewille, W.J., Vos, J.A., Nederkoorn, P.J., Wermer, M.J.H., Walderveen, M.A.A. van, Staals, J., Hofmeijer, J., Oostayen, J.A. van, Nijeholt, G.J.L.A., Boiten, J., Brouwer, P.A., Emmer, B.J., Bruijn, S.F. de, Dijk, L.C. van, Kappelle, L.J., R.H. lo, Dijk, E.J. van, Vries, J. de, Kort, P.L.M. de, Berg, J.S.P. van den, Hasselt, B.A.A.M. van, Aerden, L.A.M., Dallinga, R.J., Visser, M.C., Bot, J.C.J., Vroomen, P.C., Eshghi, O., Schreuder, T.H.C.M.L., Heijboer, R.J.J., Keizer, K., Tielbeek, A.V., Hertog, H.M. den, Gerrits, D.G., Berg-Vos, R.M. van den, Karas, G.B., Steyerberg, E.W., Flach, H.Z., Marquering, H.A., Sprengers, M.E.S., Jenniskens, S.F.M., Beenen, L.F.M., Berg, R. van den, Koudstaal, P.J., Zwam, W.H. van, Roos, Y.B.W.E.M., Oostenbrugge, R.J. van, Majoie, C.B.L.M., Lugt, A. van der, Dippel, D.W.J., Multictr Randomized Clin Trial End, Other departments, Radiology and Nuclear Medicine, ACS - Amsterdam Cardiovascular Sciences, ANS - Neurovascular Disorders, Graduate School, Neurology, Biomedical Engineering and Physics, Other Research, MUMC+: MA AIOS Neurologie (9), RS: CARIM - R3.03 - Cerebral small vessel disease, Klinische Neurowetenschappen, MUMC+: MA Med Staf Spec Neurologie (9), RS: CARIM - R3.11 - Imaging, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, Clinical Neurophysiology, Faculty of Science and Technology, Radiology and nuclear medicine, Amsterdam Neuroscience - Neurovascular Disorders, Radiology & Nuclear Medicine, and Public Health

Subjects
Male, Time Factors, ANGIOGRAPHIC REPERFUSION, 030204 cardiovascular system & hematology, THERAPY, law.invention, Brain Ischemia, 0302 clinical medicine, Randomized controlled trial, Modified Rankin Scale, law, Interquartile range, Non-U.S. Gov't, 610 Medicine & health, Stroke, OUTCOMES, Research Support, Non-U.S. Gov't, Endovascular Procedures, Atrial fibrillation, Middle Aged, THROMBECTOMY, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], Multicenter Study, Treatment Outcome, Anesthesia, Tissue Plasminogen Activator, Randomized Controlled Trial, Female, IMAGING SELECTION, INTERVENTION, medicine.medical_specialty, Research Support, METIS-320854, 03 medical and health sciences, Reperfusion therapy, Fibrinolytic Agents, SDG 3 - Good Health and Well-being, medicine, Journal Article, Humans, Aged, Intention-to-treat analysis, COMPLEXITY, business.industry, Other Research Radboud Institute for Health Sciences [Radboudumc 0], medicine.disease, Surgery, INTRAVENOUS T-PA, IR-103531, ENDOVASCULAR TREATMENT, Reperfusion, Neurology (clinical), business, 030217 neurology & neurosurgery, Fibrinolytic agent
Abstract

Item does not contain fulltext IMPORTANCE: Intra-arterial treatment (IAT) for acute ischemic stroke caused by intracranial arterial occlusion leads to improved functional outcome in patients treated within 6 hours after onset. The influence of treatment delay on treatment effect is not yet known. OBJECTIVE: To evaluate the influence of time from stroke onset to the start of treatment and from stroke onset to reperfusion on the effect of IAT. DESIGN, SETTING, AND PARTICIPANTS: The Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) was a multicenter, randomized clinical open-label trial of IAT vs no IAT in 500 patients. The time to the start of treatment was defined as the time from onset of symptoms to groin puncture (TOG). The time from onset of treatment to reperfusion (TOR) was defined as the time to reopening the vessel occlusion or the end of the procedure in cases for which reperfusion was not achieved. Data were collected from December 3, 2010, to June 3, 2014, and analyzed (intention to treat) from July 1, 2014, to September 19, 2015. MAIN OUTCOMES AND MEASURES: Main outcome was the modified Rankin Scale (mRS) score for functional outcome (range, 0 [no symptoms] to 6 [death]). Multiple ordinal logistic regression analysis estimated the effect of treatment and tested for the interaction of time to randomization, TOG, and TOR with treatment. The effect of treatment as a risk difference on reaching independence (mRS score, 0-2) was computed as a function of TOG and TOR. Calculations were adjusted for age, National Institutes of Health Stroke Scale score, previous stroke, atrial fibrillation, diabetes mellitus, and intracranial arterial terminus occlusion. RESULTS: Among 500 patients (58% male; median age, 67 years), the median TOG was 260 (interquartile range [IQR], 210-311) minutes; median TOR, 340 (IQR, 274-395) minutes. An interaction between TOR and treatment (P = .04) existed, but not between TOG and treatment (P = .26). The adjusted risk difference (95% CI) was 25.9% (8.3%-44.4%) when reperfusion was reached at 3 hours, 18.8% (6.6%-32.6%) at 4 hours, and 6.7% (0.4%-14.5%) at 6 hours. CONCLUSION AND RELEVANCE: For every hour of reperfusion delay, the initially large benefit of IAT decreases; the absolute risk difference for a good outcome is reduced by 6% per hour of delay. Patients with acute ischemic stroke require immediate diagnostic workup and IAT in case of intracranial arterial vessel occlusion. TRIAL REGISTRATION: trialregister.nl Identifier: NTR1804.

Published
2016
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50. Global survey of the frequency of atrial fibrillation–associated stroke

Author

Perera, Kanjana S., Vanassche, Thomas, Bosch, Jackie, Swaminathan, Balakumar, Mundl, Hardi, Giruparajah, Mohana, Barboza, Miguel A., O’Donnell, Martin J., Gomez-Schneider, Maia, Hankey, Graeme J., Yoon, Byung-Woo, Roxas, Artemio, Lavallee, Philippa, Sargento-Freitas, Joao, Shamalov, Nikolay, Brouns, Raf, Gagliardi, Rubens J., Kasner, Scott E., Pieroni, Alessio, Vermehren, Philipp, Kitagawa, Kazuo, Wang, Yongjun, Muir, Keith, Coutinho, Jonathan M., Connolly, Stuart J., Hart, Robert G., Czeto, K., Kahn, M., Mattina, K.R., Ameriso, S.F., Pujol-Lereis, V., Hawkes, M., Pertierra, L., Perera, N., De Smedt, A., Van Dyck, R., Van Hooff, R.J., Yperzeele, Laetitia, Gagliardi, V.D.B., Cerqueir, L.G., Yang, X., Chen, W., Amarenco, P., Guidoux, C., Ringleb, P.A., Bereczki, D., Vastagh, I., Canavan, M., Toni, D., Anzini, A., Colosimo, C., De Michele, M., Di Mascio, M.T., Durastanti, L., Falcou, A., Fausti, S., Mancini, A., Mizumo, S., Uchiyama, S., Kim, C.K., Jung, S., Kim, Y., Kim, J.A., Jo, J.Y., Arauz, A., Quiroz-Compean, A., Colin, J., Nederkoorn, P.J., Marianito, V.P., Cunha, L., Santo, G., Silva, F., Coelho, J., Kustova, M., Meshkova, K., Williams, G., Siegler, J., Zhang, C., Gallatti, N., and Kruszewski, M.

Subjects
Human medicine
Abstract

Background and Purpose— Atrial fibrillation (AF) is increasingly recognized as the single most important cause of disabling ischemic stroke in the elderly. We undertook an international survey to characterize the frequency of AF-associated stroke, methods of AF detection, and patient features. Methods— Consecutive patients hospitalized for ischemic stroke in 2013 to 2014 were surveyed from 19 stroke research centers in 19 different countries. Data were analyzed by global regions and World Bank income levels. Results— Of 2144 patients with ischemic stroke, 590 (28%; 95% confidence interval, 25.6–29.5) had AF-associated stroke, with highest frequencies in North America (35%) and Europe (33%) and lowest in Latin America (17%). Most had a history of AF before stroke (15%) or newly detected AF on electrocardiography (10%); only 2% of patients with ischemic stroke had unsuspected AF detected by poststroke cardiac rhythm monitoring. The mean age and 30-day mortality rate of patients with AF-associated stroke (75 years; SD, 11.5 years; 10%; 95% confidence interval, 7.6–12.6, respectively) were substantially higher than those of patients without AF (64 years; SD, 15.58 years; 4%; 95% confidence interval, 3.3–5.4; P75 years old) and more often women.

Published
2016

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