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3,850 results on '"Hofmeijer J"'

4. 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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5. Changes in postictal cerebral perfusion are related to the duration of electroconvulsive therapy-induced seizures.

Author

Pottkämper JCM, Verdijk JPAJ, Aalbregt E, Stuiver S, van de Mortel L, Norris DG, van Putten MJAM, Hofmeijer J, van Wingen GA, and van Waarde JA

Subjects
Humans, Animals, Rats, Bayes Theorem, Seizures etiology, Perfusion, Cerebrovascular Circulation, Electroencephalography, Electroconvulsive Therapy adverse effects, Electroconvulsive Therapy methods, Depressive Disorder, Major diagnostic imaging, Depressive Disorder, Major therapy
Abstract

Objective: Postictal symptoms may result from cerebral hypoperfusion, which is possibly a consequence of seizure-induced vasoconstriction. Longer seizures have previously been shown to cause more severe postictal hypoperfusion in rats and epilepsy patients. We studied cerebral perfusion after generalized seizures elicited by electroconvulsive therapy (ECT) and its relation to seizure duration., Methods: Patients with a major depressive episode who underwent ECT were included. During treatment, 21-channel continuous electroencephalogram (EEG) was recorded. Arterial spin labeling magnetic resonance imaging scans were acquired before the ECT course (baseline) and approximately 1 h after an ECT-induced seizure (postictal) to quantify global and regional gray matter cerebral blood flow (CBF). Seizure duration was assessed from the period of epileptiform discharges on the EEG. Healthy controls were scanned twice to assess test-retest variability. We performed hypothesis-driven Bayesian analyses to study the relation between global and regional perfusion changes and seizure duration., Results: Twenty-four patients and 27 healthy controls were included. Changes in postictal global and regional CBF were correlated with seizure duration. In patients with longer seizure durations, global decrease in CBF reached values up to 28 mL/100 g/min. Regional reductions in CBF were most prominent in the inferior frontal gyrus, cingulate gyrus, and insula (up to 35 mL/100 g/min). In patients with shorter seizures, global and regional perfusion increased (up to 20 mL/100 g/min). These perfusion changes were larger than changes observed in healthy controls, with a maximum median global CBF increase of 12 mL/100 g/min and a maximum median global CBF decrease of 20 mL/100 g/min., Significance: Seizure duration is a key factor determining postictal perfusion changes. In future studies, seizure duration needs to be considered as a confounding factor due to its opposite effect on postictal perfusion., (© 2023 The Authors. Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.)

Published
2024
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6. The International Cardiac Arrest Research Consortium Electroencephalography Database.

Author

Amorim E, Zheng WL, Ghassemi MM, Aghaeeaval M, Kandhare P, Karukonda V, Lee JW, Herman ST, Sivaraju A, Gaspard N, Hofmeijer J, van Putten MJAM, Sameni R, Reyna MA, Clifford GD, and Westover MB

Subjects
Humans, Adolescent, Retrospective Studies, Prospective Studies, Electroencephalography, Coma diagnosis, Heart Arrest diagnosis
Abstract

Objectives: To develop the International Cardiac Arrest Research (I-CARE), a harmonized multicenter clinical and electroencephalography database for acute hypoxic-ischemic brain injury research involving patients with cardiac arrest., Design: Multicenter cohort, partly prospective and partly retrospective., Setting: Seven academic or teaching hospitals from the United States and Europe., Patients: Individuals 16 years old or older who were comatose after return of spontaneous circulation following a cardiac arrest who had continuous electroencephalography monitoring were included., Interventions: Not applicable., Measurements and Main Results: Clinical and electroencephalography data were harmonized and stored in a common Waveform Database-compatible format. Automated spike frequency, background continuity, and artifact detection on electroencephalography were calculated with 10-second resolution and summarized hourly. Neurologic outcome was determined at 3-6 months using the best Cerebral Performance Category (CPC) scale. This database includes clinical data and 56,676 hours (3.9 terabytes) of continuous electroencephalography data for 1,020 patients. Most patients died ( n = 603, 59%), 48 (5%) had severe neurologic disability (CPC 3 or 4), and 369 (36%) had good functional recovery (CPC 1-2). There is significant variability in mean electroencephalography recording duration depending on the neurologic outcome (range, 53-102 hr for CPC 1 and CPC 4, respectively). Epileptiform activity averaging 1 Hz or more in frequency for at least 1 hour was seen in 258 patients (25%) (19% for CPC 1-2 and 29% for CPC 3-5). Burst suppression was observed for at least 1 hour in 207 (56%) and 635 (97%) patients with CPC 1-2 and CPC 3-5, respectively., Conclusions: The I-CARE consortium electroencephalography database provides a comprehensive real-world clinical and electroencephalography dataset for neurophysiology research of comatose patients after cardiac arrest. This dataset covers the spectrum of abnormal electroencephalography patterns after cardiac arrest, including epileptiform patterns and those in the ictal-interictal continuum., Competing Interests: Dr. van Putten is the founder of Clinical Science Systems. Dr. Westover is a co-founder of Beacon Biosignals. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

Published
2023
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8. Ghrelin for Neuroprotection in Post-Cardiac Arrest Coma: a one-year follow-up of cognitive and psychosocial outcomes.

Author

van Gils PCW, Nutma S, Meeske KF, van Heugten C, van den Bergh WM, Foudraine NA, le Feber J, Filius PMG, van Putten MJAM, Beishuizen A, and Hofmeijer J

Abstract

Background: Effective treatments to improve brain recovery after cardiac arrest are needed. Ghrelin showed efficacy in experimental models and was associated with lower neuron specific enolase levels in the clinical Ghrelin in Coma (GRECO) trial. Here we present cognitive and psychosocial outcomes at one-year follow-up., Methods: GRECO was a phase 2 multicenter, double-blind, randomized, placebo-controlled trial in comatose patients after cardiac arrest. The intervention was intravenous acyl-ghrelin 600 μg twice daily or placebo for one week, starting within 12 hours after the arrest. Patients were assessed after one year using cognitive tests and questionnaires measuring participation, health-related quality of life, mood, and caregiver strain. Composite z-scores of the cognitive tests were computed by comparing the scores to those of a norm-population and averaging the tests for memory, attention and executive functioning separately. Groups were compared based on composite z-scores and cutoff scores for psychosocial outcomes., Results: Of the 160 participants originally included, 66 of the 85 participants who survived to one year after OHCA completed the psychosocial and cognitive follow-up. The intervention group scored numerically higher across all cognitive domains compared to the control group, but the differences were not statistically significant (memory median = -.850 vs. -1.385, U = 424.5, p = .587; attention median = -.733 vs. -.717, U = 420.5, p = .548; executive functioning median = -.311 vs. -.369, U = 408.5, p = .323). There were significantly fewer signs of depression in the intervention group, U = 322.5, p = .014., Conclusions: This predefined secondary analysis found that ghrelin treatment was associated with non-significantly but consistently better cognitive outcomes and significantly fewer signs of depression. This is in line with the primary outcomes., Trial Registration: Clinicaltrialsregister.eu: EUCTR2018-000005-23-NL., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Published
2024
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9. Functional connectivity in resting-state networks relates to short-term global cognitive functioning in cardiac arrest survivors.

Author

Verhulst MMLH, Keijzer HM, van Gils PCW, van Heugten CM, Meijer FJA, Tonino BAR, Bonnes JL, Delnoij TSR, Hofmeijer J, and Helmich RC

Subjects
Humans, Male, Female, Middle Aged, Aged, Prospective Studies, Executive Function physiology, Heart Arrest complications, Heart Arrest physiopathology, Heart Arrest diagnostic imaging, Magnetic Resonance Imaging, Cognitive Dysfunction physiopathology, Cognitive Dysfunction etiology, Cognitive Dysfunction diagnostic imaging, Connectome, Nerve Net diagnostic imaging, Nerve Net physiopathology, Default Mode Network diagnostic imaging, Default Mode Network physiopathology, Survivors
Abstract

Long-term cognitive impairment is common in cardiac arrest survivors. Screening to identify patients at risk is recommended. Functional magnetic resonance brain imaging (fMRI) holds potential to contribute to prediction of cognitive outcomes. In this study, we investigated the possible value of early changes in resting-state networks for predicting short and long-term cognitive functioning of cardiac arrest survivors. We performed a prospective multicenter cohort study in cardiac arrest survivors in three Dutch hospitals. Resting-state fMRI scans were acquired within a month after cardiac arrest. We primarily focused on functional connectivity within the default-mode network (DMN) and salience network (SN), and additionally explored functional connectivity in seven other networks. Cognitive outcome was measured using the Montreal Cognitive Assessment (MoCA) during hospital admission and at 3 and 12 months, and by neuropsychological examination (NPE) at 12 months. We tested mixed effects models to evaluate the value of connectivity within the networks for predicting global cognitive outcomes at the three time points, and long-term cognitive outcomes in the memory, attention, and executive functioning domains. We included 80 patients (age 60 ± 11 years, 72 (90%) male). MoCA scores increased significantly between hospital admission and 3 months (ΔMoCA hospital-3M  = 2.89, p < 0.01), but not between 3 and 12 months (ΔMoCA 3M-12M  = 0.38, p = 0.52). Connectivity within the DMN, SN, and dorsal attention network (DAN) was positively related to global cognitive functioning during hospital admission (β DMN  = 0.85, p = 0.03; β SN  = 1.48, p < 0.01; β DAN  = 0.96, p = 0.01), but not at 3 and 12 months. Network connectivity was also unrelated to long-term memory, attention, or executive functioning. Resting-state functional connectivity in the DMN, SN, and DAN measured in the first month after cardiac arrest is related to short-term global, but not long-term global or domain-specific cognitive performance of survivors. These results do not support the value of functional connectivity within these RSNs for prediction of long-term cognitive performance after cardiac arrest., (© 2024 The Author(s). Human Brain Mapping published by Wiley Periodicals LLC.)

Published
2024
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10. Long term functioning with poor neurologic outcome after cardiac arrest.

Author

Nutma S, Roesink O, van Heugten CM, and Hofmeijer J

Subjects
Humans, Male, Female, Aged, Middle Aged, Prospective Studies, Activities of Daily Living, Coma etiology, Netherlands epidemiology, Cardiopulmonary Resuscitation methods, Quality of Life, Heart Arrest complications, Heart Arrest therapy, Registries, Recovery of Function
Abstract

Aim: Around six percent of comatose patients after cardiac arrest have a Cerebral Performance Categories score of three (CPC3) at six months after the arrest, classified as severe neurological disability. There is limited knowledge regarding the likelihood of further recovery in the cognitive, emotional, and quality of life domains. We aimed to estimate the probability of recovery towards independency., Methods: From a prospective Registry on comatose cardiac arrest patients admitted between 2013 and 2017 in two Dutch hospitals, we included patients with a CPC3 at six months after cardiac arrest. We followed patients up to November 2023. The primary outcome measure was the CPC score at time of follow up. Secondary outcomes were scores on questionnaires on cognition, mood, and quality of life according to the minimal dataset of acquired brain injury., Results: In our cohort of 667 patients, 29 (4.3%) had a CPC3 score at six months (median age 68 years, 83% male). At a median time of eight years after cardiac arrest, sixteen patients had died. Twelve of thirteen alive patients still had a CPC3 score (92%) and one a CPC2 (8%). Seven patients agreed with further interviewing, one showed independency in activities of daily living (14%). Six patients (86%) reported limitations due to physical and one (14%) due to emotional problems. All had severe cognitive impairment. Six (86%) missed cognitive rehabilitation., Conclusion: Our study shows that while the probability of recovery towards independence for patients with severe neurological disability at six months after cardiac arrest is limited, most long-term survivors are satisfied with their quality of life., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: ‘J. Hofmeijer is supported by a Dutch governmental grant from ZonMW (grant number 95105001). J. Hofmeijer is supported by a grant from the Dutch Heart Association (grant number CEI 2018T070). Furthermore there is nothing to declare’., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Published
2024
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11. Exploring postictal recovery with acetaminophen or nimodipine: A randomized-controlled crossover trial.

Author

Pottkämper JCM, Verdijk JPAJ, Stuiver S, Aalbregt E, Ten Doesschate F, Verwijk E, Schmettow M, van Wingen GA, van Putten MJAM, Hofmeijer J, and van Waarde JA

Subjects
Humans, Female, Male, Middle Aged, Adult, Seizures drug therapy, Seizures physiopathology, Aged, Prospective Studies, Cerebrovascular Circulation drug effects, Cerebrovascular Circulation physiology, Magnetic Resonance Imaging, Recovery of Function physiology, Recovery of Function drug effects, Nimodipine pharmacology, Nimodipine administration & dosage, Cross-Over Studies, Acetaminophen pharmacology, Acetaminophen administration & dosage, Electroencephalography
Abstract

Objective: The postictal state is underrecognized in epilepsy. Animal models show improvement of postictal symptoms and cerebral perfusion with acetaminophen or nimodipine. We studied the effects of acetaminophen or nimodipine on postictal electroencephalographic (EEG) recovery, clinical reorientation, and hypoperfusion in patients with ECT-induced seizures., Methods: In this prospective clinical trial with three-condition randomized crossover design, study interventions were administered orally 2 h before ECT sessions (1000 mg acetaminophen, 60 mg nimodipine, or a placebo condition). Primary outcome measure was the speed of postictal EEG recovery. Secondary outcomes were the extent of postictal EEG recovery, clinical reorientation time, and postictal cerebral blood flow as assessed by perfusion-weighted MRI. Bayesian generalized mixed-effects models were applied for analyses., Results: We included 300 seizures, postictal EEGs, and reorientation time values, and 76 MRI perfusion measures from 33 patients (median age 53 years, 19 female). Pretreatment with acetaminophen or nimodipine was not associated with change in speed of EEG recovery compared to placebo (1.13 [95%CI 0.92, 1.40] and 1.07 [95%CI 0.87, 1.31], respectively), nor with the secondary outcomes. No patient reached full EEG recovery at 1 h post-seizure, despite clinical recovery in 89%. Longer seizures were associated with slower EEG recovery and lower postictal perfusion. Nimodipine altered regional perfusion in the posterior cortex., Interpretation: Pretreatment with acetaminophen or nimodipine did not alleviate symptoms and signs of the postictal state. Systematic study of the postictal state after ECT-induced seizures is feasible., (© 2024 The Author(s). Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.)

Published
2024
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12. Sex differences in clot, vessel and tissue characteristics in patients with a large vessel occlusion treated with endovascular thrombectomy.

Author

van der Meij A, Holswilder G, Bernsen MLE, van Os HJ, Hofmeijer J, Spaander FH, Martens JM, van den Wijngaard IR, Lingsma HF, Konduri PR, Blm Majoie C, Schonewille WJ, Dippel DW, Kruyt ND, Nederkoorn PJ, van Walderveen MA, and Wermer MJ

Subjects
Humans, Female, Male, Aged, Middle Aged, Aged, 80 and over, Computed Tomography Angiography, Sex Factors, Registries, Sex Characteristics, Treatment Outcome, Cerebral Angiography, Thrombectomy methods, Endovascular Procedures methods, Ischemic Stroke diagnostic imaging, Ischemic Stroke therapy, Ischemic Stroke surgery
Abstract

Introduction: To improve our understanding of the relatively poor outcome after endovascular treatment (EVT) in women we assessed possible sex differences in baseline neuroimaging characteristics of acute ischemic stroke patients with large anterior vessel occlusion (LVO)., Patients and Methods: We included all consecutive patients from the MR CLEAN Registry who underwent EVT between 2014 and 2017. On baseline non-contrast CT and CT angiography, we assessed clot location and clot burden score (CBS), vessel characteristics (presence of atherosclerosis, tortuosity, size, and collateral status), and tissue characteristics with the Alberta Stroke Program Early Computed Tomography Score (ASPECTS). Radiological outcome was assessed with the extended thrombolysis in cerebral infarction score (eTICI) and functional outcome with the modified Rankin Scale score (mRS) at 90 days. Sex-differences were assessed with multivariable regression analyses with adjustments for possible confounders., Results: 3180 patients were included (median age 72 years, 48% women). Clots in women were less often located in the intracranial internal carotid artery (ICA) (25%vs 28%, odds ratio (OR) 0.85;95% confidence interval: 0.73-1.00). CBS was similar between sexes (median 6, IQR 4-8). Intracranial (aOR 0.73;95% CI:0.62-0.87) and extracranial (aOR 0.64;95% CI:0.43-0.95) atherosclerosis was less prevalent in women. Vessel tortuosity was more frequent in women in the cervical ICA (aOR 1.89;95% CI:1.39-2.57) and women more often had severe elongation of the aortic arch (aOR 1.38;95% CI:1.00-1.91). ICA radius was smaller in women (2.3vs 2.5 mm, mean difference 0.22;95% CI:0.09-0.35) while M1 radius was essentially equal (1.6vs 1.7 mm, mean difference 0.09;95% CI:-0.02-0.21). Women had better collateral status (⩾50% filling in 62%vs 53% in men, aOR 1.48;95% CI:1.29-1.70). Finally, ASPECT scores were equal between women and men (median 9 in both sexes, IQR 8-10vs 9-10). Reperfusion rates were similar between women and men (acOR 0.94;95% CI:0.83-1.07). However, women less often reached functional independence than men (34%vs 46%, aOR 0.68;95% CI:0.53-0.86)., Discussion and Conclusion: On baseline imaging of this Dutch Registry, men and women with LVO mainly differ in vessel characteristics such as atherosclerotic burden, extracranial vessel tortuosity, and collateral status. These sex differences do not result in different reperfusion rates and are, therefore, not likely to explain the worse functional outcome in women after EVT., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: IW reports consulting fees from Philips, and is stockholder and inventor of a patent owned by Neurophyxia; PK is a co-founder and shareholder of in Steps B.V.; and is funded by GEMINI (www.dth-gemini.eu): a European Union’s Horizon research and innovation program (Grant Agreement Number: 101136438) and RadPath AI project (2021191). CM reports grants from TWIN Foundation during the conduct of the study (paid to institution), grants from CVON. Dutch Heart Foundation, grants from European Commission, grants from Healthcare Evaluation Netherlands, grants from Stryker outside the submitted work (paid to institution), and is shareholder of Nico-lab; MJHW reports a Vidi grant [project number 91717337] which is a personal grant from the Netherlands Organization of Scientific Research (NWO/ZonMw) and an Aspasia grant.

Published
2024
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13. Cracking coma: MRI and EEG markers of outcome after cardiac arrest

Author

Klijn, C.J.M., Hofmeijer, J., Hoedemaekers, C.W.E., Keijzer, H.M., Klijn, C.J.M., Hofmeijer, J., Hoedemaekers, C.W.E., and Keijzer, H.M.

Abstract

Radboud University, 13 september 2022, Promotores : Klijn, C.J.M., Hofmeijer, J. Co-promotor : Hoedemaekers, C.W.E., Contains fulltext : 252874.pdf (Publisher’s version ) (Open Access)

Published
2022

14. Quantitative Characterization of Rhythmic and Periodic EEG Patterns in Patients in a Coma After Cardiac Arrest and Association With Outcome.

Author

van Putten MJAM, Ruijter BJ, Horn J, van Rootselaar AF, Tromp SC, van Kranen-Mastenbroek V, Gaspard N, and Hofmeijer J

Subjects
Humans, Male, Female, Middle Aged, Aged, Coma physiopathology, Coma etiology, Electroencephalography methods, Heart Arrest complications, Heart Arrest physiopathology
Abstract

Objectives: Rhythmic and periodic patterns (RPPs) on EEG in patients in a coma after cardiac arrest are associated with a poor neurologic outcome. We characterize RPPs using qEEG in relation to outcomes., Methods: Post hoc analysis was conducted on 172 patients in a coma after cardiac arrest from the TELSTAR trial, all with RPPs. Quantitative EEG included corrected background continuity index (BCI*), relative discharge power (RDP), discharge frequency, and shape similarity. Neurologic outcomes at 3 months after arrest were categorized as poor (CPC = 3-5) or good (CPC = 1-2)., Results: A total of 16 patients (9.3%) had a good outcome. Patients with good outcomes showed later RPP onset (28.5 vs 20.1 hours after arrest, p < 0.05) and higher background continuity at RPP onset (BCI * = 0.83 vs BCI * = 0.59, p < 0.05). BCI* < 0.45 at RPP onset, maximum BCI* <0.76, RDP > 0.47, or shape similarity >0.75 were consistently associated with poor outcomes, identifying 36%, 22%, 40%, or 24% of patients with poor outcomes, respectively. In patients meeting both BCI* > 0.44 at RPP onset and BCI* > 0.75 within 72 hours, the probability of good outcomes doubled to 18%., Discussion: Sufficient EEG background continuity before and during RPPs is crucial for meaningful recovery. Background continuity, discharge power, and shape similarity can help select patients with relevant chances of recovery and may guide treatment., Trial Registration Information: February 4, 2014, ClinicalTrial.gov, NCT02056236.

Published
2024
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15. Cortical excitation/inhibition ratios in patients with major depression treated with electroconvulsive therapy: an EEG analysis.

Author

Stuiver S, Pottkämper JCM, Verdijk JPAJ, Ten Doesschate F, Aalbregt E, van Putten MJAM, Hofmeijer J, and van Waarde JA

Subjects
Humans, Male, Female, Middle Aged, Adult, Aged, Cerebral Cortex physiopathology, Electroconvulsive Therapy, Depressive Disorder, Major therapy, Depressive Disorder, Major physiopathology, Electroencephalography
Abstract

Electroconvulsive therapy (ECT) is an effective treatment for major depression, but its working mechanisms are poorly understood. Modulation of excitation/inhibition (E/I) ratios may be a driving factor. Here, we estimate cortical E/I ratios in depressed patients and study whether these ratios change over the course of ECT in relation to clinical effectiveness. Five-minute resting-state electroencephalography (EEG) recordings of 28 depressed patients were recorded before and after their ECT course. Using a novel method based on critical dynamics, functional E/I (fE/I) ratios in the frequency range of 0.5-30 Hz were estimated in frequency bins of 1 Hz for the whole brain and for pre-defined brain regions. Change in Hamilton Depression Rating Scale (HDRS) score was used to estimate clinical effectiveness. To account for test-retest variability, repeated EEG recordings from an independent sample of 31 healthy controls (HC) were included. At baseline, no differences in whole brain and regional fE/I ratios were found between patients and HC. At group level, whole brain and regional fE/I ratios did not change over the ECT course. However, in responders, frontal fE/I ratios in the frequencies 12-28 Hz increased significantly (p FDR  < 0.05 [FDR = false discovery rate]) over the ECT course. In non-responders and HC, no changes occurred over time. In this sample, frontal fE/I ratios increased over the ECT course in relation to treatment response. Modulation of frontal fE/I ratios may be an important mechanism of action of ECT., (© 2023. The Author(s).)

Published
2024
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16. Ghrelin for Neuroprotection in Post-Cardiac Arrest Coma: A Randomized Clinical Trial.

Author

Nutma S, Beishuizen A, van den Bergh WM, Foudraine NA, le Feber J, Filius PMG, Cornet AD, van der Palen J, van Putten MJAM, and Hofmeijer J

Subjects
Humans, Male, Female, Middle Aged, Double-Blind Method, Aged, Neuroprotection physiology, Heart Arrest complications, Out-of-Hospital Cardiac Arrest complications, Ghrelin therapeutic use, Coma etiology, Neuroprotective Agents therapeutic use
Abstract

Importance: Out-of-hospital cardiac arrest survival rates have markedly risen in the last decades, but neurological outcome only improved marginally. Despite research on more than 20 neuroprotective strategies involving patients in comas after cardiac arrest, none have demonstrated unequivocal evidence of efficacy; however, treatment with acyl-ghrelin has shown improved functional and histological brain recovery in experimental models of cardiac arrest and was safe in a wide variety of human study populations., Objective: To determine safety and potential efficacy of intravenous acyl-ghrelin to improve neurological outcome in patients in a coma after cardiac arrest., Design, Setting, and Participants: A phase 2, double-blind, placebo-controlled, multicenter, randomized clinical trial, Ghrelin Treatment of Comatose Patients After Cardiac Arrest: A Clinical Trial to Promote Cerebral Recovery (GRECO), was conducted between January 18, 2019, and October 17, 2022. Adult patients 18 years or older who were in a comatose state after cardiac arrest were assessed for eligibility; patients were from 3 intensive care units in the Netherlands. Expected death within 48 hours or unfeasibility of treatment initiation within 12 hours were exclusion criteria., Interventions: Patients were randomized to receive intravenous acyl-ghrelin, 600 μg (intervention group), or placebo (control group) within 12 hours after cardiac arrest, continued for 7 days, twice daily, in addition to standard care., Main Outcomes and Measures: Primary outcome was the score on the Cerebral Performance Categories (CPC) scale at 6 months. Safety outcomes included any serious adverse events. Secondary outcomes were mortality and neuron-specific enolase (NSE) levels on days 1 and 3., Results: A total of 783 adult patients in a coma after cardiac arrest were assessed for eligibility, and 160 patients (median [IQR] age, 68 [57-75] years; 120 male [75%]) were enrolled. A total of 81 patients (51%) were assigned to the intervention group, and 79 (49%) were assigned to the control group. The common odds ratio (OR) for any CPC improvement in the intervention group was 1.78 (95% CI, 0.98-3.22; P = .06). This was consistent over all CPC categories. Mean (SD) NSE levels on day 1 after cardiac arrest were significantly lower in the intervention group (34 [6] μg/L vs 56 [13] μg/L; P = .04) and on day 3 (28 [6] μg/L vs 52 [14] μg/L; P = .08). Serious adverse events were comparable in incidence and type between the groups. Mortality was 37% (30 of 81) in the intervention group vs 51% (40 of 79) in the control group (absolute risk reduction, 14%; 95% CI, -2% to 29%; P = .08)., Conclusions and Relevance: In patients in a coma after cardiac arrest, intravenous treatment with acyl-ghrelin was safe and potentially effective to improve neurological outcome. Phase 3 trials are needed for conclusive evidence., Trial Registration: Clinicaltrialsregister.eu: EUCTR2018-000005-23-NL.

Published
2024
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20. Risk factors for atherosclerotic and medial arterial calcification of the intracranial internal carotid artery

Author

Majoie, C.B., Roos, Y.B., Duijm, L.E., Keizer, K., van der Lugt, A., Dippel, D.W., Droogh-de Greve, K.E., Bienfait, H.P., van Walderveen, M.A., Wermer, M.J.H., Lycklama à Nijeholt, G.J., Boiten, J., Duyndam, D., Kwa, V.I., Meijer, F.J., van Dijk, E.J., Kesselring, F.O., Hofmeijer, J., Vos, J.A., Schonewille, W.J., van Rooij, W.J., de Kort, P.L., Pleiter, C.C., Bakker, S.L., Bot, J., Visser, M.C., Velthuis, B.K., van der Schaaf, I.C., Dankbaar, J.W., Mali, W.P., van Seeters, T., Horsch, A.D., Niesten, J.M., Biessels, G.J., Kappelle, L.J., Luitse, M.J., van der Graaf, Y., Vos, Annelotte, Kockelkoren, Remko, de Vis, Jill B., van der Schouw, Yvonne T., van der Schaaf, Irene C., Velthuis, Birgitta K., Mali, Willem P.T.M., and de Jong, Pim A.

Published
2018
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21. Cerebrospinal fluid volume improves prediction of malignant edema after endovascular treatment of stroke

Author

Kauw, F., Bernsen, M.L.E., Dankbaar, J.W., Jong, H.W.A.M. de, Kappelle, L.J., Velthuis, B.K., Worp, H.B. van der, Lugt, A. van der, Roos, Y.B.W.E.M., Yo, L.S.F., Walderveen, M.A.A. van, Hofmeijer, J., Bennink, E., MR CLEAN Registry Investigators, TechMed Centre, Clinical Neurophysiology, Radiology & Nuclear Medicine, Neurology, ACS - Atherosclerosis & ischemic syndromes, and Amsterdam Neuroscience - Neurovascular Disorders

Subjects
Ischemic stroke, Neurology, thrombectomy, malignant edema, computed tomography, cerebrospinal fluid
Abstract

Background: The ratio of intracranial cerebrospinal fluid (CSF) volume to intracranial volume (ICV) has been identified as a potential predictor of malignant edema formation in patients with acute ischemic stroke. Aims: We aimed to evaluate the added value of the CSF/ICV ratio in a model to predict malignant edema formation in patients who underwent endovascular treatment. Methods: We included patients from the MR CLEAN Registry, a prospective national multicenter registry of patients who were treated with endovascular treatment between 2014 and 2017 because of acute ischemic stroke caused by large vessel occlusion. The CSF/ICV ratio was automatically measured on baseline thin-slice noncontrast CT. The primary outcome was the occurrence of malignant edema based on clinical and imaging features. The basic model included the following predictors: age, National Institutes of Health Stroke Scale, Alberta Stroke Program Early CT score, occlusion of the internal carotid artery, collateral score, time between symptom onset and groin puncture, and unsuccessful reperfusion. The extended model included the basic model and the CSF/ICV ratio. The performance of the basic and the extended model was compared with the likelihood ratio test. Results: Malignant edema occurred in 40 (6%) of 683 patients. In the extended model, a lower CSF/ICV ratio was associated with the occurrence of malignant edema (odds ratio (OR) per percentage point, 1.2; 95% confidence interval (CI) 1.1–1.3, p Conclusions: Adding the CSF/ICV ratio improves a multimodal prediction model for the occurrence of malignant edema after endovascular treatment.

Published
2023

24. 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

25. Systematic Review - Combining Neuroprotection With Reperfusion in Acute Ischemic Stroke

Author

Vos, E. M., Geraedts, V. J., van der Lugt, A., Dippel, D. W. J., Wermer, M. J. H., Hofmeijer, J., van Es, A. C. G. M., Roos, Y. B. W. E. M., Peeters-Scholte, C. M. P. C. D., van den Wijngaard, I. R., Vos, E. M., Geraedts, V. J., van der Lugt, A., Dippel, D. W. J., Wermer, M. J. H., Hofmeijer, J., van Es, A. C. G. M., Roos, Y. B. W. E. M., Peeters-Scholte, C. M. P. C. D., and van den Wijngaard, I. R.

Abstract

Background: Clinical trials of neuroprotection in acute ischemic stroke (AIS) have provided disappointing results. Reperfusion may be a necessary condition for positive effects of neuroprotective treatments. This systematic review provides an overview of efficacy of neuroprotective agents in combination with reperfusion therapy in AIS. Methods: A literature search was performed on the following databases, namely PubMed, Embase, Web of Science, Cochrane Library, Emcare. All databases were searched up to September 23rd 2021. All randomized controlled trials in which patients were treated with neuroprotective strategies within 12 h of stroke onset in combination with intravenous thrombolysis (IVT), endovascular therapy (EVT), or both were included. Results: We screened 1,764 titles/abstracts and included 30 full reports of unique studies with a total of 16,160 patients. In 15 studies neuroprotectants were tested for clinical efficacy, where all patients had to receive reperfusion therapies, either IVT and/or EVT. Heterogeneity in reported outcome measures was observed. Treatment was associated with improved clinical outcome for: 1) uric acid in patients treated with EVT and IVT, 2) nerinetide in patients who underwent EVT without IVT, 3) imatinib in stroke patients treated with IVT with or without EVT, 4) remote ischemic perconditioning and IVT, and 5) high-flow normobaric oxygen treatment after EVT, with or without IVT. Conclusion: Studies specifically testing effects of neuroprotective agents in addition to IVT and/or EVT are scarce. Future neuroprotection studies should report standardized functional outcome measures and combine neuroprotective agents with reperfusion therapies in AIS or aim to include prespecified subgroup analyses for treatment with IVT and/or EVT.

Published
2022

26. Free water corrected diffusion tensor imaging discriminates between good and poor outcomes of comatose patients after cardiac arrest.

Author

Keijzer, H.M., Duering, M., Pasternak, O., Meijer, F.J.A., Verhulst, M.M.L.H., Tonino, B.A.R., Blans, M.J., Hoedemaekers, C.W.E., Klijn, C.J.M., Hofmeijer, J., Keijzer, H.M., Duering, M., Pasternak, O., Meijer, F.J.A., Verhulst, M.M.L.H., Tonino, B.A.R., Blans, M.J., Hoedemaekers, C.W.E., Klijn, C.J.M., and Hofmeijer, J.

Abstract

Item does not contain fulltext, OBJECTIVES: Approximately 50% of comatose patients after cardiac arrest never regain consciousness. Cerebral ischaemia may lead to cytotoxic and/or vasogenic oedema, which can be detected by diffusion tensor imaging (DTI). Here, we evaluate the potential value of free water corrected mean diffusivity (MD) and fractional anisotropy (FA) based on DTI, for the prediction of neurological recovery of comatose patients after cardiac arrest. METHODS: A total of 50 patients after cardiac arrest were included in this prospective cohort study in two Dutch hospitals. DTI was obtained 2-4 days after cardiac arrest. Outcome was assessed at 6 months, dichotomised as poor (cerebral performance category 3-5; n = 20) or good (n = 30) neurological outcome. We calculated the whole brain mean MD and FA and compared between patients with good and poor outcomes. In addition, we compared a preliminary prediction model based on clinical parameters with or without the addition of MD and FA. RESULTS: We found significant differences between patients with good and poor outcome of mean MD (good: 726 [702-740] × 10(-6) mm(2)/s vs. poor: 663 [575-736] × 10(-6) mm(2)/s; p = 0.01) and mean FA (0.30 ± 0.03 vs. 0.28 ± 0.03; p = 0.03). An exploratory prediction model combining clinical parameters, MD and FA increased the sensitivity for reliable prediction of poor outcome from 60 to 85%, compared to the model containing clinical parameters only, but confidence intervals are overlapping. CONCLUSIONS: Free water-corrected MD and FA discriminate between patients with good and poor outcomes after cardiac arrest and hold the potential to add to multimodal outcome prediction. KEY POINTS: • Whole brain mean MD and FA differ between patients with good and poor outcome after cardiac arrest. • Free water-corrected MD can better discriminate between patients with good and poor outcome than uncorrected MD. • A combination of free water-corrected MD (sensitive to grey matter abnormalities) and FA (sensitive to wh

Published
2023

27. MRI factors associated with cognitive functioning after acute onset brain injury: Systematic review and meta-analysis.

Author

Verhulst, M.M.L.H., Glimmerveen, A.B., Heugten, C.M. van, Helmich, R.C.G., Hofmeijer, J., Verhulst, M.M.L.H., Glimmerveen, A.B., Heugten, C.M. van, Helmich, R.C.G., and Hofmeijer, J.

Abstract

Item does not contain fulltext, Impairments of memory, attention, and executive functioning are frequently reported after acute onset brain injury. MRI markers hold potential to contribute to identification of patients at risk for cognitive impairments and clarification of mechanisms. The aim of this systematic review was to summarize and value the evidence on MRI markers of memory, attention, and executive functioning after acute onset brain injury. We included ninety-eight studies, on six classes of MRI factors (location and severity of damage (n = 15), volume/atrophy (n = 36), signs of small vessel disease (n = 15), diffusion-weighted imaging measures (n = 36), resting-state functional MRI measures (n = 13), and arterial spin labeling measures (n = 1)). Three measures showed consistent results regarding their association with cognition. Smaller hippocampal volume was associated with worse memory in fourteen studies (pooled correlation 0.58 [95% CI: 0.46-0.68] for whole, 0.11 [95% CI: 0.04-0.19] for left, and 0.34 [95% CI: 0.17-0.49] for right hippocampus). Lower fractional anisotropy in cingulum and fornix was associated with worse memory in six and five studies (pooled correlation 0.20 [95% CI: 0.08-0.32] and 0.29 [95% CI: 0.20-0.37], respectively). Lower functional connectivity within the default-mode network was associated with worse cognition in four studies. In conclusion, hippocampal volume, fractional anisotropy in cingulum and fornix, and functional connectivity within the default-mode network showed consistent associations with cognitive performance in all types of acute onset brain injury. External validation and cut off values for predicting cognitive impairments are needed for clinical implementation.

Published
2023

28. EEG in a four-electrode frontotemporal montage reliably predicts outcome after cardiac arrest.

Author

Admiraal, M.M., Merkerk, M. van, Horn, J., Koelman, J.H.T.M., Hofmeijer, J., Hoedemaekers, C.W., Rootselaar, A.F. van, Admiraal, M.M., Merkerk, M. van, Horn, J., Koelman, J.H.T.M., Hofmeijer, J., Hoedemaekers, C.W., and Rootselaar, A.F. van

Abstract

01 juli 2023, Item does not contain fulltext, AIM: To increase efficiency of continuous EEG monitoring for prognostication of neurological outcome in patients after cardiac arrest, we investigated the reliability of EEG in a four-electrode frontotemporal (4-FT) montage, compared to our standard nine-electrode (9-EL) montage. METHODS: EEG recorded with Ag/AgCl cup-electrodes at 12 and/or 24 h after cardiac arrest of 153 patients was available from a previous study. 220 EEG epochs of 5 minutes were reexamined in a 4-FT montage according to the ACNS criteria. Background classification was compared to the available 9-EL classification using Cohens kappa. Reliability for prognostication was assessed in 151 EEG epochs at 24 h after CA using sensitivity and specificity for prediction of poor (cerebral performance categories (CPC) 3-5) and good (CPC 1-2) neurological outcome. RESULTS: Agreement for EEG background classification between the two montages was substantial with a kappa of 0.85 (95%-CI 0.81-0.90). Specificity for prediction of poor outcome was 100% (95%-CI 95-100) for both montages, sensitivity was 31% (95%-CI 21-43) for the 4-FT montage and 35% (95%-CI 24-47) for the 9-EL montage. Good outcome was predicted with 65% specificity (95%-CI 53-76) and 81% sensitivity (95%-CI 71-89) for the 4-FT montage, similar to the 9-EL montage. CONCLUSION: In this cohort, EEG background patterns determined in a four-electrode frontotemporal montage predict both poor and good outcome after CA with similar reliability. Our results may contribute to decreasing the workload of EEG monitoring in patients after CA without compromising reliability of outcome prediction. However, validation in a larger cohort is necessary, as is a multimodal approach.

Published
2023

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

Author

Olthuis, S.G.H., Pirson, F.A.V., Pinckaers, F.M.E., Hinsenveld, W.H., Nieboer, D., Ceulemans, A., Knapen, R.R.M.M., Robbe, M.M.Q., Berkhemer, O.A., Walderveen, Marianne A.A. van, Lycklama a Nijeholt, G.J., Uyttenboogaart, M., Schonewille, W.J., Sluijs, P.M. van der, Wolff, L., Voorst, H. van, Postma, A.A., Roosendaal, S.D., Hoorn, A. van der, Emmer, B.J., Krietemeijer, M.G.M., Doormaal, P.J. van, Roozenbeek, B., Goldhoorn, R.B., Staals, J., Ridder, I.R. de, Leij, C. van der, Coutinho, J.M., Worp, H.B. van der, Lo, R.T., Bokkers, R.P., Dijk, E.J. van, Boogaarts, H.D., Wermer, M.J., Es, A.C. van, Tuijl, J.H. van, Kortman, H.G., Gons, R.A., Yo, L.S., Vos, J.A., Laat, K.F. de, Dijk, L.C. van, Wijngaard, I.R. van den, Hofmeijer, J., Martens, J.M., Brouwers, P.J., Bulut, T., Remmers, M.J., Jong, T.E.A.M. de, Hertog, H.M. den, Hasselt, B.A. van, Rozeman, A.D., Elgersma, O.E.H., Veen, B. van der, Sudiono, D.R., Lingsma, H.F., Roos, Y.B.W.E.M., Majoie, C.B.L.M., Lugt, A. van der, Dippel, D.W., Zwam, W.H. van, Oostenbrugge, R.J. van, Olthuis, S.G.H., Pirson, F.A.V., Pinckaers, F.M.E., Hinsenveld, W.H., Nieboer, D., Ceulemans, A., Knapen, R.R.M.M., Robbe, M.M.Q., Berkhemer, O.A., Walderveen, Marianne A.A. van, Lycklama a Nijeholt, G.J., Uyttenboogaart, M., Schonewille, W.J., Sluijs, P.M. van der, Wolff, L., Voorst, H. van, Postma, A.A., Roosendaal, S.D., Hoorn, A. van der, Emmer, B.J., Krietemeijer, M.G.M., Doormaal, P.J. van, Roozenbeek, B., Goldhoorn, R.B., Staals, J., Ridder, I.R. de, Leij, C. van der, Coutinho, J.M., Worp, H.B. van der, Lo, R.T., Bokkers, R.P., Dijk, E.J. van, Boogaarts, H.D., Wermer, M.J., Es, A.C. van, Tuijl, J.H. van, Kortman, H.G., Gons, R.A., Yo, L.S., Vos, J.A., Laat, K.F. de, Dijk, L.C. van, Wijngaard, I.R. van den, Hofmeijer, J., Martens, J.M., Brouwers, P.J., Bulut, T., Remmers, M.J., Jong, T.E.A.M. de, Hertog, H.M. den, Hasselt, B.A. van, Rozeman, A.D., Elgersma, O.E.H., Veen, B. van der, Sudiono, D.R., Lingsma, H.F., Roos, Y.B.W.E.M., Majoie, C.B.L.M., Lugt, A. van der, Dippel, D.W., Zwam, W.H. van, and Oostenbrugge, R.J. van

Abstract

Item does not contain fulltext, BACKGROUND: Endovascular treatment for anterior circulation ischaemic stroke is effective and safe within a 6 h window. MR CLEAN-LATE aimed to assess efficacy and safety of endovascular treatment for patients treated in the late window (6-24 h from symptom onset or last seen well) selected on the basis of the presence of collateral flow on CT angiography (CTA). METHODS: MR CLEAN-LATE was a multicentre, open-label, blinded-endpoint, randomised, controlled, phase 3 trial done in 18 stroke intervention centres in the Netherlands. Patients aged 18 years or older with ischaemic stroke, presenting in the late window with an anterior circulation large-vessel occlusion and collateral flow on CTA, and a neurological deficit score of at least 2 on the National Institutes of Health Stroke Scale were included. Patients who were eligible for late-window endovascular treatment were treated according to national guidelines (based on clinical and perfusion imaging criteria derived from the DAWN and DEFUSE-3 trials) and excluded from MR CLEAN-LATE enrolment. Patients were randomly assigned (1:1) to receive endovascular treatment or no endovascular treatment (control), in addition to best medical treatment. Randomisation was web based, with block sizes ranging from eight to 20, and stratified by centre. The primary outcome was the modified Rankin Scale (mRS) score at 90 days after randomisation. Safety outcomes included all-cause mortality at 90 days after randomisation and symptomatic intracranial haemorrhage. All randomly assigned patients who provided deferred consent or died before consent could be obtained comprised the modified intention-to-treat population, in which the primary and safety outcomes were assessed. Analyses were adjusted for predefined confounders. Treatment effect was estimated with ordinal logistic regression and reported as an adjusted common odds ratio (OR) with a 95% CI. This trial was registered with the ISRCTN, ISRCTN19922220. FINDINGS: Between Feb 2, 2018

Published
2023

30. Myoclonus in comatose patients with electrographic status epilepticus after cardiac arrest: Corresponding EEG patterns, effects of treatment and outcomes.

Author

Nutma, S., Ruijter, B.J., Beishuizen, A., Tromp, S.C., Scholten, E., Horn, J., Bergh, W.M. van den, Kranen-Mastenbroek, V.H. van, Thomeer, E.C., Moudrous, W., Aries, M., Hoedemaekers, A., Doorduin, J., Putten, M.J.A. van, Hofmeijer, J., Nutma, S., Ruijter, B.J., Beishuizen, A., Tromp, S.C., Scholten, E., Horn, J., Bergh, W.M. van den, Kranen-Mastenbroek, V.H. van, Thomeer, E.C., Moudrous, W., Aries, M., Hoedemaekers, A., Doorduin, J., Putten, M.J.A. van, and Hofmeijer, J.

Abstract

Item does not contain fulltext, OBJECTIVE: To clarify the significance of any form of myoclonus in comatose patients after cardiac arrest with rhythmic and periodic EEG patterns (RPPs) by analyzing associations between myoclonus and EEG pattern, response to anti-seizure medication and neurological outcome. DESIGN: Post hoc analysis of the prospective randomized Treatment of ELectroencephalographic STatus Epilepticus After Cardiopulmonary Resuscitation (TELSTAR) trial. SETTING: Eleven ICUs in the Netherlands and Belgium. PATIENTS: One hundred and fifty-seven adult comatose post-cardiac arrest patients with RPPs on continuous EEG monitoring. INTERVENTIONS: Anti-seizure medication vs no anti-seizure medication in addition to standard care. MEASUREMENTS AND MAIN RESULTS: Of 157 patients, 98 (63%) had myoclonus at inclusion. Myoclonus was not associated with one specific RPP type. However, myoclonus was associated with a smaller probability of a continuous EEG background pattern (48% in patients with vs 75% without myoclonus, odds ratio (OR) 0.31; 95% confidence interval (CI) 0.16-0.64) and earlier onset of RPPs (24% vs 9% within 24 hours after cardiac arrest, OR 3.86;95% CI 1.64-9.11). Myoclonus was associated with poor outcome at three months, but not invariably so (poor neurological outcome in 96% vs 82%, p = 0.004). Anti-seizure medication did not improve outcome, regardless of myoclonus presence (6% good outcome in the intervention group vs 2% in the control group, OR 0.33; 95% CI 0.03-3.32). CONCLUSIONS: Myoclonus in comatose patients after cardiac arrest with RPPs is associated with poor outcome and discontinuous or suppressed EEG. However, presence of myoclonus does not interact with the effects of anti-seizure medication and cannot predict a poor outcome without false positives.

Published
2023

32. Effects of oral anticoagulation in people with atrial fibrillation after spontaneous intracranial haemorrhage (COCROACH): prospective, individual participant data meta-analysis of randomised trials.

Author

Al-Shahi Salman, R., Stephen, J., Tierney, J.F., Lewis, Steff C., Newby, D.E., Parry-Jones, A.R., White, P.M., Connolly, S.J., Benavente, O.R., Dowlatshahi, D., Cordonnier, C., Viscoli, C.M., Sheth, K.N., Kamel, H., Veltkamp, R., Larsen, K.T., Hofmeijer, J., Kerkhoff, H., Schreuder, F.H.B.M., Shoamanesh, A., Klijn, C.J.M., Worp, H.B. van der, Al-Shahi Salman, R., Stephen, J., Tierney, J.F., Lewis, Steff C., Newby, D.E., Parry-Jones, A.R., White, P.M., Connolly, S.J., Benavente, O.R., Dowlatshahi, D., Cordonnier, C., Viscoli, C.M., Sheth, K.N., Kamel, H., Veltkamp, R., Larsen, K.T., Hofmeijer, J., Kerkhoff, H., Schreuder, F.H.B.M., Shoamanesh, A., Klijn, C.J.M., and Worp, H.B. van der

Abstract

Contains fulltext : 300023.pdf (Publisher’s version ) (Open Access), BACKGROUND: The safety and efficacy of oral anticoagulation for prevention of major adverse cardiovascular events in people with atrial fibrillation and spontaneous intracranial haemorrhage are uncertain. We planned to estimate the effects of starting versus avoiding oral anticoagulation in people with spontaneous intracranial haemorrhage and atrial fibrillation. METHODS: In this prospective meta-analysis, we searched bibliographic databases and trial registries using the strategies of a Cochrane systematic review (CD012144) on June 23, 2023. We included clinical trials if they were registered, randomised, and included participants with spontaneous intracranial haemorrhage and atrial fibrillation who were assigned to either start long-term use of any oral anticoagulant agent or avoid oral anticoagulation (ie, placebo, open control, another antithrombotic agent, or another intervention for the prevention of major adverse cardiovascular events). We assessed eligible trials using the Cochrane Risk of Bias tool. We sought data for individual participants who had not opted out of data sharing from chief investigators of completed trials, pending completion of ongoing trials in 2028. The primary outcome was any stroke or cardiovascular death. We used individual participant data to construct a Cox regression model of the time to the first occurrence of outcome events during follow-up in the intention-to-treat dataset supplied by each trial, followed by meta-analysis using a fixed-effect inverse-variance model to generate a pooled estimate of the hazard ratio (HR) with 95% CI. This study is registered with PROSPERO, CRD42021246133. FINDINGS: We identified four eligible trials; three were restricted to participants with atrial fibrillation and intracranial haemorrhage (SoSTART [NCT03153150], with 203 participants) or intracerebral haemorrhage (APACHE-AF [NCT02565693], with 101 participants, and NASPAF-ICH [NCT02998905], with 30 participants), and one included a subgroup of p, 01 december 2023

Published
2023

33. Value of EEG in outcome prediction of hypoxic-ischemic brain injury in the ICU: A narrative review.

Author

Hoedemaekers, C.W.E., Hofmeijer, J., Horn, J., Hoedemaekers, C.W.E., Hofmeijer, J., and Horn, J.

Abstract

Contains fulltext : 300204.pdf (Publisher’s version ) (Open Access), Prognostication of comatose patients after cardiac arrest aims to identify patients with a large probability of favourable or unfavouble outcome, usually within the first week after the event. Electroencephalography (EEG) is a technique that is increasingly used for this purpose and has many advantages, such as its non-invasive nature and the possibility to monitor the evolution of brain function over time. At the same time, use of EEG in a critical care environment faces a number of challenges. This narrative review describes the current role and future applications of EEG for outcome prediction of comatose patients with postanoxic encephalopathy., 01 augustus 2023

Published
2023

35. Role of intravenous alteplase on late lesion growth and clinical outcome after stroke treatment

Author

Konduri, P., Cavalcante, F., van Voorst, H., Rinkel, L., Kappelhof, M., van Kranendonk, K., Treurniet, K., Emmer, B., Coutinho, J., Wolff, L., Hofmeijer, J., Uyttenboogaart, M., van Zwam, W., Roos, Y., Majoie, C., Marquering, H., Radiology & Nuclear Medicine, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: Carim - B05 Cerebral small vessel disease, and RS: Carim - B06 Imaging

Subjects
intracranial, acute stroke, neurovascular coupling, ENDOVASCULAR THERAPY, Brain edema, INFARCT GROWTH, VOLUME, TPA, RECANALIZATION, REPERFUSION, intracerebral hemorrhage, FINAL INFARCT
Abstract

Several acute ischemic stroke mechanisms that cause lesion growth continue after treatment which is detrimental to long-term clinical outcome. The potential role of intravenous alteplase treatment (IVT), a standard in stroke care, in cessing the physiological processes causing post-treatment lesion development is understudied. We analyzed patients from the MR CLEAN-NO IV trial with good quality 24-hour and 1-week follow-up Non-Contrast CT scans. We delineated hypo- and hyper-dense regions on the scans as lesion. We performed univariable logistic and linear regression to estimate the influence of IVT on the presence (growth > 0 ml) and extent of late lesion growth. The association between late lesion growth and mRS was assessed using ordinal logistic regression. Interaction analysis was performed to evaluate the influence of IVT on this association. Of the 63/116 were randomized to included patients, IVT. Median growth was 8.4(-0.88-26) ml. IVT was not significantly associated with the presence (OR: 1.24 (0.57-2.74, p = 0.59) or extent (beta = 5.1(-8.8-19), p = 0.47) of growth. Late lesion growth was associated with worse clinical outcome (aOR: 0.85(0.76-0.95), p < 0.01; per 10 ml). IVT did not influence this association (p = 0.18). We did not find evidence that IVT influences late lesion growth or the relationship between growth and worse clinical outcome. Therapies to reduce lesion development are necessary.

Published
2023

37. Restoration of postictal cortical activity after electroconvulsive therapy relates to recovery of orientation in person, place, and time.

Author

Stuiver S, Pottkämper JCM, Verdijk JPAJ, Ten Doesschate F, van Putten MJAM, Hofmeijer J, and van Waarde JA

Subjects
Humans, Seizures therapy, Time Factors, Electroencephalography, Electroconvulsive Therapy
Abstract

Background: Most patients show temporary impairments in clinical orientation after electroconvulsive therapy (ECT)-induced seizures. It is unclear how postictal reorientation relates to electroencephalography (EEG) restoration. This relationship may provide additional measures to quantify postictal recovery and shed light on neurophysiological aspects of reorientation after ECT., Methods: We analyzed prospectively collected clinical and continuous ictal and postictal EEG data from ECT patients. Postictal EEG restoration up to 1 h was estimated by the evolution of the normalized alpha-delta ratio (ADR). Times to reorientation in the cognitive domains of person, place, and time were assessed postictally. In each cognitive domain, a linear mixed model was fitted to investigate the relationships between time to reorientation and postictal EEG restoration., Results: In total, 272 pairs of ictal-postictal EEG and reorientation times of 32 patients were included. In all domains, longer time to reorientation was associated with slower postictal EEG recovery. Longer seizure duration and postictal administration of midazolam were related to longer time to reorientation in all domains. At 1-hour post-seizure, most patients were clinically reoriented, while their EEG had only partly restored., Conclusions: We show a relationship between postictal EEG restoration and clinical reorientation after ECT-induced seizures. EEG was more sensitive than reorientation time in all domains to detect postictal recovery beyond 1-hour post-seizure. Our findings indicate that clinical reorientation probably depends on gradual cortical synaptic recovery, with longer seizure duration leading to longer postsynaptic suppression after ECT seizures.

Published
2024
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38. Siamese model for collateral score prediction from computed tomography angiography images in acute ischemic stroke.

Author

Fortunati V, Su J, Wolff L, van Doormaal PJ, Hofmeijer J, Martens J, Bokkers RPH, van Zwam WH, van der Lugt A, and van Walsum T

Abstract

Introduction: Imaging biomarkers, such as the collateral score as determined from Computed Tomography Angiography (CTA) images, play a role in treatment decision making for acute stroke patients. In this manuscript, we present an end-to-end learning approach for automatic determination of a collateral score from a CTA image. Our aim was to investigate whether such end-to-end learning approaches can be used for this classification task, and whether the resulting classification can be used in existing outcome prediction models., Methods: The method consists of a preprocessing step, where the CTA image is aligned to an atlas and divided in the two hemispheres: the affected side and the healthy side. Subsequently, a VoxResNet based convolutional neural network is used to extract features at various resolutions from the input images. This is done by using a Siamese model, such that the classification is driven by the comparison between the affected and healthy using a unique set of features for both hemispheres. After masking the resulting features for both sides with the vascular region and global average pooling (per hemisphere) and concatenation of the resulting features, a fully connected layer is used to determine the categorized collateral score., Experiments: Several experiments have been performed to optimize the model hyperparameters and training procedure, and to validate the final model performance. The hyperparameter optimization and subsequent model training was done using CTA images from the MR CLEAN Registry, a Dutch multi-center multi-vendor registry of acute stroke patients that underwent endovascular treatment. A separate set of images, from the MR CLEAN Trial, served as an external validation set, where collateral scoring was assessed and compared with both human observers and a recent more traditional model. In addition, the automated collateral scores have been used in an existing functional outcome prediction model that uses both imaging and non-imaging clinical parameters., Conclusion: The results show that end-to-end learning of collateral scoring in CTA images is feasible, and does perform similar to more traditional methods, and the performance also is within the inter-observer variation. Furthermore, the results demonstrate that the end-to-end classification results also can be used in an existing functional outcome prediction model., Competing Interests: VF was employed by Quantib BV. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) WZ and RB declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Fortunati, Su, Wolff, van Doormaal, Hofmeijer, Martens, Bokkers, van Zwam, van der Lugt and van Walsum.)

Published
2024
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39. Degree of differentiation impacts neurobiological signature and resistance to hypoxia of SH-SY5Y cells.

Author

Voogd EJHF, Doorn N, Levers MR, Hofmeijer J, and Frega M

Subjects
Humans, Cell Line, Tumor, Cell Differentiation, Hypoxia, Neuroblastoma metabolism, Induced Pluripotent Stem Cells metabolism, Brain Diseases
Abstract

Objective. SH-SY5Y cells are valuable neuronal in vitro models for studying patho-mechanisms and treatment targets in brain disorders due to their easy maintenance, rapid expansion, and low costs. However, the use of various degrees of differentiation hampers appreciation of results and may limit the translation of findings to neurons or the brain. Here, we studied the neurobiological signatures of SH-SY5Y cells in terms of morphology, expression of neuronal markers, and functionality at various degrees of differentiation, as well as their resistance to hypoxia. We compared these to neurons derived from human induced pluripotent stem cells (hiPSCs), a well-characterized neuronal in vitro model. Approach. We cultured SH-SY5Y cells and neurons derived from hiPSCs on glass coverslips or micro-electrode arrays. We studied expression of mature neuronal markers, electrophysiological activity, and sensitivity to hypoxia at various degrees of differentiation (one day up to three weeks) in SH-SY5Y cells. We used hiPSC derived neurons as a reference. Main results. Undifferentiated and shortly differentiated SH-SY5Y cells lacked neuronal characteristics. Expression of neuronal markers and formation of synaptic puncta increased during differentiation. Longer differentiation was associated with lower resistance to hypoxia. At three weeks of differentiation, MAP2 expression and vulnerability to hypoxia were similar to hiPSC-derived neurons, while the number of synaptic puncta and detected events were significantly lower. Our results show that at least three weeks of differentiation are necessary to obtain neurobiological signatures that are comparable to those of hiPSC-derived neurons, as well as similar sensitivities to metabolic stress . Significance. This indicates that extended differentiation protocols should be used to study neuronal characteristics and to model brain disorders with SH-SY5Y cells. We provided insights that may offer the basis for the utilization of SH-SY5Y cells as a more relevant neuronal model in the study of brain disorders., (Creative Commons Attribution license.)

Published
2024
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40. Sex differences in outcomes after endovascular treatment in posterior circulation stroke: results from the MR CLEAN Registry.

Author

Ali M, Dekker L, Ali M, Van Zwet EW, Hofmeijer J, Nederkoorn PJ, Majoie CB, van Es AC, Uyttenboogaart M, van der Meij A, van Walderveen MAA, Visser MC, Dippel DW, Schonewille WJ, van den Wijngaard IR, Kruyt ND, and Wermer MJH

Abstract

Background: Women with anterior circulation large vessel occlusion (LVO) have been reported to have worse outcomes after endovascular treatment (EVT) than men. Whether these disparities also exist in LVO of the posterior circulation is yet uncertain. We assessed sex differences in clinical, technical, and safety outcomes of EVT in posterior circulation LVO., Methods: We used data of patients with posterior circulation LVO included in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry (2014-2018). Primary outcome was the modified Rankin Scale (mRS) score at 90 days assessed with multivariable ordinal regression analysis. Secondary outcomes included favorable functional outcome (mRS ≤3), functional independence (mRS ≤2), death within 90 days, National Institutes of Health Stroke Scale (NIHSS) score 24-48 hours postintervention, complications, successful reperfusion (extended Thrombolysis in Cerebral Ischemia 2B-3), and procedure duration analyzed with multivariable logistic and linear regression analyses., Results: We included 264 patients (42% women). Compared with men, women were older (median age 68 vs 63 years), more often had prestroke disability (mRS ≥1: 37% vs 30%), and received intravenous thrombolytics less often (45% vs 56%). Clinical outcomes were similar between sexes (adjusted (common) OR (aOR) 0.82, 95% CI 0.51 to 1.34; favorable functional outcome 50% vs 43%, aOR 1.31, 95% CI 0.77 to 2.25; death 32% vs 29%, aOR 0.98, 95% CI 0.52 to 1.84). In addition, NIHSS score after 24-48 hours (median 7 vs 9), successful reperfusion (77% vs 73%), and complications did not differ between men and women., Conclusions: Outcomes in women treated with EVT for posterior circulation LVO were similar compared with men despite less favorable baseline characteristics in women. Therefore men and women may benefit equally from EVT., Competing Interests: Competing interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: MJHW reports funding from NWO/ZonMw (VIDI 91717337 and Aspasia). JH reports funding from the Dutch Heart Foundation (CEI 2018T070). CBLMM reports funding from the TWIN Foundation, CVON/Dutch Heart Foundation, European Commission, Healthcare Evaluation Netherlands, and Stryker, all outside the submitted work (paid to institution). In addition, he is shareholder of Nicolab. IRvdW reports consulting fees from Philips, Medtronic, and Neurophyxia. DWJD reports funding from the Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organization for Health Research and Development, Health Holland Top Sector Life Sciences & Health, and unrestricted grants from Penumbra Inc, Stryker European Operations BV, Medtronic, Thrombolytic Science, LLC and Cerenovus, all paid to the institution. The other authors had no conflicting interests., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

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2024
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41. Cognitive screening and rehabilitation after cardiac arrest: only a few hurdles to take.

Author

van Til JA, Hemels MEW, and Hofmeijer J

Abstract

Dutch and European guidelines recommend systematic screening for cognitive and emotional impairments in cardiac arrest survivors. We aimed to clarify opinions on cognitive screening and rehabilitation, identify barriers and facilitators for implementation in the Netherlands, and arrive at recommendations in this field. We conducted 22 semi-structured interviews with various stakeholders using the Tailored Implementation in Chronic Diseases checklist. There is broad-based acknowledgement of the relevance of cognitive impairment and a positive attitude regarding early cognitive screening among health professionals and patients. Barriers to implementation include a lack of practical recommendations on how, where and when to screen, insufficient knowledge of cognitive consequences of cardiac arrest, insufficient collaboration and knowledge sharing among different specialties within hospitals, insufficient resources, and insufficient evidence of the effectiveness of screening and therapy to justify financial compensation. Most of the identified barriers to implementation are solvable: national guidelines need practical recommendations and knowledge gaps among healthcare workers can be bridged by in-hospital collaboration. Fulfilling these requirements should be sufficient for the implementation of simple screening and tailored advice. More extensive cognitive rehabilitation therapy needs stronger evidence of efficacy in order to warrant stronger guideline recommendations and financial reimbursement., (© 2023. The Author(s).)

Published
2024
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42. Additional predictive value of optic nerve sheath diameter for neurological prognosis after cardiac arrest: a prospective cohort study.

Author

Verhulst MMLH, Visser IM, Keijzer HM, de Kruijf NLM, Peters EJG, Wilbers T, Peelen RV, Hofmeijer J, and Blans MJ

Abstract

Background: The goal is to estimate the additional value of ultrasonographic optic nerve sheath diameter (ONSD) measurement on days 1-3, on top of electroencephalography (EEG), pupillary light reflexes (PLR), and somatosensory evoked potentials (SSEP), for neurological outcome prediction of comatose cardiac arrest patients. We performed a prospective longitudinal cohort study in adult comatose patients after cardiac arrest. ONSD was measured on days 1-3 using ultrasound. Continuous EEG, PLR, and SSEP were acquired as standard care. Poor outcome was defined as cerebral performance categories 3-5 at 3-6 months. Logistic regression models were created for outcome prediction based on the established predictors with and without ONSD. Additional predictive value was assessed by increase in sensitivity for poor (at 100% specificity) and good outcome (at 90% specificity)., Results: We included 100 patients, 54 with poor outcome. Mean ONSD did not differ significantly between patients with good and poor outcome. Sensitivity for predicting poor outcome increased by adding ONSD to EEG and SSEP from 25% to 41% in all patients and from 27% to 50% after exclusion of patients with non-neurological death., Conclusions: ONSD on days 1-3 after cardiac arrest holds potential to add to neurological outcome prediction., Trial Registration: clinicaltrials.gov, NCT04084054. Registered 10 September 2019, https://www., Clinicaltrials: gov/study/NCT04084054 ., (© 2023. The Author(s).)

Published
2023
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43. Handling missing values in the analysis of between-hospital differences in ordinal and dichotomous outcomes: a simulation study.

Author

van Linschoten RCA, Amini M, van Leeuwen N, Eijkenaar F, den Hartog SJ, Nederkoorn PJ, Hofmeijer J, Emmer BJ, Postma AA, van Zwam W, Roozenbeek B, Dippel D, and Lingsma HF

Subjects
Humans, Reproducibility of Results, Prospective Studies, Computer Simulation, Brain Ischemia, Stroke therapy
Abstract

Missing data are frequently encountered in registries that are used to compare performance across hospitals. The most appropriate method for handling missing data when analysing differences in outcomes between hospitals with a generalised linear mixed model is unclear. We aimed to compare methods for handling missing data when comparing hospitals on ordinal and dichotomous outcomes. We performed a simulation study using data from the Multicentre Randomised Controlled Trial of Endovascular Treatment for Acute Ischaemic Stroke in the Netherlands (MR CLEAN) Registry, a prospective cohort study in 17 hospitals performing endovascular therapy for ischaemic stroke in the Netherlands. The investigated methods for handling missing data, both case-mix adjustment variables and outcomes, were complete case analysis, single imputation, multiple imputation, single imputation with deletion of imputed outcomes and multiple imputation with deletion of imputed outcomes. Data were generated as missing completely at random (MCAR), missing at random and missing not at random (MNAR) in three scenarios: (1) 10% missing data in case-mix and outcome; (2) 40% missing data in case-mix and outcome; and (3) 40% missing data in case-mix and outcome with varying degree of missing data among hospitals. Bias and reliability of the methods were compared on the mean squared error (MSE, a summary measure combining bias and reliability) relative to the hospital effect estimates from the complete reference data set. For both the ordinal outcome (ie, the modified Rankin Scale) and a common dichotomised version thereof, all methods of handling missing data were biased, likely due to shrinkage of the random effects. The MSE of all methods was on average lowest under MCAR and with fewer missing data, and highest with more missing data and under MNAR. The 'multiple imputation, then deletion' method had the lowest MSE for both outcomes under all simulated patterns of missing data. Thus, when estimating hospital effects on ordinal and dichotomous outcomes in the presence of missing data, the least biased and most reliable method to handle these missing data is 'multiple imputation, then deletion'., Competing Interests: Competing interests: WvZ has received consulting fees from Codman and Stryker. DD has received research grants from Stryker and Bracco Imaging., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2023
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44. Effects of oral anticoagulation in people with atrial fibrillation after spontaneous intracranial haemorrhage (COCROACH): prospective, individual participant data meta-analysis of randomised trials.

Author

Al-Shahi Salman R, Stephen J, Tierney JF, Lewis SC, Newby DE, Parry-Jones AR, White PM, Connolly SJ, Benavente OR, Dowlatshahi D, Cordonnier C, Viscoli CM, Sheth KN, Kamel H, Veltkamp R, Larsen KT, Hofmeijer J, Kerkhoff H, Schreuder FHBM, Shoamanesh A, Klijn CJM, and van der Worp HB

Subjects
Humans, Prospective Studies, Intracranial Hemorrhages chemically induced, Anticoagulants adverse effects, Randomized Controlled Trials as Topic, Atrial Fibrillation complications, Atrial Fibrillation drug therapy, Stroke prevention & control
Abstract

Background: The safety and efficacy of oral anticoagulation for prevention of major adverse cardiovascular events in people with atrial fibrillation and spontaneous intracranial haemorrhage are uncertain. We planned to estimate the effects of starting versus avoiding oral anticoagulation in people with spontaneous intracranial haemorrhage and atrial fibrillation., Methods: In this prospective meta-analysis, we searched bibliographic databases and trial registries using the strategies of a Cochrane systematic review (CD012144) on June 23, 2023. We included clinical trials if they were registered, randomised, and included participants with spontaneous intracranial haemorrhage and atrial fibrillation who were assigned to either start long-term use of any oral anticoagulant agent or avoid oral anticoagulation (ie, placebo, open control, another antithrombotic agent, or another intervention for the prevention of major adverse cardiovascular events). We assessed eligible trials using the Cochrane Risk of Bias tool. We sought data for individual participants who had not opted out of data sharing from chief investigators of completed trials, pending completion of ongoing trials in 2028. The primary outcome was any stroke or cardiovascular death. We used individual participant data to construct a Cox regression model of the time to the first occurrence of outcome events during follow-up in the intention-to-treat dataset supplied by each trial, followed by meta-analysis using a fixed-effect inverse-variance model to generate a pooled estimate of the hazard ratio (HR) with 95% CI. This study is registered with PROSPERO, CRD42021246133., Findings: We identified four eligible trials; three were restricted to participants with atrial fibrillation and intracranial haemorrhage (SoSTART [NCT03153150], with 203 participants) or intracerebral haemorrhage (APACHE-AF [NCT02565693], with 101 participants, and NASPAF-ICH [NCT02998905], with 30 participants), and one included a subgroup of participants with previous intracranial haemorrhage (ELDERCARE-AF [NCT02801669], with 80 participants). After excluding two participants who opted out of data sharing, we included 412 participants (310 [75%] aged 75 years or older, 249 [60%] with CHA 2 DS 2 -VASc score ≤4, and 163 [40%] with CHA 2 DS 2 -VASc score >4). The intervention was a direct oral anticoagulant in 209 (99%) of 212 participants who were assigned to start oral anticoagulation, and the comparator was antiplatelet monotherapy in 67 (33%) of 200 participants assigned to avoid oral anticoagulation. The primary outcome of any stroke or cardiovascular death occurred in 29 (14%) of 212 participants who started oral anticoagulation versus 43 (22%) of 200 who avoided oral anticoagulation (pooled HR 0·68 [95% CI 0·42-1·10]; I 2 =0%). Oral anticoagulation reduced the risk of ischaemic major adverse cardiovascular events (nine [4%] of 212 vs 38 [19%] of 200; pooled HR 0·27 [95% CI 0·13-0·56]; I 2 =0%). There was no significant increase in haemorrhagic major adverse cardiovascular events (15 [7%] of 212 vs nine [5%] of 200; pooled HR 1·80 [95% CI 0·77-4·21]; I 2 =0%), death from any cause (38 [18%] of 212 vs 29 [15%] of 200; 1·29 [0·78-2·11]; I 2 =50%), or death or dependence after 1 year (78 [53%] of 147 vs 74 [51%] of 145; pooled odds ratio 1·12 [95% CI 0·70-1·79]; I 2 =0%)., Interpretation: For people with atrial fibrillation and intracranial haemorrhage, oral anticoagulation had uncertain effects on the risk of any stroke or cardiovascular death (both overall and in subgroups), haemorrhagic major adverse cardiovascular events, and functional outcome. Oral anticoagulation reduced the risk of ischaemic major adverse cardiovascular events, which can inform clinical practice. These findings should encourage recruitment to, and completion of, ongoing trials., Funding: British Heart Foundation., Competing Interests: Declaration of interests SJC reports institutional funding from Daiichi Sankyo. CC reports funding from the French Ministry of Health, Novartis (advisory board), and Biogen, Bayer and Bristol Myers Squibb (BMS; steering committees). HK reports funding from the US National Institutes of Health (NIH) and National Institute of Neurological Disorders and Stroke (NINDS; U01NS095869, R01HL144541, R01NS123576, and U01NS106513); funding from BMS-Pfizer Alliance; funding from Roche Diagnostics; being Deputy Editor for JAMA Neurology; participation on clinical trial steering or executive committees for Medtronic, Janssen, and Javelin Medical; participation on endpoint adjudication committees for AstraZeneca, Novo Nordisk, and Boehringer Ingelheim; and household ownership interests in TETMedical, Spectrum Plastics Group, and Burke Porter Group. CJMK and FHBMS report institutional funding from the Dutch Heart Foundation Clinical Established Investigator grant (2012T077) for APACHE-AF. DEN reports institutional funding from BMS and provision of a PET tracer from Life Molecular Imaging. APJ reports personal consulting fees and speaker fees from AstraZeneca. RA-SS reports institutional funding from the British Heart Foundation (CS/18/2/33719) for this work, institutional funding from the UK National Institute for Health and Care Research and The Stroke Association outside the submitted work, being Data Monitoring Committee chair for ELAN (NCT03148457), and consulting fees paid to the University of Edinburgh from Recursion Pharmaceuticals, Bioxodes, and Population Health Research Institute at McMaster University (Hamilton, ON, Canada). KS reports institutional funding from NIH NINDS (U01NS106513, U24NS129500, R01MD016178, R01EB31114, U24NS107215, R01NR018335, R01NS110721), American Heart Association, Hyperfine, Biogen, and Bard, and consulting fees from Astrocyte, Zoll and Sense (Data Safety and Monitoring Board), and CSL Behring. AS reports institutional funding from Heart and Stroke Foundation of Canada, Canadian Institutes of Health Research, NIH, Bayer, Daiichi Sankyo, and Servier Canada; consulting fees from Bayer, Daiichi Sankyo, Servier Canada, AstraZeneca, and Bioxodes; speaker fees from Bayer, Daiichi Sankyo, Servier Canada, and AstraZeneca; payment for expert testimony from Canadian Medical Protective Agency, support for meetings from Bayer, and Data Monitoring Committee membership for Bayer. HBvdW reports institutional funding from Stryker, Dutch Heart Foundation, and the EU, consulting fees from Bayer and TargED, and membership of the Executive Committee of the European Stroke Organisation. RV reports institutional funding from Bayer, BMS, Pfizer, Daiichi Sankyo, Boehringer, and Medtronic; consulting fees from AstraZeneca; speaker fees from BMS-Pfizer, Data Monitoring Committee participation for Bayer and Portola; stock options in Bayer and Novartis; materials from Medtronic; and chair of the World Stroke Organisation research committee. CV reports personal support from NIH NINDS (UO1NS106513). PMW reports institutional funding from Stryker, Medtronic, and Penumbra, and Data Monitoring Committee membership for PROTECT-U, TENSION, and MR CLEAN NO IV. All other authors declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Published
2023
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45. Prognosis After Cardiac Arrest: The Additional Value of DWI and FLAIR to EEG.

Author

Keijzer HM, Verhulst MMLH, Meijer FJA, Tonino BAR, Bosch FH, Klijn CJM, Hoedemaekers CWE, and Hofmeijer J

Subjects
Cohort Studies, Electroencephalography methods, Humans, Prognosis, Prospective Studies, Coma diagnostic imaging, Coma etiology, Heart Arrest complications, Heart Arrest diagnostic imaging, Heart Arrest therapy
Abstract

Background: Despite application of the multimodal European Resuscitation Council and European Society of Intensive Care Medicine algorithm, neurological prognosis of patients who remain comatose after cardiac arrest remains uncertain in a large group of patients. In this study, we investigate the additional predictive value of visual and quantitative brain magnetic resonance imaging (MRI) to electroencephalography (EEG) for outcome estimation of comatose patients after cardiac arrest., Methods: We performed a prospective multicenter cohort study in patients after cardiac arrest submitted in a comatose state to the intensive care unit of two Dutch hospitals. Continuous EEG was recorded during the first 3 days and MRI was performed at 3 ± 1 days after cardiac arrest. EEG at 24 h and ischemic damage in 21 predefined brain regions on diffusion weighted imaging and fluid-attenuated inversion recovery on a scale from 0 to 4 were related to outcome. Quantitative MRI analyses included mean apparent diffusion coefficient (ADC) and percentage of brain volume with ADC < 450 × 10 -6 mm 2 /s, < 550 × 10 -6 mm 2 /s, and < 650 × 10 -6 mm 2 /s. Poor outcome was defined as a Cerebral Performance Category score of 3-5 at 6 months., Results: We included 50 patients, of whom 20 (40%) demonstrated poor outcome. Visual EEG assessment correctly identified 3 (15%) with poor outcome and 15 (50%) with good outcome. Visual grading of MRI identified 13 (65%) with poor outcome and 25 (89%) with good outcome. ADC analysis identified 11 (55%) with poor outcome and 3 (11%) with good outcome. EEG and MRI combined could predict poor outcome in 16 (80%) patients at 100% specificity, and good outcome in 24 (80%) at 63% specificity. Ischemic damage was most prominent in the cortical gray matter (75% vs. 7%) and deep gray nuclei (45% vs. 3%) in patients with poor versus good outcome., Conclusions: Magnetic resonance imaging is complementary with EEG for the prediction of poor and good outcome of patients after cardiac arrest who are comatose at admission., (© 2022. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.)

Published
2022
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46. ESICM LIVES 2016: part three: Milan, Italy. 1–5 October 2016

Author

Velasquez, T., Mackey, G., Lusk, J., Kyle, U. G., Fontenot, T., Marshall, P., Shekerdemian, L. S., Coss-Bu, J. A., Nishigaki, A., Yatabe, T., Tamura, T., Yamashita, K., Yokoyama, M., Ruiz-Rodriguez, J. C., Encina, B., Belmonte, R., Troncoso, I., Tormos, P., Riveiro, M., Baena, J., Sanchez, A., Bañeras, J., Cordón, J., Duran, N., Ruiz, A., Caballero, J., Nuvials, X., Riera, J., Serra, J., Rutten, A. M. F., van Ieperen, S. N. M., Der Kinderen, E. P. H. M., Van Logten, T., Kovacikova, L., Skrak, P., Zahorec, M., Kyle, U. G., Akcan-Arikan, A., Silva, J. C., Mackey, G., Lusk, J., Goldsworthy, M., Shekerdemian, L. S., Coss-Bu, J. A., Wood, D., Harrison, D., Parslow, R., Davis, P., Pappachan, J., Goodwin, S., Ramnarayan, P., Chernyshuk, S., Yemets, H., Zhovnir, V., Pulitano’, S. M., De Rosa, S., Mancino, A., Villa, G., Tosi, F., Franchi, P., Conti, G., Patel, B., Khine, H., Shah, A., Sung, D., Singer, L., Haghbin, S., Inaloo, S., Serati, Z., Idei, M., Nomura, T., Yamamoto, N., Sakai, Y., Yoshida, T., Matsuda, Y., Yamaguchi, Y., Takaki, S., Yamaguchi, O., Goto, T., Longani, N., Medar, S., Abdel-Aal, I. R., El Adawy, A. S., Mohammed, H. M. E. H., Mohamed, A. N., Parry, S. M., Knight, L. D., Denehy, L., De Morton, N., Baldwin, C. E., Sani, D., Kayambu, G., da Silva, V. Z. M., Phongpagdi, P., Puthucheary, Z. A., Granger, C. L., Rydingsward, J. E., Horkan, C. M., Christopher, K. B., McWilliams, D., Jones, C., Reeves, E., Atkins, G., Snelson, C., Aitken, L. M., Rattray, J., Kenardy, J., Hull, A. M., Ullman, A., Le Brocque, R., Mitchell, M., Davis, C., Macfarlane, B., Azevedo, J. C., Rocha, L. L., De Freitas, F. F. M., Cavalheiro, A. M., Lucinio, N. M., Lobato, M. S., Ebeling, G., Kraegpoeth, A., Laerkner, E., De Brito-Ashurst, I., White, C., Gregory, S., Forni, L. G., Flowers, E., Curtis, A., Wood, C. A., Siu, K., Venkatesan, K., Muhammad, J. B. H., Ng, L., Seet, E., Baptista, N., Escoval, A., Tomas, E., Agrawal, R., Mathew, R., Varma, A., Dima, E., Charitidou, E., Perivolioti, E., Pratikaki, M., Vrettou, C., Giannopoulos, A., Zakynthinos, S., Routsi, C., Atchade, E., Houzé, S., Jean-Baptiste, S., Thabut, G., Genève, C., Tanaka, S., Lortat-Jacob, B., Augustin, P., Desmard, M., Montravers, P., de Molina, F. J. González, Barbadillo, S., Alejandro, R., Álvarez-Lerma, F., Vallés, J., Catalán, R. M., Palencia, E., Jareño, A., Granada, R. M., Ignacio, M. L., Cui, N., Liu, D., Wang, H., Su, L., Qiu, H., Li, R., Jaffal, K., Rouzé, A., Poissy, J., Sendid, B., Nseir, S., Paramythiotou, E., Rizos, M., Frantzeskaki, F., Antoniadou, A., Vourli, S., Zerva, L., Armaganidis, A., Riera, J., Gottlieb, J., Greer, M., Wiesner, O., Martínez, M., Acuña, M., Rello, J., Welte, T., Atchade, E., Mignot, T., Houzé, S., Jean-Baptiste, S., Thabut, G., Lortat-Jacob, B., Tanaka, S., Augustin, P., Desmard, M., Montravers, P., Soussi, S., Dudoignon, E., Ferry, A., Chaussard, M., Benyamina, M., Alanio, A., Touratier, S., Chaouat, M., Lafaurie, M., Mimoun, M., Mebazaa, A., Legrand, M., Sheils, M. A., Patel, C., Mohankumar, L., Akhtar, N., Noriega, S. K. Pacheco, Aldana, N. Navarrete, León, J. L. Ávila, Baquero, J. Durand, Bernal, F. Fernández, Ahmadnia, E., Hadley, J. S., Millar, M., Hall, D., Hewitt, H., Yasuda, H., Sanui, M., Komuro, T., Kawano, S., Andoh, K., Yamamoto, H., Noda, E., Hatakeyama, J., Saitou, N., Okamoto, H., Kobayashi, A., Takei, T., Matsukubo, S., Rotzel, H. B., Lázaro, A. Serrano, Prada, D. Aguillón, Gimillo, M. Rodriguez, Barinas, O. Diaz, Cortes, M. L. Blasco, Franco, J. Ferreres, Roca, J. M. Segura, Carratalá, A., Gonçalves, B., Turon, R., Mendes, A., Miranda, F., Mata, P. J., Cavalcanti, D., Melo, N., Lacerda, P., Kurtz, P., Righy, C., Rosario, L. E. de la Cruz, Lesmes, S. P. Gómez, Romero, J. C. García, Herrera, A. N. García, Pertuz, E. D. Díaz, Sánchez, M. J. Gómez, Sanz, E. Regidor, Hualde, J. Barado, Hernández, A. Ansotegui, Irazabal, J. M. Guergué, Spatenkova, V., Bradac, O., Suchomel, P., Urli, T., Lazzeri, E. Heusch, Aspide, R., Zanello, M., Perez-Borrero, L., Garcia-Alvarez, J. M., Arias-Verdu, M. 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A., Braschi, A., Beduneau, G., Pham, T., Schortgen, F., Piquilloud, L., Zogheib, E., Jonas, M., Grelon, F., Runge, I., Terzi, N., Grangé, S., Barberet, G., Guitard, P. G., Frat, J. P., Constan, A., Chrétien, J. M., Mancebo, J., Mercat, A., Richard, J. C. M., Brochard, L., Kondili, E., Psarologakis, C., Kokkini, S., Amargianitakis, V., Babalis, D., Chytas, A., Chouvarda, I., Vaporidi, K., Georgopoulos, D., Trapp, O., Kalenka, A., Mojoli, F., Orlando, A., Bianchi, I., Torriglia, F., Bianzina, S., Pozzi, M., Iotti, G. A., Braschi, A., Lozano, J. A. Benítez, Sánchez, P. Carmona, Francioni, J. E. Barrueco, Ferrón, F. Ruiz, Simón, J. M. Serrano, Spadaro, S., Karbing, D. S., Gioia, A., Moro, F., Corte, F. Dalla, Mauri, T., Volta, C. A., Rees, S. E., Petrova, M. V., Mohan, R., Butrov, A. V., Beeharry, S. D., Vatsik, M. V., Sakieva, F. I., Gobert, F., Yonis, H., Tapponnier, R., Fernandez, R., Labaune, M. A., Burle, J. F., Barbier, J., Vincent, B., Cleyet, M., Richard, J. 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J., Gonzalez, C. A., Pinto, J. L., Orozco, V., Patiño, J. A., Garcia, P. K., Contreras, K. M., Rodriguez, P., Echeverri, J. E., GETGAG Working Group, JSEPTIC (Japanese Society of Education for Physicians and Trainees in Intensive Care) Clinical Trial Group, CAPCRI Study, for the ReVA Research Network and the PROVE Network Investigators, from the FROG ICU Investigators, The WIND study group, Plug Working Group, GETGAG/SEMICYUC, AKI Research Group, St George’s University of London, IPREA Study Group, FINNRESUSCI Study Group, PICS- HCPA: Programa Intrahospitalar de Combate à Sepse do Hospital de Clínicas de Porto Alegre, ENVIN-HELICS Study Group, ARIAM registry of adult cardiac surgery, The Rapid Diagnosis of Infections in the Critically Ill Team, Tokyo Womens Medical University, PLUG working group, PLUG Working Group, On behalf of Okayama Research Investigation Organizing Network (ORION)investigators, PS-ICU Group, Japan Septic Disseminated Intravascular Coagulation (JSEPTIC DIC) study group, Student Research Committee - Shiraz University of Medical Sciences, ARIAM-ANDALUCIA, The WIND study group, PLUG Working Group, The WIND study group, PLUG Working Group, and Plug working group

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2016
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47. ESICM LIVES 2016: part two: Milan, Italy. 1–5 October 2016

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Sivakumar, S., Taccone, F. S., Desai, K. A., Lazaridis, C., Skarzynski, M., Sekhon, M., Henderson, W., Griesdale, D., Chapple, L., Deane, A., Williams, L., Strickland, R., Lange, K., Heyland, D., Chapman, M., Rowland, M. J., Garry, P., Westbrook, J., Corkill, R., Antoniades, C. A., Pattinson, K. T., Fatania, G., Strong, A. J., Myers, R. B., Lazaridis, C., Jermaine, C. M., Robertson, C. S., Rusin, C. G., Hofmeijer, J., Sondag, L., Tjepkema-Cloostermans, M. C., Beishuizen, A., Bosch, F. H., van Putten, M. J. A. M., Carteron, L., Patet, C., Solari, D., Oddo, M., Ali, M. A., Dias, C., Almeida, R., Vaz-Ferreira, A., Silva, J., Monteiro, E., Cerejo, A., Rocha, A. P., Elsayed, A. A., Abougabal, A. M., Beshey, B. N., Alzahaby, K. M., Pozzebon, S., Ortiz, A. Blandino, Cristallini, S., Lheureux, O., Brasseur, A., Vincent, J. L., Creteur, J., Taccone, F. S., Hravnak, M., Yousef, K., Chang, Y., Crago, E., Friedlander, R. M., Abdelmonem, S. A., Tahon, S. A., Helmy, T. A., Meligy, H. S., Puig, F., Dunn-Siegrist, I., Pugin, J., Gupta, S., Govil, D., Srinivasan, S., Patel, S. J., N, J. K., Gupta, A., Tomar, D. S., Shafi, M., Harne, R., Arora, D. P., Talwar, N., Mazumdar, S., Papakrivou, E. E., Makris, D., Manoulakas, E., Tsolaki, B., Karadodas, B., Zakynthinos, E., Garcia, I. Palacios, Martin, A. Diaz, Encinares, V. Sanchez, Ibañez, M. Pachón, Montero, J. Garnacho, Labrador, G., Cangueiro, T. Cebrero, Poulose, V., Koh, J., Kam, J. W., Yeter, H., Kara, A., Aktepe, O., Topeli, A., Tsolakoglou, I., Intas, G., Stergiannis, P., Kolaros, A. A., Chalari, E., Athanasiadou, E., Martika, A., Fildisis, G., Faivre, V., Mengelle, C., Favier, B., Payen, D., Poppe, A., Winkler, M. S., Mudersbach, E., Schreiber, J., Wruck, M. L., Schwedhelm, E., Kluge, S., Zöllner, C., Tavladaki, T., Spanaki, A. M., Dimitriou, H., Kondili, E., Choulaki, C., Meleti, E., Kafetzopoulos, D., Georgopoulos, D., Briassoulis, G., la Torre, A. García-de, de la Torre-Prados, M. V., Tsvetanova-Spasova, T., Nuevo-Ortega, P., Rueda-Molina, C., Fernández-Porcel, A., Camara-Sola, E., Salido-Díaz, L., García-Alcántara, A., Tavladaki, T., Spanaki, A. M., Dimitriou, H., Kondili, E., Choulaki, C., Meleti, D. E., Kafetzopoulos, D., Georgopoulos, D., Briassoulis, G., Suberviola, B., Riera, J., Rellan, L., Sanchez, M., Robles, J. C., Lopez, E., Vicente, R., Miñambres, E., Santibañez, M., Le Guen, M., Moore, J., Mason, N., Windpassinger, M., Plattner, O., Mascha, E., Sessler, D. I., Research, Outcomes, Melia, U., Fontanet, J., van den Berg, J. P., Struys, M. M. R. F., Vereecke, H. E. M., Jensen, E. W., Rood, P. J. T., van de Schoor, F., van Tertholen, K., Pickkers, P., van den Boogaard, M., Beardow, Z. J., Redhead, H., Paramasivam, K., Numan, T., van den Boogaard, M., Kamper, A. M., Rood, P., Peelen, L. M., Zeman, P. M., Slooter, A. J., van Ewijk, C. E., Jacobs, G. E., Girbes, A. R. J., Myatra, S. N., Harish, M. M., Prabu, N. R., Siddiqui, S., Kulkarni, A. P., Divatia, J. V., Murbach, L. D., Leite, M. A., Osaku, E. F., Costa, C. R. L. M., Pelenz, M., Neitzke, N. M., Moraes, M. M., Jaskowiak, J. L., Silva, M. M. M., Zaponi, R. S., Abentroth, L. R. L., Ogasawara, S. M., Jorge, A. C., Duarte, P. A. D., Hernández-Sánchez, N., Sánchez-Hurtado, L. A., García-Guillen, F. J., Ñamendys-Silva, S. A., Maghsoudi, B., Emami, M., Khosravi, M. B., Zand, F., Tabatabaie, H. R., Masjedi, M., Sabetiyan, G., Mokri, A., Troubleyn, J., Diltoer, M., Jacobs, R., Nguyen, D. N., De Waele, E., De Regt, J., Honoré, P. M., Van Gorp, V., Spapen, H. D., Contreras, R. S., Toapanta, N. D., Moreno, G., Sabater, J., Torrado, H., Gonzalez, M., Marin, M., Farigola, E., Gonzalez, A., Fernandez, J., Vera, A., Gisbert, X., Juliá, C., Uya, J., Corral, L., Elias-Jones, I., Gemmell, L., MacKay, A., Randall, D., Adwaney, A., Blunden, M., Prowle, J. R., Kirwan, C. J., Thomas, N., Martin, A., Owen, H., Darwin, L., Conway, D., Atkinson, D., Sharman, M., Moore, J., Barbanti, C., Amour, J., Gaudard, P., Rozec, B., Mauriat, P., M’rini, M., Leger, P. L., Cambonie, G., Liet, J. M., Girard, C., Laroche, S., Damas, P., Assaf, Z., Loron, G., Lecourt, L., Pouard, P., Randall, D., Adwaney, A., Blunden, M., Prowle, J.R., Kirwan, C. J., Kim, S. H., Na, S., Kim, J., Oh, S. Y., Jung, C. W., Yoo, S. H., Min, S. H., Chung, E. J., Lee, H., Lee, N. J., Lee, K. W., Suh, K. S., Ryu, H. G., Marshall, D. C., Goodson, R. J., Salciccioli, J. D., Shalhoub, J., Potter, E. K., Kirk-Bayley, J., Karanjia, N. D., Forni, L. G., Creagh-Brown, B. C., Bossy, M., Nyman, M., Tailor, A., Creagh-Brown, B., D’Antini, D., Spadaro, S., Valentino, F., Sollitto, F., Cinnella, G., Mirabella, L., Calvo, F. J. Redondo, Bejarano, N., Padilla, D., Baladron, V., Villajero, P., Villazala, R., Redondo, J., Yuste, A. S., Liu, J., Shen, F., Teboul, J. 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Buyukkidan, Kureshi, N., Fenerty, L., Thibault-Halman, G., Erdogan, M., Walling, S., Green, R. S., Clarke, D. B., Briassoulis, P., Kalimeris, K., Ntzouvani, A., Nomikos, T., Papaparaskeva, K., Politi, E., Kostopanagiotou, G., Crewdson, K., Rehn, M., Weaver, A., Brohi, K., Lockey, D., Wright, S., Thomas, K., Baker, C., Mansfield, L., Stafford, V., Wade, C., Watson, G., Bryant, A., Chadwick, T., Shen, J., Wilkinson, J., Furneval, J., Henderson, A., Hugill, K., Howard, P., Roy, A., Bonner, S., Baudouin, S., Ramírez, C. Sánchez, Escalada, S. Hípola, Viera, M. A. Hernández, Santana, M. Cabrera, Balcázar, L. Caipe, Monroy, N. Sangil, Campelo, F. Artiles, Vázquez, C. F. Lübbe, Santana, P. Saavedra, Santana, S. Ruiz, Carteron, L., Patet, C., Quintard, H., Solari, D., Bouzat, P., Oddo, M., Wollersheim, T., Malleike, J., Haas, K., Carbon, N., Schneider, J., Birchmeier, C., Fielitz, J., Spuler, S., Weber-Carstens, S., Enseñat, L., Pérez-Madrigal, A., Saludes, P., Proença, L., Gruartmoner, G., Espinal, C., Mesquida, J., Huber, W., Eckmann, M., Elkmann, F., Gruber, A., Lahmer, T., Mayr, U., Herner, A., Schellnegger, R., Schneider, J., Schmid, R. M., Ayoub, W., Samy, W., Esmat, A., Battah, A., Mukhtar, S., Mongkolpun, W., Cortés, D. Orbegozo, Cordeiro, C. P. R., Vincent, J. L., Creteur, J., Funcke, S., Groesdonk, H., Saugel, B., Wagenpfeil, G., Wagenpfeil, S., Reuter, D. A., Fernandez, M. M., Fernandez, R., Magret, M., González-Castro, A., Bouza, M. T., Ibañez, M., García, C., Balerdi, B., Mas, A., Arauzo, V., Añón, J. M., Ruiz, F., Ferreres, J., Tomás, R., Alabert, M., Tizón, A. I., Altaba, S., Llamas, N., Goligher, E C., Fan, E., Herridge, M., Vorona, S., Sklar, M., Dres, M., Rittayamai, N., Lanys, A., Urrea, C., Tomlinson, G., Reid, W. D., Rubenfeld, G. D., Kavanagh, B. P., Brochard, L. J., Ferguson, N. D., Neto, A. Serpa, de Abreu, M. Gama, Pelosi, P., Schultz, M. J., Guérin, C., Papazian, L., Reignier, J., Ayzac, L., Loundou, A., Forel, J. M., Rolland-Debord, C., Bureau, C., Poitou, T., Clavel, M., Perbet, S., Terzi, N., Kouatchet, A., Similowski, T., Demoule, A., Hunfeld, N., Trogrlic, Z., Ladage, S., Osse, R. J., Koch, B., Rietdijk, W., Devlin, J., van der Jagt, M., Picetti, E., Ceccarelli, P., Mensi, F., Malchiodi, L., Risolo, S., Rossi, I., Antonini, M. V., Servadei, F., Caspani, M. L., Roquilly, A., Lasocki, S., Seguin, P., Geeraerts, T., Perrigault, P. F., Dahyot-Fizelier, C., Paugam-Burtz, C., Cook, F., Cinotti, R., dit Latte, D. Demeure, Mahe, P. J., Fortuit, C., Feuillet, F., Asehnoune, K., Marzorati, C., Spina, S., Scaravilli, V., Vargiolu, A., Riva, M., Giussani, C., Sganzerla, E., Citerio, G., Barbadillo, S., de Molina, F. J. González, Álvarez-Lerma, F., Rodríguez, A., Zakharkina, T., Martin-Loeches, I., Matamoros, S., Povoa, P., Torres, A., Kastelijn, J., Hofstra, J. J., de Jong, M., Schultz, M., Sterk, P., Artigas, A., Bos, L. J., Moreau, A. S., Martin-Loeches, I., Povoa, P., Salluh, J., Rodriguez, A., Nseir, S., de Jong, E., van Oers, J. A., Beishuizen, A., Girbes, A. R. J., Nijsten, M. W. N., de Lange, D. W., Bonvicini, D., Labate, D., Benacchio, L., Olivieri, A., Pizzirani, E., Lopez-Delgado, J. C., Gonzalez-Romero, M., Fuentes-Mila, V., Berbel-Franco, D., Romera-Peregrina, I., Martinez-Pascual, A., Perez-Sanchez, J., Abellan-Lencina, R., Ávila-Espinoza, R. E., Moreno-Gonzalez, G., Sbraga, F., Griffiths, S., Grocott, M. P. W., Creagh-Brown, B., Doyle, J., Wilkerson, P., Soon, Y., Huddart, S., Dickinson, M., Riga, A., Zuleika, A., Miyamoto, K., Kawazoe, Y., Morimoto, T., Yamamoto, T., Fuke, A., Hashimoto, A., Koami, H., Beppu, S., Katayama, Y., Ito, M., Ohta, Y., Yamamura, H., Rygård, S. L., Holst, L B., Wetterslev, J., Johansson, P. I., Perner, A., Soliman, I. W., de Lange, D. W., van Dijk, D., van Delden, J. J. M., Cremer, O. L., Slooter, A. J. C., Peelen, L. M., McWilliams, D., Snelson, C., Neves, A. Das, Loudet, C. I., Busico, M., Vazquez, D., Villalba, D., Veronesi, M., Lischinsky, A., López, F. J. L., Mori, L. Benito, Plotnikow, G., Díaz, A., Giannasi, S., Hernandez, R., Krzisnik, L., Cecotti, C., Viola, L., Lopez, R., Sottile, J. P., Benavent, G., Estenssoro, E., Chen, C. M., Lai, C. C., Cheng, K. C., Chou, W., Chan, K. S., Roeker, L. E., Horkan, C. M., Gibbons, F. K., Christopher, K. B., Weijs, P. J. M., Mogensen, K. M., Rawn, J. D., Robinson, M. K., Christopher, K. 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C., Vieira, Jr, J. M., Azevedo, L. C. P., Nurses of the Central and General ICUs of Shiraz Namazi Hospital, Sedation an Delirium Group Hospital Universitari de Bellvitge, SPACeR group (Surrey Peri-operative, Anaesthesia and Critical Care Collaborative Research Group), for the PRoVENT investigators and the PROVE Network, SEMICYUC/GETGAG Working Group, TAVeM study group, POPC-CB investigators, DESIRE (DExmedetomidine for Sepsis in ICU Randomized Evaluation) Trial Investigators, GEMINI, Bioethics work group of SEMICYUC, The FINNAKI Study Group, Queen Square Neuroanaesthesia and Neurocritical Care Resreach Group, Renal Transplantation HUVR, GEMINI, EDISVAL Group, EDISVAL Group, PLUG Working group, TAVeM study Group, The FINNAKI Study Group, on behalf of Department of Professional Development, ESICM, Critical Care Research Group, SIRAKI group, and Grupo ESBAGA

Published
2016
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48. 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

49. Path From Clinical Research to Implementation Endovascular Treatment of Ischemic Stroke in the Netherlands

Author

Wiegers, Eveline, Compagne, Kars, Janssen, Paula, Venema, Esmee, Deckers, Jaap, Schonewille, WJ, Vos, JA, Nijeholt, G, Roozenbeek, Bob, Martens, JM, Hofmeijer, J, van Oostenbrugge, RJ, Zwam, WH, Majoie, C, van der Lugt, Aad, Lingsma, Hester, Roos, Y, Dippel, Diederik, Wiegers, Eveline, Compagne, Kars, Janssen, Paula, Venema, Esmee, Deckers, Jaap, Schonewille, WJ, Vos, JA, Nijeholt, G, Roozenbeek, Bob, Martens, JM, Hofmeijer, J, van Oostenbrugge, RJ, Zwam, WH, Majoie, C, van der Lugt, Aad, Lingsma, Hester, Roos, Y, and Dippel, Diederik

Published
2020

50. Anesthetic management during endovascular treatment of acute ischemic stroke in the MR CLEAN Registry

Author

Goldhoorn, RJB, Bernsen, MLE, Hofmeijer, J, Martens, JM, Lingsma, Hester, Dippel, Diederik, van der Lugt, Aad, Buhre, WF, Roos, YBWEM, Majoie, C B M, Vos, JA, Boiten, J, Emmer, Bart, van Oostenbrugge, RJ, Zwam, WH, Goldhoorn, RJB, Bernsen, MLE, Hofmeijer, J, Martens, JM, Lingsma, Hester, Dippel, Diederik, van der Lugt, Aad, Buhre, WF, Roos, YBWEM, Majoie, C B M, Vos, JA, Boiten, J, Emmer, Bart, van Oostenbrugge, RJ, and Zwam, WH

Published
2020

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