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3. Type of intracranial hemorrhage after endovascular stroke treatment: association with functional outcome

Author

van der Steen, Wouter, van der Ende, Nadinda A M, Luijten, Sven P R, Rinkel, Leon A, van Kranendonk, Katinka R, van Voorst, Henk, Roosendaal, Stefan D, Beenen, Ludo F M, Coutinho, Jonathan M, Emmer, Bart J, van Oostenbrugge, Robert J, Majoie, Charles B L.M, Lingsma, Hester F, van der Lugt, Aad, Dippel, Diederik W J, and Roozenbeek, Bob

Abstract

BackgroundIntracranial hemorrhage (ICH) is a frequent complication after endovascular stroke treatment.ObjectiveTo assess the association of the occurrence and type of ICH after endovascular treatment (EVT) with functional outcome.MethodsWe analyzed data from the MR CLEAN-NO IV and MR CLEAN-MED trials. Both trials included adult patients with ischemic stroke with a large vessel occlusion in the anterior circulation, who were eligible for EVT. ICH was classified (1) as asymptomatic or symptomatic (concomitant neurological deterioration of ≥4 points on the NIHSS, or ≥2 points on 1 NIHSS item), and (2) according to the Heidelberg Bleeding Classification. We used multivariable ordinal logistic regression analyses to assess the association of the occurrence and type of ICH with the modified Rankin Scale score at 90 days.ResultsOf 1017 included patients, 331 (33%) had an asymptomatic ICH, and 90 (9%) had a symptomatic ICH. Compared with no ICH, both asymptomatic (adjusted common OR (acOR)=0.76; 95% CI 0.58 to 0.98) and symptomatic (acOR=0.07; 95% CI 0.04 to 0.14) ICH were associated with worse functional outcome. In particular, isolated parenchymal hematoma type 2 (acOR=0.37; 95% CI 0.14 to 0.95), combined parenchymal hematoma with hemorrhage outside infarcted brain tissue (acOR=0.17; 95% CI 0.10 to 0.30), and combined hemorrhages outside infarcted brain tissue (acOR=0.14; 95% CI 0.03 to 0.74) were associated with worse functional outcome than no ICH.Strength of the association of ICH with functional outcome depends on the type of ICH. Although the association is stronger for symptomatic ICH, asymptomatic ICH after EVT is also associated with worse functional outcome.

Published
2023
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4. Determinants of Symptomatic Intracranial Hemorrhage After Endovascular Stroke Treatment: A Retrospective Cohort Study.

Author

van der Steen, Wouter, van der Ende, Nadinda A.M., van Kranendonk, Katinka R., Chalos, Vicky, van Oostenbrugge, Robert J., van Zwam, Wim H., Roos, Yvo B.W.E.M., van Doormaal, Pieter J., van Es, Adriaan C.G.M., Lingsma, Hester F., Majoie, Charles B.L.M., van der Lugt, Aad, Dippel, Diederik W.J., Roozenbeek, Bob, and MR CLEAN Trial and MR CLEAN Registry Investigators

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

Author

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

Published
2022
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7. Blood Pressure in the First 6 Hours Following Endovascular Treatment for Ischemic Stroke Is Associated With Outcome.

Author

Samuels, Noor, van de Graaf, Rob A., van den Berg, Carlijn A.L., Uniken Venema, Simone M., Bala, Kujtesa, van Doormaal, Pieter Jan, van der Steen, Wouter, Witvoet, Elbert, Boiten, Jelis, den Hertog, Heleen, Schonewille, Wouter J., Hofmeijer, Jeannette, Schreuder, Floris, Schreuder, Tobien A.H.C.M.L., van der Worp, H. Bart, Roos, Yvo B.W.E.M., Majoie, Charles B.L.M., Burke, James F., van Es, Adriaan C.G.M., and van der Lugt, Aad

Published
2021
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8. Safety and efficacy of aspirin, unfractionated heparin, both, or neither during endovascular stroke treatment (MR CLEAN-MED): an open-label, multicentre, randomised controlled trial

Author

van der Steen, Wouter, van de Graaf, Rob A, Chalos, Vicky, Lingsma, Hester F, van Doormaal, Pieter Jan, Coutinho, Jonathan M, Emmer, Bart J, de Ridder, Inger, van Zwam, Wim, van der Worp, H Bart, van der Schaaf, Irene, Gons, Rob A R, Yo, Lonneke S F, Boiten, Jelis, van den Wijngaard, Ido, Hofmeijer, Jeannette, Martens, Jasper, Schonewille, Wouter, Vos, Jan Albert, Tuladhar, Anil Man, de Laat, Karlijn F, van Hasselt, Boudewijn, Remmers, Michel, Vos, Douwe, Rozeman, Anouk, Elgersma, Otto, Uyttenboogaart, Maarten, Bokkers, Reinoud P H, van Tuijl, Julia, Boukrab, Issam, van den Berg, René, Beenen, Ludo F M, Roosendaal, Stefan D, Postma, Alida Annechien, Krietemeijer, Menno, Lycklama, Geert, Meijer, Frederick J A, Hammer, Sebastiaan, van der Hoorn, Anouk, Yoo, Albert J, Gerrits, Dick, Truijman, Martine T B, Zinkstok, Sanne, Koudstaal, Peter J, Manschot, Sanne, Kerkhoff, Henk, Nieboer, Daan, Berkhemer, Olvert, Wolff, Lennard, van der Sluijs, P Matthijs, van Voorst, Henk, Tolhuisen, Manon, Roos, Yvo B W E M, Majoie, Charles B L M, Staals, Julie, van Oostenbrugge, Robert J, Jenniskens, Sjoerd F M, van Dijk, Lukas C, den Hertog, Heleen M, van Es, Adriaan C G M, van der Lugt, Aad, Dippel, Diederik W J, and Roozenbeek, Bob

Abstract

Aspirin and unfractionated heparin are often used during endovascular stroke treatment to improve reperfusion and outcomes. However, the effects and risks of anti-thrombotics for this indication are unknown. We therefore aimed to assess the safety and efficacy of intravenous aspirin, unfractionated heparin, both, or neither started during endovascular treatment in patients with ischaemic stroke.

Published
2022
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9. Blood Pressure in the First 6 Hours Following Endovascular Treatment for Ischemic Stroke Is Associated With Outcome

Author

Samuels, Noor, van de Graaf, Rob A., van den Berg, Carlijn A.L., Uniken Venema, Simone M., Bala, Kujtesa, van Doormaal, Pieter Jan, van der Steen, Wouter, Witvoet, Elbert, Boiten, Jelis, den Hertog, Heleen, Schonewille, Wouter J., Hofmeijer, Jeannette, Schreuder, Floris, Schreuder, Tobien A.H.C.M.L., van der Worp, H. Bart, Roos, Yvo B.W.E.M., Majoie, Charles B.L.M., Burke, James F., van Es, Adriaan C.G.M., van der Lugt, Aad, Roozenbeek, Bob, Lingsma, Hester F., and Dippel, Diederik W.J.

Abstract

Supplemental Digital Content is available in the text.

Published
2021
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10. Safety and efficacy of periprocedural antithrombotics in patients with successful reperfusion after endovascular stroke treatment.

Author

van der Steen, Wouter, van der Sluijs, P. Matthijs, van de Graaf, Rob A., Su, Ruisheng, Wolff, Lennard, van Voorst, Henk, den Hertog, Heleen M., van Doormaal, Pieter Jan, van Es, Adriaan C.G.M., Staals, Julie, van Zwam, Wim, Lingsma, Hester F., van den Berg, René, Majoie, Charles B.L.M., van der Lugt, Aad, Dippel, Diederik W.J., Roozenbeek, Bob, and MR CLEAN-MED investigators

Abstract

Objectives: We aimed to evaluate whether the overall harmful effect of periprocedural treatment with aspirin or heparin during endovascular stroke treatment is different in patients with a successful reperfusion after the procedure.Materials and Methods: We performed a post-hoc analysis of the MR CLEAN-MED trial, including adult patients with a large vessel occlusion in the anterior circulation eligible for endovascular treatment (EVT). In this trial, patients were randomized for periprocedural intravenous treatment with aspirin or no aspirin (1:1 ratio), and for moderate-dose unfractionated heparin, low-dose unfractionated heparin or no unfractionated heparin (1:1:1 ratio). We tested for interaction between the post-EVT extended thrombolysis in cerebral infarction (eTICI) score and treatment with periprocedural medication with multivariable regression analyses. The primary outcome was the modified Rankin Scale score at 90 days. Secondary outcomes were final infarct volume, intracranial hemorrhage, and symptomatic intracranial hemorrhage.Results: Of 534 included patients, 93 (17%) had a post-EVT eTICI score of 0-2a, 115 (22%) a score of 2b, 73 (14%) a score of 2c, and 253 (47%) a score of 3. For both aspirin and heparin, we found no interaction between post-EVT eTICI score and treatment on the modified Rankin Scale score (p=0.76 and p=0.47, respectively). We found an interaction between post-EVT eTICI score and treatment with heparin on the final infarct volume (p=0.01). Of note, this interaction showed a biologically implausible distribution over the subgroups.Conclusions: The overall harmful effect of periprocedural aspirin and unfractionated heparin is not different in patients with a successful reperfusion after EVT. [ABSTRACT FROM AUTHOR]

Published
2022
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11. Timing of symptomatic intracranial hemorrhage after endovascular stroke treatment

Author

van der Steen, Wouter, van der Ende, Nadinda AM, van Kranendonk, Katinka R, Chalos, Vicky, Brouwer, Josje, van Oostenbrugge, Robert J, van Zwam, Wim H, van Doormaal, Pieter J, van Es, Adriaan CGM, Majoie, Charles BLM, van der Lugt, Aad, Dippel, Diederik WJ, and Roozenbeek, Bob

Abstract

Introduction: Little is known about the timing of occurrence of symptomatic intracranial hemorrhage (sICH) after endovascular therapy (EVT) for acute ischemic stroke. A better understanding could optimize in-hospital surveillance time points and duration. The aim of this study was to delineate the probability of sICH over time and to identify factors associated with its timing.Patients and methods: We retrospectively analyzed data from the Dutch MR CLEAN trial and MR CLEAN Registry. We included adult patients who underwent EVT for an anterior circulation large vessel occlusion within 6.5 h of stroke onset. In patients with sICH (defined as ICH causing an increase of ⩾4 points on the National Institutes of Health Stroke Scale [NIHSS]), univariable and multivariable linear regression analysis was used to identify factors associated with the timing of sICH. This was defined as the time between end of EVT and the time of first CT-scan on which ICH was seen as a proxy.Results: SICH occurred in 205 (6%) of 3391 included patients. Median time from end of EVT procedure to sICH detection on NCCT was 9.0 [IQR 2.9–22.5] hours, with a rapidly decreasing incidence after 24 h. None of the analyzed factors, including baseline NIHSS, intravenous alteplase treatment, and poor reperfusion at the end of the procedure were associated with the timing of sICH.Conclusion: SICHs primarily occur in the first hours after EVT, and less frequently beyond 24 h. Guidelines that recommend to perform frequent neurological assessments for at least 24 h after intravenous alteplase treatment can be applied to ischemic stroke patients treated with EVT.

Published
2022
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