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1. Predicting outcome of endovascular treatment for acute ischemic stroke: Potential value of machine learning algorithms

Author

Van Os, H.J.A. (Hendrikus J.A.), Ramos, L.A. (Lucas A.), Hilbert, A. (Adam), Van Leeuwen, M. (Matthijs), Walderveen, M.A.A. (Marianne) van, Kruyt, N.D. (Nyika), Dippel, D.W.J. (Diederik), Steyerberg, E.W. (Ewout), Schaaf, I.C. (Irene) van der, Lingsma, H.F. (Hester), Schonewille, W.J. (Wouter), Majoie, C.B. (Charles), Olabarriaga, S.D. (Silvia D.), Zwinderman, K. (Koos), Venema, E. (Esmee), Marquering, H. (Henk), Wermer, M.J.H. (Marieke), Van Os, H.J.A. (Hendrikus J.A.), Ramos, L.A. (Lucas A.), Hilbert, A. (Adam), Van Leeuwen, M. (Matthijs), Walderveen, M.A.A. (Marianne) van, Kruyt, N.D. (Nyika), Dippel, D.W.J. (Diederik), Steyerberg, E.W. (Ewout), Schaaf, I.C. (Irene) van der, Lingsma, H.F. (Hester), Schonewille, W.J. (Wouter), Majoie, C.B. (Charles), Olabarriaga, S.D. (Silvia D.), Zwinderman, K. (Koos), Venema, E. (Esmee), Marquering, H. (Henk), and Wermer, M.J.H. (Marieke)

Abstract

Background: Endovascular treatment (EVT) is effective for stroke patients with a large vessel occlusion (LVO) of the anterior circulation. To further improve personalized stroke care, it is essential to accurately predict outcome after EVT. Machine learning might outperform classical prediction methods as it is capable of addressing complex interactions and non-linear relations between variables. Methods: We included patients from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry, an observational cohort of LVO patients treated with EVT. We applied the following machine learning algorithms: Random Forests, Support Vector Machine, Neural Network, and Super Learner and compared their predictive value with classic logistic regression models using various variable selection methodologies. Outcome variables were good reperfusion (post-mTICI ≥ 2b) and functional independence (modified Rankin Scale ≤2) at 3 months using (1) only baseline variables and (2) baseline and treatment variables. Area under the ROC-curves (AUC) and difference of mean AUC between the models were assessed. Results: We included 1,383 EVT patients, with good reperfusion in 531 (38%) and functional independence in 525 (38%) patients. Machine learning and logistic regression models all performed poorly in predicting good reperfusion (range mean AUC: 0.53-0.57), and moderately in predicting 3-months functional independence (range mean AUC: 0.77-0.79) using only baseline variables. All models performed well in predicting 3-months functional independence using both baseline and treatment variables (range mean AUC: 0.88-0.91) with a negligible difference of mean AUC (0.01; 95%CI: 0.00-0.01) between best performing machine learning algorithm (Random Forests) and best performing logistic regression model (based on prior knowledge). Conclusion: In patients with LVO machine learning algorithms did not outperform logistic regressi

Published
2018
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2. Temporal profile of body temperature in acute ischemic stroke: Relation to infarct size and outcome

Author

Geurts, M. (Marjolein), Scheijmans, F.E.V. (Féline E.V.), Seeters, T. (Tom) van, Biessels, G.J., Kappelle, L.J. (Jaap), Velthuis, B.K. (Birgitta K.), Worp, H.B. (Bart) van der, Majoie, C.B. (Charles), Roos, Y.B.W.E.M. (Yvo), Duijm, L.E.M. (Lucien), Keizer, K. (Koos), Lugt, A. (Aad) van der, Dippel, D.W.J. (Diederik), Greve, D. (Droogh-de), Bienfait, H.P. (Henri), Walderveen, M.A.A. (Marianne) van, Wermer, M.J.H. (Marieke), Lycklama à Nijeholt, G.J. (Geert), Boiten, J. (Jelis), Duyndam, A. (Anita), Kwa, V.I.H., Meijer, F.J. (F.), Dijk, E.J. (Ewoud) van, Kesselring, A.M. (Anouk), Hofmeijer, J., Vos, J.A. (Jan Albert), Schonewille, W.J. (Wouter), Rooij, W.J. (W.) van, Kort, P.L.M. (Paul) de, Pleiter, C.C. (C.), Bakker, S.L.M. (Stef), Bot, J., Visser, M.C. (Marieke), Velthuis, B.K. (Birgitta), Schaaf, I.C. (Irene) van der, Dankbaar, J.W. (Jan), Mali, W.P. (Willem), van Seeters, T., Horsch, A.D. (Alexander D.), Niesten, J.M. (Joris), Biessels, G.J. (Geert Jan), Luitse, J.S.K., Graaf, Y. (Yolanda) van der, Geurts, M. (Marjolein), Scheijmans, F.E.V. (Féline E.V.), Seeters, T. (Tom) van, Biessels, G.J., Kappelle, L.J. (Jaap), Velthuis, B.K. (Birgitta K.), Worp, H.B. (Bart) van der, Majoie, C.B. (Charles), Roos, Y.B.W.E.M. (Yvo), Duijm, L.E.M. (Lucien), Keizer, K. (Koos), Lugt, A. (Aad) van der, Dippel, D.W.J. (Diederik), Greve, D. (Droogh-de), Bienfait, H.P. (Henri), Walderveen, M.A.A. (Marianne) van, Wermer, M.J.H. (Marieke), Lycklama à Nijeholt, G.J. (Geert), Boiten, J. (Jelis), Duyndam, A. (Anita), Kwa, V.I.H., Meijer, F.J. (F.), Dijk, E.J. (Ewoud) van, Kesselring, A.M. (Anouk), Hofmeijer, J., Vos, J.A. (Jan Albert), Schonewille, W.J. (Wouter), Rooij, W.J. (W.) van, Kort, P.L.M. (Paul) de, Pleiter, C.C. (C.), Bakker, S.L.M. (Stef), Bot, J., Visser, M.C. (Marieke), Velthuis, B.K. (Birgitta), Schaaf, I.C. (Irene) van der, Dankbaar, J.W. (Jan), Mali, W.P. (Willem), van Seeters, T., Horsch, A.D. (Alexander D.), Niesten, J.M. (Joris), Biessels, G.J. (Geert Jan), Luitse, J.S.K., and Graaf, Y. (Yolanda) van der

Abstract

Background: High body temperatures after ischemic stroke have been associated with larger infarct size, but the temporal profile of this relation is unknown. We assess the relation between temporal profile of body temperature and infarct size and functional outcome in patients with acute ischemic stroke. Methods: In 419 patients with acute ischemic stroke we assessed the relation between body temperature on admission and during the first 3 days with both infarct size and functional outcome. Infarct size was measured in milliliters on CT or MRI after 3 days. Poor functional outcome was defined as a modified Rankin Scale score ≥3 at 3 months. Results: Body temperature on admission was not associated with infarct size or poor outcome in adjusted analyses. By contrast, each additional 1.0 °C in body temperature on day 1 was associated with 0.31 ml larger infarct size (95% confidence interval (CI) 0.04-0.59), on day 2 with 1.13 ml larger infarct size(95% CI, 0.83-1.43), and on day 3 with 0.80 ml larger infarct size (95% CI, 0.48-1.12), in adjusted linear regression analyses. Higher peak body temperatures on days two and three were also associated with poor outcome (adjusted relative risks per additional 1.0 °C in body temperature, 1.52 (95% CI, 1.17-1.99) and 1.47 (95% CI, 1.22-1.77), respectively). Conclusions: Higher peak body temperatures during the first days after ischemic stroke, rather than on admission, are associated with larger infarct size and poor functional outcome. This suggests that prevention of high temperatures may improve outcome if continued for at least 3 days.

Published
2016
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3. Assessment of collateral status by dynamic ct angiography in acute mca stroke: Timing of acquisition and relationship with final infarct volume

Author

Van Den Wijngaard, I.R. (Ido R.), Holswilder, G. (Ghislaine), Wermer, M.J.H. (Marieke), Boiten, J. (Jelis), Algra, A. (Ale), Dippel, D.W.J. (Diederik), Dankbaar, J.W. (Jan), Velthuis, B.K. (Birgitta), Boers, A.M.M. (Anna), Majoie, C.B. (Charles), Walderveen, M.A.A. (Marianne) van, Van Den Wijngaard, I.R. (Ido R.), Holswilder, G. (Ghislaine), Wermer, M.J.H. (Marieke), Boiten, J. (Jelis), Algra, A. (Ale), Dippel, D.W.J. (Diederik), Dankbaar, J.W. (Jan), Velthuis, B.K. (Birgitta), Boers, A.M.M. (Anna), Majoie, C.B. (Charles), and Walderveen, M.A.A. (Marianne) van

Abstract

BACKGROUND AND PURPOSE: Dynamic CTA is a promising technique for visualization of collateral filling in patients with acute ischemic stroke. Our aim was to describe collateral filling with dynamic CTA and assess the relationship with infarct volume at follow-up. MATERIALS AND METHODS: We selected patients with acute ischemic stroke due to proximal MCA occlusion. Patients underwent NCCT, single-phase CTA, and whole-brain CT perfusion/dynamic CTA within 9 hours after stroke onset. For each patient, a detailed assessment of the extent and velocity of arterial filling was obtained. Poor radiologic outcome was defined as an infarct volume of\70 mL. The association between collateral score and follow-up infarct volume was analyzed with Poisson regression. RESULTS: Sixty-one patients with a mean age of 67 years were included. For all patients combined, the interval that contained the peak of arterial filling in both hemispheres was between 11 and 21 seconds after ICA contrast entry. Poor collateral status as assessed with dynamic CTA was more strongly associated with infarct volume of 70 mL (risk ratio, 1.9; 95% CI, 1.3-2.9) than with single-phase CTA (risk ratio, 1.4; 95% CI, 0.8-2.5). Four subgroups (good-versus-poor and fast-versus-slo

Published
2016
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4. Automated entire thrombus density measurements for robust and comprehensive thrombus characterization in patients with acute ischemic stroke

Author

Santos, E.M.M. (Emilie M.), Niessen, W.J. (Wiro), Yoo, A.J. (Albert J.), Berkhemer, O.A. (Olvert), Beenen, L.F.M. (Ludo), Majoie, C.B. (Charles), Marquering, H. (Henk), Fransen, P.S.S. (Puck), Beumer, D. (Debbie), Van Den Berg, L.A. (Lucie A.), Lingsma, H.F. (Hester), Schonewille, W.J. (Wouter), Vos, J.A. (Jan Albert), Nederkoorn, P.J. (Paul), Wermer, M.J.H. (Marieke), Walderveen, M.A.A. (Marianne) van, Staals, J. (Julie), Hofmeijer, J., Oostayen, J.A. (Jacques) van, Lycklama à Nijeholt, G.J. (Geert), Boiten, J. (Jelis), Brouwer, P.A. (Patrick A.), Emmer, B.J. (Bart J.), Bruijn, S.F. (S.) de, Dijk, L.C. (Lukas) van, Kappelle, L.J., Lo, R.H. (Rob H.), Dijk, E.J. (Ewoud) van, De Vries, J. (Joost), Kort, P.L.M. (Paul) de, Berg, J.S.P. (Jan) van den, Van Hasselt, B.A.A.M. (Boudewijn A. A. M.), Aerden, L.A.M. (Leo), Dallinga, R.J. (René J.), Visser, M.C. (Marieke), Bot, J. (Joseph), Vroomen, P.C. (Patrick C.), Eshghi, O.S. (Omid S.), Schreuder, T.H.C.M.L. (Tobien H. C. M. L.), Heijboer, M.P. (Rien), Keizer, K. (Koos), Tielbeek, A.V. (Alexander), Hertog, H.M. (Heleen) den, Gerrits, D.G. (Dick G.), Berg-Vos, R.M. (R.) van den, Karas, G. (Giorgos), Steyerberg, E.W. (Ewout), Flach, H.Z. (Zwenneke), Sprengers, M.E.S. (Marieke), Jenniskens, S. (Sjoerd), Van Den Berg, R., Koudstaal, P.J. (Peter), Zwam, W.H. (Wim) van, Roos, Y.B.W.E.M. (Yvo), Lugt, A. (Aad) van der, Oostenbrugge, R.J. (Robert Jan) van, Dippel, D.W.J. (Diederik), Santos, E.M.M. (Emilie M.), Niessen, W.J. (Wiro), Yoo, A.J. (Albert J.), Berkhemer, O.A. (Olvert), Beenen, L.F.M. (Ludo), Majoie, C.B. (Charles), Marquering, H. (Henk), Fransen, P.S.S. (Puck), Beumer, D. (Debbie), Van Den Berg, L.A. (Lucie A.), Lingsma, H.F. (Hester), Schonewille, W.J. (Wouter), Vos, J.A. (Jan Albert), Nederkoorn, P.J. (Paul), Wermer, M.J.H. (Marieke), Walderveen, M.A.A. (Marianne) van, Staals, J. (Julie), Hofmeijer, J., Oostayen, J.A. (Jacques) van, Lycklama à Nijeholt, G.J. (Geert), Boiten, J. (Jelis), Brouwer, P.A. (Patrick A.), Emmer, B.J. (Bart J.), Bruijn, S.F. (S.) de, Dijk, L.C. (Lukas) van, Kappelle, L.J., Lo, R.H. (Rob H.), Dijk, E.J. (Ewoud) van, De Vries, J. (Joost), Kort, P.L.M. (Paul) de, Berg, J.S.P. (Jan) van den, Van Hasselt, B.A.A.M. (Boudewijn A. A. M.), Aerden, L.A.M. (Leo), Dallinga, R.J. (René J.), Visser, M.C. (Marieke), Bot, J. (Joseph), Vroomen, P.C. (Patrick C.), Eshghi, O.S. (Omid S.), Schreuder, T.H.C.M.L. (Tobien H. C. M. L.), Heijboer, M.P. (Rien), Keizer, K. (Koos), Tielbeek, A.V. (Alexander), Hertog, H.M. (Heleen) den, Gerrits, D.G. (Dick G.), Berg-Vos, R.M. (R.) van den, Karas, G. (Giorgos), Steyerberg, E.W. (Ewout), Flach, H.Z. (Zwenneke), Sprengers, M.E.S. (Marieke), Jenniskens, S. (Sjoerd), Van Den Berg, R., Koudstaal, P.J. (Peter), Zwam, W.H. (Wim) van, Roos, Y.B.W.E.M. (Yvo), Lugt, A. (Aad) van der, Oostenbrugge, R.J. (Robert Jan) van, and Dippel, D.W.J. (Diederik)

Abstract

Background and Purpose: In acute ischemic stroke (AIS) management, CT-based thrombus density has been associated with treatment success. However, currently used thrombus measurements are prone to inter-observer variability and oversimplify the heterogeneous thrombus composition. Our aim was first to introduce an automated method to assess the entire thrombus density and then to compare the measured entire thrombus density with respect to current standard manual measurements. Materials and Method: In 135 AIS patients, the density distribution of the entire thrombus was determined. Density distributions were described usingmedians, interquartile ranges (IQR), kurtosis, and skewedness. Differences between themedian of entire thrombusmeasurements and commonly applied manualmeasurements using 3 regions of interest were determined using linear regression. Results: Density distributions varied considerably with medians ranging from 20.0 to 62.8 HU and IQRs ranging from 9.3 to 55.8 HU. The average median of the thrombus density distributions (43.5 ± 10.2 HU) was lower than the manual assessment (49.6 ± 8.0 HU) (p<0.05). The difference between manual measurements and median density of entire thrombus decreased with increasing density (r = 0.64; p<0.05), revealing relatively higher manual measurements for low density thrombi such that manual density measurement tend overestimates the

Published
2016
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5. Diagnostic yield and accuracy of CT angiography, MR angiography, and digital subtraction angiography for detection of macrovascular causes of intracerebral haemorrhage: Prospective, multicentre cohort study

Author

Van Asch, C.J.J. (Charlotte J.J.), Velthuis, B.K. (Birgitta K.), Rinkel, G.J.E. (Gabriël J.E.), Algra, A. (Ale), Kort, G.A.P. (G. A P) de, Witkamp, T.D. (Theo), De Ridder, J.C.M. (Johanna C.M.), Van Nieuwenhuizen, K.M. (Koen M.), De Leeuw, F.-E. (Frank-Erik), Schonewille, W.J. (Wouter), Kort, P.L.M. (Paul) de, Dippel, D.W.J. (Diederik), Raaymakers, T.W.M. (Theodora W.M.), Hofmeijer, J., Wermer, M.J.H. (Marieke), Kerkhoff, H. (Henk), Jellema, K. (Korné), Bronner, I.M. (Irene M.), Remmers, M.J.M. (Michel ), Bienfait, H.P. (Henri), Witjes, R.J.G.M. (Ron J.G.M.), Greving, J.P. (Jacoba), Klijn, C.J.M. (Catharina J.M.), Leeuw, H.F. (Frank) de, Boogaarts, H.B., Dijk, E.J. (Ewoud) van, Schonewille, W.J., Pellikaan, W.M.J., Puppels-De Waard, C., De Kort, P.L.M., Peluso, J.P., Tuijl, J. (Jordie) van, Joosten, F.B.M. (Frank), Khajeh, L. (Ladbon), Raaijmakers, T.W.M., Wermer, M.J., Walderveen, M.A.A. (Marianne) van, Kerkhoff, H., Zock, E., Lycklama à Nijeholt, G.J. (Geert), Bronner, I.M., Remmers, M.J.M., Witjes, R.J.G.M., Bienfait, H.P., Droogh-Greve, K.E., Donders, R. (Rogier), Kwa, V.I.H., Schreuder, T.H.C.M.L. (Tobien H. C. M. L.), Franke, C.L. (Cees), Straver, J.S., Jansen, C., Bakker, S.L.M. (Stef), Pleiter, C.C. (C.), Visser, M.C. (Marieke), Van Asch, C.J.J., Velthuis, B.K. (Birgitta), Rinkel, G.J.E. (Gabriel), Van Nieuwenhuizen, K.M., Van Asch, C.J.J. (Charlotte J.J.), Velthuis, B.K. (Birgitta K.), Rinkel, G.J.E. (Gabriël J.E.), Algra, A. (Ale), Kort, G.A.P. (G. A P) de, Witkamp, T.D. (Theo), De Ridder, J.C.M. (Johanna C.M.), Van Nieuwenhuizen, K.M. (Koen M.), De Leeuw, F.-E. (Frank-Erik), Schonewille, W.J. (Wouter), Kort, P.L.M. (Paul) de, Dippel, D.W.J. (Diederik), Raaymakers, T.W.M. (Theodora W.M.), Hofmeijer, J., Wermer, M.J.H. (Marieke), Kerkhoff, H. (Henk), Jellema, K. (Korné), Bronner, I.M. (Irene M.), Remmers, M.J.M. (Michel ), Bienfait, H.P. (Henri), Witjes, R.J.G.M. (Ron J.G.M.), Greving, J.P. (Jacoba), Klijn, C.J.M. (Catharina J.M.), Leeuw, H.F. (Frank) de, Boogaarts, H.B., Dijk, E.J. (Ewoud) van, Schonewille, W.J., Pellikaan, W.M.J., Puppels-De Waard, C., De Kort, P.L.M., Peluso, J.P., Tuijl, J. (Jordie) van, Joosten, F.B.M. (Frank), Khajeh, L. (Ladbon), Raaijmakers, T.W.M., Wermer, M.J., Walderveen, M.A.A. (Marianne) van, Kerkhoff, H., Zock, E., Lycklama à Nijeholt, G.J. (Geert), Bronner, I.M., Remmers, M.J.M., Witjes, R.J.G.M., Bienfait, H.P., Droogh-Greve, K.E., Donders, R. (Rogier), Kwa, V.I.H., Schreuder, T.H.C.M.L. (Tobien H. C. M. L.), Franke, C.L. (Cees), Straver, J.S., Jansen, C., Bakker, S.L.M. (Stef), Pleiter, C.C. (C.), Visser, M.C. (Marieke), Van Asch, C.J.J., Velthuis, B.K. (Birgitta), Rinkel, G.J.E. (Gabriel), and Van Nieuwenhuizen, K.M.

Abstract

Study question What are the diagnostic yield and accuracy of early computed tomography (CT) angiography followed by magnetic resonance imaging/angiography (MRI/MRA) and digital subtraction angiography (DSA) in patients with non-traumatic intracerebral haemorrhage? Methods This prospective diagnostic study enrolled 298 adults (18-70 years) treated in 22 hospitals in the Netherlands over six years. CT angiography was performed within seven days of haemorrhage. If the result was negative, MRI/MRA was performed four to eight weeks later. DSA was performed when the CT angiography or MRI/MRA results were inconclusive or negative. The main outcome was a macrovascular cause, including arteriovenous malformation, aneurysm, dural arteriovenous fistula, and cavernoma. Three blinded neuroradiologists independently evaluated the images for macrovascular causes of haemorrhage. The reference standard was the best available evidence from all findings during one year's follow-up. Study answer and limitations A macrovascular cause was identified in 69 patients (23%). 291 patients (98%) underwent CT angiography; 214 with a negative result underwent additional MRI/MRA and 97 with a negative result for both CT angiography and MRI/MRA underwent DSA. Early CT angiography detected 51 macrovascular causes (yield 17%, 95% confidence interval 13% to 22%). CT angiography with MRI/MRA identified two additional macrovascular causes (18%, 14% to 23%) and these modalities combined with DSA another 15 (23%, 18% to 28%). This last extensive strategy failed to detect a cavernoma, which was identified on MRI during follow-up (reference strategy). The positive predictive value of CT angiography was 72% (60% to 82%), of additional MRI/MRA was 35% (14% to 62%), and of additional DSA was 100% (75% to 100%). None of the patients experienced complications with CT angiography or MRI/MRA; 0.6% of patients who underwent DSA experienced permanent sequelae. Not all patients with negative CT angiography and MRI/M

Published
2015
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6. Characteristics of misclassified ct perfusion ischemic core in patients with acute ischemic stroke

Author

Geuskens, R.R.E.G. (Ralph R.E.G.), Borst, J. (Jordi), Lucas, M. (Marit), Boers, A.M.M. (Anna), Berkhemer, O.A. (Olvert), Roos, Y.B.W.E.M. (Yvo), Walderveen, M.A.A. (Marianne) van, Jenniskens, S. (Sjoerd), Zwam, W.H. (Wim) van, Dippel, D.W.J. (Diederik), Majoie, C.B. (Charles), Marquering, H. (Henk), Geuskens, R.R.E.G. (Ralph R.E.G.), Borst, J. (Jordi), Lucas, M. (Marit), Boers, A.M.M. (Anna), Berkhemer, O.A. (Olvert), Roos, Y.B.W.E.M. (Yvo), Walderveen, M.A.A. (Marianne) van, Jenniskens, S. (Sjoerd), Zwam, W.H. (Wim) van, Dippel, D.W.J. (Diederik), Majoie, C.B. (Charles), and Marquering, H. (Henk)

Abstract

Background CT perfusion (CTP) is used to estimate the extent of ischemic core and penumbra in patients with acute ischemic stroke. CTP reliability, however, is limited. This study aims to identify regions misclassified as ischemic core on CTP, using infarct on follow-up noncontrast CT. We aim to assess differences in volumetric and perfusion characteristics in these regions compared to areas that ended up as infarct on follow

Published
2015
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7. No relation between body temperature and arterial recanalization at three days in patients with acute ischaemic stroke

Author

Geurts, M. (Marjolein), Worp, H.B. (Bart) van der, Horsch, A.D. (Alexander D.), Kappelle, L.J. (Jaap), Biessels, G.J. (Geert Jan), Velthuis, B.K. (Birgitta), Majoie, C.B. (Charles), Roos, Y.B.W.E.M. (Yvo), Duijm, L.E.M. (Lucien), Keizer, K. (Koos), Lugt, A. (Aad) van der, Dippel, D.W.J. (Diederik), Droogh-De Greve, K.E., Bienfait, H.P. (Henri), Walderveen, M.A.A. (Marianne) van, Wermer, M.J.H. (Marieke), Lycklama à Nijeholt, G.J. (Geert), Boiten, J. (Jelis), Duyndam, A. (Anita), Kwa, V.I.H., Meijer, F.J. (F.), Dijk, E.J. (Ewoud) van, Kesselring, A.M. (Anouk), Hofmeijer, J., Vos, J.A. (Jan Albert), Schonewille, W.J. (Wouter), Rooij, W.J. (W.) van, Kort, P.L.M. (Paul) de, Pleiter, C.C. (C.), Bakker, S.L.M. (Stef), Bot, J. (Joseph), Visser, M.C. (Marieke), Schaaf, I.C. (Irene) van der, Dankbaar, J.W. (Jan), Mali, W.P. (Willem), Seeters, T. (Tom) van, Niesten, J.M. (Joris), Biessels, G.J., Kappelle, L.J., Luitse, J.S.K., Graaf, Y. (Yolanda) van der, Geurts, M. (Marjolein), Worp, H.B. (Bart) van der, Horsch, A.D. (Alexander D.), Kappelle, L.J. (Jaap), Biessels, G.J. (Geert Jan), Velthuis, B.K. (Birgitta), Majoie, C.B. (Charles), Roos, Y.B.W.E.M. (Yvo), Duijm, L.E.M. (Lucien), Keizer, K. (Koos), Lugt, A. (Aad) van der, Dippel, D.W.J. (Diederik), Droogh-De Greve, K.E., Bienfait, H.P. (Henri), Walderveen, M.A.A. (Marianne) van, Wermer, M.J.H. (Marieke), Lycklama à Nijeholt, G.J. (Geert), Boiten, J. (Jelis), Duyndam, A. (Anita), Kwa, V.I.H., Meijer, F.J. (F.), Dijk, E.J. (Ewoud) van, Kesselring, A.M. (Anouk), Hofmeijer, J., Vos, J.A. (Jan Albert), Schonewille, W.J. (Wouter), Rooij, W.J. (W.) van, Kort, P.L.M. (Paul) de, Pleiter, C.C. (C.), Bakker, S.L.M. (Stef), Bot, J. (Joseph), Visser, M.C. (Marieke), Schaaf, I.C. (Irene) van der, Dankbaar, J.W. (Jan), Mali, W.P. (Willem), Seeters, T. (Tom) van, Niesten, J.M. (Joris), Biessels, G.J., Kappelle, L.J., Luitse, J.S.K., and Graaf, Y. (Yolanda) van der

Abstract

Background: Recanalization of an occluded intracranial artery is influenced by temperature-dependent enzymes, including alteplase. We assessed the relation between body temperature on admission and recanalization. Methods: We included 278 patients with acute ischaemic stroke within nine hours after symptom onset, who had an intracranial arterial occlusion on admission CT angiography, in 13 participating centres. We calculated the relation per every 0.1°Celsius increase in admission body temperature and recanalization at three days. Results: Recanalization occurred in 80% of occluded arteries. There was no relation between body temperature and recanalization at three days after adjustments for age, NIHSS score on admission and treatment with alteplase (adjusted odds ratio per 0.1°Celsius, 0.99; 95% confidence interval, 0.94-1.05; p = 0.70). Results for patients treated or not treated with alteplase were essentially the same. Conclusions: Our findings suggest that in patients with acute ischaemic stroke there is no relation between body temperature on admission and recanalization of an occluded intracranial artery three days later, irrespective of treatment with alteplase.

Published
2015
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8. Prediction of outcome in patients with suspected acute ischaemic stroke with CT perfusion and CT angiography: The Dutch acute stroke trial (DUST) study protocol

Author

Seeters, T. (Tom) van, Biessels, G.J. (Geert Jan), Schaaf, I.C. (Irene) van der, Dankbaar, J.W. (Jan), Horsch, A.D. (Alexander), Luitse, J.S.K., Niesten, J.M. (Joris), Mali, W.P. (Willem), Kappelle, L.J. (Jaap), Graaf, Y. (Yolanda) van der, Velthuis, B.K. (Birgitta), Majoie, C.B. (Charles), Roos, Y.B.W.E.M. (Yvo), Duijm, L.E.M. (Lucien), Keizer, K. (Koos), Lugt, A. (Aad) van der, Dippel, D.W.J. (Diederik), Droogh-de Greeve, K.E. (K.), Bienfait, H.P. (Henri), Walderveen, M.A.A. (Marianne) van, Wermer, M.J.H. (Marieke), Lycklamaà Nijeholt, G.J. (G.), Boiten, J. (Jelis), Duyndam, A. (Anita), Kwa, S.L.S. (Stefan), Meijer, F.J. (F.), Dijk, E.J. (Ewoud) van, Kesselring, A.M. (Anouk), Hofmeijer, J., Vos, J.A. (Jan Albert), Schonewille, W.J. (Wouter), Rooij, W.J. (W.) van, Kort, P.L.M. (Paul) de, Pleiter, C.C. (C.), Bakker, S.L.M. (Stef), Bot, J. (Joseph), Visser, M.C. (Marieke), Seeters, T. (Tom) van, Biessels, G.J. (Geert Jan), Schaaf, I.C. (Irene) van der, Dankbaar, J.W. (Jan), Horsch, A.D. (Alexander), Luitse, J.S.K., Niesten, J.M. (Joris), Mali, W.P. (Willem), Kappelle, L.J. (Jaap), Graaf, Y. (Yolanda) van der, Velthuis, B.K. (Birgitta), Majoie, C.B. (Charles), Roos, Y.B.W.E.M. (Yvo), Duijm, L.E.M. (Lucien), Keizer, K. (Koos), Lugt, A. (Aad) van der, Dippel, D.W.J. (Diederik), Droogh-de Greeve, K.E. (K.), Bienfait, H.P. (Henri), Walderveen, M.A.A. (Marianne) van, Wermer, M.J.H. (Marieke), Lycklamaà Nijeholt, G.J. (G.), Boiten, J. (Jelis), Duyndam, A. (Anita), Kwa, S.L.S. (Stefan), Meijer, F.J. (F.), Dijk, E.J. (Ewoud) van, Kesselring, A.M. (Anouk), Hofmeijer, J., Vos, J.A. (Jan Albert), Schonewille, W.J. (Wouter), Rooij, W.J. (W.) van, Kort, P.L.M. (Paul) de, Pleiter, C.C. (C.), Bakker, S.L.M. (Stef), Bot, J. (Joseph), and Visser, M.C. (Marieke)

Abstract

Background: Prediction of clinical outcome in the acute stage of ischaemic stroke can be difficult when based on patient characteristics, clinical findings and on non-contrast CT. CT perfusion and CT angiography may provide additional prognostic information and guide treatment in the early stage. We present the study protocol of the Dutch acute Stroke Trial (DUST). The DUST aims to assess the prognostic value of CT perfusion and CT angiography in predicting stroke outcome, in addition to patient characteristics and non-contrast CT. For this purpose, individualised prediction models for clinical outcome after stroke based on the best predictors from patient characteristics and CT imaging will be developed and validated.Methods/design: The DUST is a prospective multi-centre cohort study in 1500 patients with suspected acute ischaemic stroke. All patients undergo non-contrast CT, CT perfusion and CT angiography within 9 hours after onset of the neurological deficits, and, if possible, follow-up imaging after 3 days. The primary outcome is a dichotomised score on the modified Rankin Scale, assessed at 90 days. A score of 0-2 represents good outcome, and a score of 3-6 represents poor outcome. Three logistic regression models will be developed, including patient characteristics and non-contrast CT (model A), with addition of CT angiography (model B), and CT perfusion parameters (model C). Model derivation will be performed in 60% of the study population, and model validation in the remaining 40% of the patients. Additional prognostic value of the models will be determined with the area under the curve (AUC) from the receiver operating characteristic (ROC) curve, calibration plots, assessment of goodness-of-fit, and likelihood ratio tests.Discussion: This study will provide insight in the added prognostic

Published
2014
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