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5. Cerebral Edema in Patients With Large Hemispheric Infarct Undergoing Reperfusion Treatment

Author

Ng, Felix C, Yassi, Nawaf, Sharma, Gagan, Brown, Scott B, Goyal, Mayank, Majoie, Charles BLM, Jovin, Tudor G, Hill, Michael D, Muir, Keith W, Saver, Jeffrey L, Guillemin, Francis, Demchuk, Andrew M, Menon, Bijoy K, San Roman, Luis, Liebeskind, David S, White, Philip, Dippel, Diederik WJ, Davalos, Antoni, Bracard, Serge, Mitchell, Peter J, Wald, Michael J, Davis, Stephen M, Sheth, Kevin N, Kimberly, W Taylor, Campbell, Bruce CV, and Collaborators, for the HERMES

Subjects
Biomedical Imaging, Heart Disease, Cardiovascular, Neurosciences, Heart Disease - Coronary Heart Disease, Stroke, Clinical Research, Brain Disorders, Brain Edema, Brain Infarction, Endovascular Procedures, Humans, Reperfusion, Reperfusion Injury, Thrombectomy, edema, infarction, ischemic stroke, reperfusion, thrombectomy, HERMES Collaborators, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Neurology & Neurosurgery
Abstract

Background and purposeWhether reperfusion into infarcted tissue exacerbates cerebral edema has treatment implications in patients presenting with extensive irreversible injury. We investigated the effects of endovascular thrombectomy and reperfusion on cerebral edema in patients presenting with radiological evidence of large hemispheric infarction at baseline.MethodsIn a systematic review and individual patient-level meta-analysis of 7 randomized controlled trials comparing thrombectomy versus medical therapy in anterior circulation ischemic stroke published between January 1, 2010, and May 31, 2017 (Highly Effective Reperfusion Using Multiple Endovascular Devices collaboration), we analyzed the association between thrombectomy and reperfusion with maximal midline shift (MLS) on follow-up imaging as a measure of the space-occupying effect of cerebral edema in patients with large hemispheric infarction on pretreatment imaging, defined as diffusion-magnetic resonance imaging or computed tomography (CT)-perfusion ischemic core 80 to 300 mL or noncontrast CT-Alberta Stroke Program Early CT Score ≤5. Risk of bias was assessed using the Cochrane tool.ResultsAmong 1764 patients, 177 presented with large hemispheric infarction. Thrombectomy and reperfusion were associated with functional improvement (thrombectomy common odds ratio =2.30 [95% CI, 1.32–4.00]; reperfusion common odds ratio =4.73 [95% CI, 1.66–13.52]) but not MLS (thrombectomy β=−0.27 [95% CI, −1.52 to 0.98]; reperfusion β=−0.78 [95% CI, −3.07 to 1.50]) when adjusting for age, National Institutes of Health Stroke Score, glucose, and time-to-follow-up imaging. In an exploratory analysis of patients presenting with core volume >130 mL or CT-Alberta Stroke Program Early CT Score ≤3 (n=76), thrombectomy was associated with greater MLS after adjusting for age and National Institutes of Health Stroke Score (β=2.76 [95% CI, 0.33–5.20]) but not functional improvement (odds ratio, 1.71 [95% CI, 0.24–12.08]).ConclusionsIn patients presenting with large hemispheric infarction, thrombectomy and reperfusion were not associated with MLS, except in the subgroup with very large core volume (>130 mL) in whom thrombectomy was associated with increased MLS due to space-occupying ischemic edema. Mitigating cerebral edema-mediated secondary injury in patients with very large infarcts may further improve outcomes after reperfusion therapies.

Published
2021

6. Automated Final Lesion Segmentation in Posterior Circulation Acute Ischemic Stroke Using Deep Learning.

Author

Zoetmulder, Riaan, Konduri, Praneeta, Obdeijn, Iris, Gavves, Efstratios, Išgum, Ivana, Majoie, Charles, Dippel, Diederik, Roos, Yvo, Goyal, Mayank, Mitchell, Peter, Campbell, Bruce, Lopes, Demetrius, Reimann, Gernot, Jovin, Tudor, Saver, Jeffrey, Muir, Keith, White, Phil, Bracard, Serge, Chen, Bailiang, Brown, Scott, Schonewille, Wouter, van der Hoeven, Erik, Puetz, Volker, and Marquering, Henk

Subjects
CT, deep learning, posterior stroke, segmentation, transfer learning
Abstract

Final lesion volume (FLV) is a surrogate outcome measure in anterior circulation stroke (ACS). In posterior circulation stroke (PCS), this relation is plausibly understudied due to a lack of methods that automatically quantify FLV. The applicability of deep learning approaches to PCS is limited due to its lower incidence compared to ACS. We evaluated strategies to develop a convolutional neural network (CNN) for PCS lesion segmentation by using image data from both ACS and PCS patients. We included follow-up non-contrast computed tomography scans of 1018 patients with ACS and 107 patients with PCS. To assess whether an ACS lesion segmentation generalizes to PCS, a CNN was trained on ACS data (ACS-CNN). Second, to evaluate the performance of only including PCS patients, a CNN was trained on PCS data. Third, to evaluate the performance when combining the datasets, a CNN was trained on both datasets. Finally, to evaluate the performance of transfer learning, the ACS-CNN was fine-tuned using PCS patients. The transfer learning strategy outperformed the other strategies in volume agreement with an intra-class correlation of 0.88 (95% CI: 0.83-0.92) vs. 0.55 to 0.83 and a lesion detection rate of 87% vs. 41-77 for the other strategies. Hence, transfer learning improved the FLV quantification and detection rate of PCS lesions compared to the other strategies.

Published
2021

7. Prediction of Outcome and Endovascular Treatment Benefit

Author

Venema, Esmee, Roozenbeek, Bob, Mulder, Maxim JHL, Brown, Scott, Majoie, Charles BLM, Steyerberg, Ewout W, Demchuk, Andrew M, Muir, Keith W, Dávalos, Antoni, Mitchell, Peter J, Bracard, Serge, Berkhemer, Olvert A, Lycklama à Nijeholt, Geert J, van Oostenbrugge, Robert J, Roos, Yvo BWEM, van Zwam, Wim H, van der Lugt, Aad, Hill, Michael D, White, Philip, Campbell, Bruce CV, Guillemin, Francis, Saver, Jeffrey L, Jovin, Tudor G, Goyal, Mayank, Dippel, Diederik WJ, Lingsma, Hester F, der Lugt, Aad van, Boiten, Jelis, Vos, Jan Albert, Jansen, Ivo GH, Goldhoorn, Robert-Jan B, Compagne, Kars CJ, Kappelhof, Manon, Brouwer, Josje, den Hartog, Sanne J, Hinsenveld, Wouter H, van Es, Adriaan CGM, Emmer, Bart J, Coutinho, Jonathan M, Schonewille, Wouter J, Wermer, Marieke JH, van Walderveen, Marianne AA, Staals, Julie, Hofmeijer, Jeannette, Martens, Jasper M, de Bruijn, Sebastiaan F, van Dijk, Lukas C, van der Worp, H Bart, Lo, Rob H, van Dijk, Ewoud J, Boogaarts, Hieronymus D, Vries, J de, de Kort, Paul LM, van Tuijl, Julia, Peluso, Jo P, Fransen, Puck, van den Berg, Jan SP, van Hasselt, Boudewijn AAM, Aerden, Leo AM, Dallinga, René J, Uyttenboogaart, Maarten, Eschgi, Omid, Bokkers, Reinoud PH, Schreuder, Tobien HCML, Heijboer, Roel JJ, Keizer, Koos, Yo, Lonneke SF, den Hertog, Heleen M, Bulut, Tomas, Brouwers, Paul JAM, Sprengers, Marieke ES, Jenniskens, Sjoerd FM, van den Berg, René, Yoo, Albert J, Beenen, Ludo FM, Postma, Alida A, Roosendaal, Stefan D, van der Kallen, Bas FW, van den Wijngaard, Ido R, Bot, Joost, van Doormaal, Pieter-Jan, Meijer, Anton, Ghariq, Elyas, van Proosdij, Marc P, Krietemeijer, G Menno, Lo, Rob, Gerrits, Dick, Dinkelaar, Wouter, and Appelman, Auke PA

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

Background and purposeBenefit of early endovascular treatment (EVT) for ischemic stroke varies considerably among patients. The MR PREDICTS decision tool, derived from MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), predicts outcome and treatment benefit based on baseline characteristics. Our aim was to externally validate and update MR PREDICTS with data from international trials and daily clinical practice.MethodsWe used individual patient data from 6 randomized controlled trials within the HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) collaboration to validate the original model. Then, we updated the model and performed a second validation with data from the observational MR CLEAN Registry. Primary outcome was functional independence (defined as modified Rankin Scale score 0–2) 3 months after stroke. Treatment benefit was defined as the difference between the probability of functional independence with and without EVT. Discriminative performance was evaluated using a concordance (C) statistic.ResultsWe included 1242 patients from HERMES (633 assigned to EVT, 609 assigned to control) and 3156 patients from the MR CLEAN Registry (all of whom underwent EVT within 6.5 hours). The C-statistic for functional independence was 0.74 (95% CI, 0.72–0.77) in HERMES and, after model updating, 0.80 (0.78–0.82) in the Registry. Median predicted treatment benefit of routinely treated patients (Registry) was 10.3% (interquartile range, 5.8%–14.4%). Patients with low (

Published
2021

8. autoTICI: Automatic Brain Tissue Reperfusion Scoring on 2D DSA Images of Acute Ischemic Stroke Patients

Author

Su, Ruisheng, Cornelissen, Sandra A. P., van der Sluijs, Matthijs, van Es, Adriaan C. G. M., van Zwam, Wim H., Dippel, Diederik W. J., Lycklama, Geert, van Doormaal, Pieter Jan, Niessen, Wiro J., van der Lugt, Aad, and van Walsum, Theo

Subjects
Electrical Engineering and Systems Science - Image and Video Processing, Computer Science - Computer Vision and Pattern Recognition
Abstract

The Thrombolysis in Cerebral Infarction (TICI) score is an important metric for reperfusion therapy assessment in acute ischemic stroke. It is commonly used as a technical outcome measure after endovascular treatment (EVT). Existing TICI scores are defined in coarse ordinal grades based on visual inspection, leading to inter- and intra-observer variation. In this work, we present autoTICI, an automatic and quantitative TICI scoring method. First, each digital subtraction angiography (DSA) acquisition is separated into four phases (non-contrast, arterial, parenchymal and venous phase) using a multi-path convolutional neural network (CNN), which exploits spatio-temporal features. The network also incorporates sequence level label dependencies in the form of a state-transition matrix. Next, a minimum intensity map (MINIP) is computed using the motion corrected arterial and parenchymal frames. On the MINIP image, vessel, perfusion and background pixels are segmented. Finally, we quantify the autoTICI score as the ratio of reperfused pixels after EVT. On a routinely acquired multi-center dataset, the proposed autoTICI shows good correlation with the extended TICI (eTICI) reference with an average area under the curve (AUC) score of 0.81. The AUC score is 0.90 with respect to the dichotomized eTICI. In terms of clinical outcome prediction, we demonstrate that autoTICI is overall comparable to eTICI., Comment: Accepted for publication in IEEE Transactions on Medical Imaging (IEEE TMI)

Published
2020
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10. 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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11. Prognostic Value of Thrombus Volume and Interaction With First-Line Endovascular Treatment Device Choice

Author

van Voorst, Henk, Bruggeman, Agnetha A.E., Andriessen, Jurr, Hoving, Jan W., Konduri, Praneeta R., Yang, Wenjin, Kappelhof, Manon, Arrarte Terreros, Nerea, Roos, Yvo B.W.E.M., van Zwam, Wim H., van der Lugt, Aad, van der Hoorn, Anouk, Boiten, Jelis, Roosendaal, Stefan, Jenniskens, Sjoerd, Caan, Matthan W.A., Marquering, Henk A., Emmer, Bart J., Majoie, Charles B.L.M., Dippel, Diederik W.J., van Oostenbrugge, Robert J., Vos, Jan Albert, Jansen, Ivo G.H., Mulder, Maxim J.H.L., Goldhoorn, Robert- Jan B., Compagne, Kars C.J., Brouwer, Josje, den Hartog, Sanne J., Hinsenveld, Wouter H., Dippel, Diederik W.J., Roozenbeek, Bob, van Es, Adriaan C.G.M., Coutinho, Jonathan M., Schonewille, Wouter J., Vos, Jan Albert, Wermer, Marieke J.H., van Walderveen, Marianne A.A., Staals, Julie, van Oostenbrugge, Robert J., Hofmeijer, Jeannette, Martens, Jasper M., Lycklama à Nijeholt, Geert J., de Bruijn, Sebastiaan F., van Dijk, Lukas C., van der Worp, H. Bart, Lo, Rob H., van Dijk, Ewoud J., Boogaarts, Hieronymus D., de Vries, J., de Kort, Paul L.M., van Tuijl, Julia, Peluso, Jo P., Fransen, Puck, van den Berg, Jan S.P., van Hasselt, Boudewijn A.A.M., Aerden, Leo A.M., Dallinga, René J., Uyttenboogaart, Maarten, Eschgi, Omid, Bokkers, Reinoud P.H., Schreuder, Tobien H.C.M.L., Heijboer, Roel J.J., Keizer, Koos, Yo, Lonneke S.F., den Hertog, Heleen M., Sturm, Emiel J.C., Brouwers, Paul J.A.M., Lycklama à Nijeholt, Geert J., van Walderveen, Marianne A.A., Sprengers, Marieke E.S., van den Berg, René, Yoo, Albert J., Beenen, Ludo F.M., Postma, Alida A., van der Kallen, Bas F.W., van den Wijngaard, Ido R., van Es, Adriaan C.G.M., Martens, Jasper M., Yo, Lonneke S.F., Vos, Jan Albert, Bot, Joost, van Doormaal, Pieter-Jan, Meijer, Anton, Ghariq, Elyas, Bokkers, Reinoud P.H., van Proosdij, Marc P., Krietemeijer, G. Menno, Peluso, Jo P., Boogaarts, Hieronymus D., Lo, Rob, Gerrits, Dick, Dinkelaar, Wouter, Appelman, Auke P.A., Hammer, Bas, Pegge, Sjoert, Vinke, Saman, Dippel, Diederik W.J., van Oostenbrugge, Robert J., Lycklama à Nijeholt, Geert J., Vos, Jan Albert, Schonewille, Wouter J., Hofmeijer, Jeannette, Martens, Jasper M., van der Worp, H. Bart, Lo, Rob H., van Oostenbrugge, Robert J., Hofmeijer, Jeannette, Flach, H. Zwenneke, Lingsma, Hester F., el Ghannouti, Naziha, Sterrenberg, Martin, Pellikaan, Wilma, Sprengers, Rita, Elfrink, Marjan, Simons, Michelle, Vossers, Marjolein, de Meris, Joke, Vermeulen, Tamara, Geerlings, Annet, van Vemde, Gina, Simons, Tiny, Messchendorp, Gert, Nicolaij, Nynke, Bongenaar, Hester, Bodde, Karin, Kleijn, Sandra, Lodico, Jasmijn, Droste, Hanneke, Wollaert, Maureen, Verheesen, Sabrina, Jeurrissen, D., Bos, Erna, Drabbe, Yvonne, Sandiman, Michelle, Aaldering, Nicoline, Zweedijk, Berber, Vervoort, Jocova, Ponjee, Eva, Romviel, Sharon, Kanselaar, Karin, Barning, Denn, Venema, Esmee, Chalos, Vicky, Geuskens, Ralph R., van Straaten, Tim, Ergezen, Saliha, Harmsma, Roger R.M., Muijres, Daan, de Jong, Anouk, Berkhemer, Olvert A., Boers, Anna M.M., Huguet, J., Groot, P.F.C., Mens, Marieke A., van Kranendonk, Katinka R., Treurniet, Kilian M., Tolhuisen, Manon L., Alves, Heitor, Weterings, Annick J., Kirkels, Eleonora L.F., Voogd, Eva J.H.F., Schupp, Lieve M., Collette, Sabine, Groot, Adrien E.D., LeCouffe, Natalie E., Prasetya, Haryadi, and Ramos, Lucas A.

Published
2023
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12. Prediction of final infarct volume from native CT perfusion and treatment parameters using deep learning

Author

Robben, David, Boers, Anna M. M., Marquering, Henk A., Langezaal, Lucianne L. C. M., Roos, Yvo B. W. E. M., van Oostenbrugge, Robert J., van Zwam, Wim H., Dippel, Diederik W. J., Majoie, Charles B. L. M., van der Lugt, Aad, Lemmens, Robin, and Suetens, Paul

Subjects
Computer Science - Computer Vision and Pattern Recognition, Physics - Medical Physics
Abstract

CT Perfusion (CTP) imaging has gained importance in the diagnosis of acute stroke. Conventional perfusion analysis performs a deconvolution of the measurements and thresholds the perfusion parameters to determine the tissue status. We pursue a data-driven and deconvolution-free approach, where a deep neural network learns to predict the final infarct volume directly from the native CTP images and metadata such as the time parameters and treatment. This would allow clinicians to simulate various treatments and gain insight into predicted tissue status over time. We demonstrate on a multicenter dataset that our approach is able to predict the final infarct and effectively uses the metadata. An ablation study shows that using the native CTP measurements instead of the deconvolved measurements improves the prediction., Comment: Accepted for publication in Medical Image Analysis

Published
2018
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13. Comparison of Prehospital Assessment by Paramedics and In-Hospital Assessment by Physicians in Suspected Stroke Patients: Results From 2 Prospective Cohort Studies

Author

Dekker, Luuk, Daems, Jasper D., Duvekot, Martijne H.C., Nguyen, T. Truc My, Venema, Esmee, van Es, Adriaan C.G.M., Rozeman, Anouk D., Moudrous, Walid, Dorresteijn, Kirsten R.I.S., Hensen, Jan-Hein J., Bosch, Jan, van Zwet, Erik W., de Schryver, Els L.L.M., Kloos, Loet M.H., de Laat, Karlijn F., Aerden, Leo A.M., van den Wijngaard, Ido R., Dippel, Diederik W.J., Kerkhoff, Henk, Wermer, Marieke J.H., Roozenbeek, Bob, Kruyt, Nyika D., Alblas, Kees C.L., Bakker, Jeannette, van Belle, Eduard, Bevelander, Timo, Buijck, Bianca, Dofferhoff-Vermeulen, Tamara, van Doormaal, Pieter Jan, Duijndam, Dion, van Eijkelenburg, Roeland P.J., Hoek, Amber, Koster, Gaia T., Kuiper, Jan Willem, de Leeuw, Arnoud M., Lingsma, Hester F., van der Lugt, Aad, Lycklama À Nijeholt, Geert, Maasland, Lisette, van Moll, Bruno J.M., Mulder, Laus J.M.M., Noordam-Reijm, Anja, Oskam, Erick, Plaisier, Aarnout, van de Wijdeven, Ruben M., Wijnhoud, Annemarie D., Willeboer, Merel L., Woudenberg, Mirjam, van der Zon, Mandy M.A., Zwets, Egon D., and Zylicz, Stas A.

Published
2023
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16. Interobserver Agreement on Intracranial Hemorrhage on Magnetic Resonance Imaging in Patients With Ischemic Stroke

Author

van der Ende, Nadinda A.M., Luijten, Sven P.R., Kluijtmans, Leo, Postma, Alida A., Cornelissen, Sandra A., van Hattem, Antonius M.G., Lycklama à Nijeholt, Geert J., Bokkers, Reinoud P.H., Thomassen, Lars, Waje-Andreassen, Ulrike, Logallo, Nicola, Bracard, Serge, Gory, Benjamin, Roozenbeek, Bob, Dippel, Diederik W.J., and van der Lugt, Aad

Published
2023
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18. Dual thrombolytic therapy with mutant pro-urokinase and small bolus alteplase for ischemic stroke (DUMAS): study protocol for a multicenter randomized controlled phase II trial

Author

van der Ende, Nadinda A. M., Roozenbeek, Bob, Smagge, Lucas E. M., Luijten, Sven P. R., Aerden, Leo A. M., Kraayeveld, Petra, van den Wijngaard, Ido R., Lycklama à Nijeholt, Geert J., den Hertog, Heleen M., Flach, H. Zwenneke, Wallace, Alexis C., Gurewich, Victor, del Zoppo, Gregory J., Meurer, William J., Lingsma, Hester F., van der Lugt, Aad, and Dippel, Diederik W. J.

Published
2022
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20. Impact of the lockdown on acute stroke treatments during the first surge of the COVID-19 outbreak in the Netherlands

Author

Benali, Faysal, Stolze, Lotte J., Rozeman, Anouk D., Dinkelaar, Wouter, Coutinho, Jonathan M., Emmer, Bart J., Gons, Rob A. R., Yo, Lonneke F. S., van Tuijl, Julia H., Boukrab, Issam, van Dam-Nolen, Dianne H. K., van den Wijngaard, Ido R., Lycklama à Nijeholt, Geert J., de Laat, Karlijn F., van Dijk, Lukas C., den Hertog, Heleen M., Flach, H. Zwenneke, Wermer, Marieke J. H., van Walderveen, Marianne A. A., Brouwers, Paul J. A. M., Bulut, Tomas, Vermeer, Sarah E., Bernsen, Marie Louise E., Uyttenboogaart, Maarten, Bokkers, Reinoud P. H., Boogaarts, Jeroen D., de Leeuw, Frank-Erik, van der Worp, H. Bart, van der Schaaf, Irene C., Schonewille, Wouter J., Vos, Jan A., Remmers, Michel J. M., Imani, Farshad, Dippel, Diederik W. J., van Zwam, Wim H., Nederkoorn, Paul J., and van Oostenbrugge, Robert J.

Published
2022
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21. Sex differences in clot, vessel and tissue characteristics in patients with a large vessel occlusion treated with endovascular thrombectomy.

Author

van der Meij, Anne, Holswilder, Ghislaine, Bernsen, Marie Louise E, van Os, Hendrikus JA, Hofmeijer, Jeannette, Spaander, Fianne HM, Martens, Jasper M, van den Wijngaard, Ido R, Lingsma, Hester F, Konduri, Praneeta R, BLM Majoie, Charles, Schonewille, Wouter J, Dippel, Diederik WJ, Kruyt, Nyika D, Nederkoorn, Paul J, van Walderveen, Marianne AA, and Wermer, Marieke JH

Published
2024
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22. Thrombus Imaging Characteristics to Predict Early Recanalization in Anterior Circulation Large Vessel Occlusion Stroke

Author

Arrarte Terreros, Nerea, primary, Stolp, Jeffrey, additional, Bruggeman, Agnetha A. E., additional, Swijnenburg, Isabella S. J., additional, Lopes, Ricardo R., additional, van Meenen, Laura C. C., additional, Groot, Adrien E. D., additional, Kappelhof, Manon, additional, Coutinho, Jonathan M., additional, Roos, Yvo B. W. E. M., additional, Emmer, Bart J., additional, Beenen, Ludo F. M., additional, Dippel, Diederik W. J., additional, van Zwam, Wim H., additional, van Bavel, Ed, additional, Marquering, Henk A., additional, and Majoie, Charles B. L. M., additional

Published
2024
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23. Posterior circulation collaterals as predictors of outcome in basilar artery occlusion: a sub-analysis of the BASICS randomized trial

Author

Lima, Fabricio O., primary, Rocha, Felipe A., additional, Silva, Henrique C., additional, Puetz, Volker, additional, Dippel, Diederik, additional, van den Wijngaard, Ido, additional, Majoie, Charles, additional, Yoo, Albert J., additional, van Zwam, Wim, additional, de Lucena, Adson F., additional, Bandeira, Diego De Almeida, additional, Arndt, Martin, additional, Barlinn, Kristian, additional, Gerber, Johannes C., additional, Langezaal, Lucianne C. M., additional, Schonewille, Wouter J., additional, Pontes Neto, Octávio M., additional, Dias, Francisco Antunes, additional, Martins, Sheila Ouriques, additional, and Mont’Alverne, Francisco José de A., additional

Published
2024
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25. Endovascular treatment of patients with stroke caused by anterior cerebral artery occlusions

Author

Vos, Erik M., Kappelhof, Manon, den Hartog, Sanne J., Coutinho, Jonathan M., Emmer, Bart J., Roozenbeek, Bob, van Zwam, Wim H., van Oostenbrugge, Robert J., van der Worp, H. Bart, Uyttenboogaart, Maarten, van Es, Adriaan C.G.M., Majoie, Charles B.L.M., Dippel, Diederik W.J., Peeters-Scholte, Cacha M.P.C.D., van den Wijngaard, Ido R., Vos, Erik M., Kappelhof, Manon, den Hartog, Sanne J., Coutinho, Jonathan M., Emmer, Bart J., Roozenbeek, Bob, van Zwam, Wim H., van Oostenbrugge, Robert J., van der Worp, H. Bart, Uyttenboogaart, Maarten, van Es, Adriaan C.G.M., Majoie, Charles B.L.M., Dippel, Diederik W.J., Peeters-Scholte, Cacha M.P.C.D., and van den Wijngaard, Ido R.

Abstract

Background: Occlusion of the anterior cerebral artery (ACA) is uncommon but may lead to significant disability. The benefit of endovascular treatment (EVT) for ACA occlusions remains uncertain. Methods: We included patients treated with EVT and compared patients with ACA occlusions with patients who had internal carotid artery (ICA) or proximal (M1/M2) middle cerebral artery (MCA) occlusions from the MR CLEAN Registry. Primary outcome was the modified Rankin Scale score (mRS). Secondary outcomes were functional independence (mRS 0–2), National Institutes of Health Stroke Scale (NIHSS) score, delta-NIHSS (baseline minus NIHSS score at 24–48 h), and successful recanalization (expanded thrombolysis in cerebral infarction (eTICI) score 2b-3). Safety outcomes were symptomatic intracranial hemorrhage (sICH), periprocedural complications, and mortality. Results: Of 5193 patients, 11 (0.2%) had primary ACA occlusions. Median NIHSS at baseline was lower in patients with ACA versus ICA/MCA occlusions (11, IQR 9–14; versus 15, IQR 11–19). Functional outcome did not differ from patients with ICA/MCA occlusions. Functional independence was 4/11 (36%) in patients with ACA versus 1949/4815 (41%) in ICA/MCA occlusions; median delta-NIHSS was − 1 (IQR − 7 to 2) and − 4 (IQR − 9 to 0), respectively. Successful recanalization was 4/9 (44%), versus 3083/4787 (64%) in ICA/MCA occlusions. Mortality was 3/11 (27%) versus 1263/4815 (26%). One patient with ACA occlusion had sICH; no other complications occurred. Conclusion: In this cohort ACA occlusions were uncommon. Functional outcome did not differ between patients with ACA occlusions and ICA/MCA occlusions. Prospective research is needed to determine feasibility, safety, and outcomes of EVT for ACA occlusions.

Published
2024

26. Advancements in diagnostic and interventional radiology for stroke treatment:the path from trial to bedside through the pre-MR CLEAN, MR CLEAN, and MR CLEAN II eras

Author

Samuels, Noor, van de Graaf, Rob A., Roos, Yvo B.W.M., Dippel, Diederik, van der Lugt, Aad, Samuels, Noor, van de Graaf, Rob A., Roos, Yvo B.W.M., Dippel, Diederik, and van der Lugt, Aad

Abstract

The stroke field is inevitably connected with imaging in which radiologists fulfill a central role. Our landmark MR CLEAN trial led to the implementation of baseline computed tomography angiography or magnetic resonance angiography in the acute stroke workup and subsequent endovascular treatment (EVT) for ischemic stroke patients with a large vessel occlusion in the anterior circulation, resulting in numerous patients worldwide currently being treated often successfully. A reversal of the pathophysiologic process behind an acute cerebrovascular event was made possible. Subsequently, in the MR CLEAN II trials, the clinical impact of both diagnostic and interventional radiologists remained a cornerstone of our research, which means value-based radiology. Within these MR CLEAN II trials, we proved that aspirin and heparin during EVT should be avoided due to increased symptomatic intracranial hemorrhage risk (MR CLEAN-MED). We concluded there is additional benefit of EVT in the 6-to-24-h window after stroke in the presence of good collaterals on baseline CTA (MR CLEAN-LATE). The impactful success of our stroke trials that changed many guidelines was mainly attributable to (1) the societal burden of the disease, with two thirds of patients dying or being independent at 3 months; (2) the fact that stroke is a common disease, (3) the relatively simple and pragmatic approach of the trials resembling real-world setting; (4) the acceleration of implementation in clinical practice facilitated by a structured approach to guideline development and conditional funding; and foremost (5) the excellent collaboration on a professional level between-disciplines, i.e., diagnostic radiologists, interventionalists, and neurologists. Critical relevance statement The MR CLEAN and MR CLEAN II trials have had tremendous impact on clinical practice, directly by more patients being treated with an effective intervention and indirectly through adoption of evidence-based guidelines. It is in

Published
2024

27. Personalized decision‑making for aneurysm treatment of aneurysmal subarachnoid hemorrhage:development and validation of a clinical prediction tool

Author

de Winkel, Jordi, Roozenbeek, Bob, Dijkland, Simone, Dammers, R., van Doormaal, Pieter Jan, van der Jagt, Mathieu, van Klaveren, David, Dippel, Diederik, Lingsma, Hester, de Winkel, Jordi, Roozenbeek, Bob, Dijkland, Simone, Dammers, R., van Doormaal, Pieter Jan, van der Jagt, Mathieu, van Klaveren, David, Dippel, Diederik, and Lingsma, Hester

Abstract

Background: In patients with aneurysmal subarachnoid hemorrhage suitable for endovascular coiling and neurosurgical clip-reconstruction, the aneurysm treatment decision-making process could be improved by considering heterogeneity of treatment effect and durability of treatment. We aimed to develop and validate a tool to predict individualized treatment benefit of endovascular coiling compared to neurosurgical clip-reconstruction. Methods: We used randomized data (International Subarachnoid Aneurysm Trial, n = 2143) to develop models to predict 2-month functional outcome and to predict time-to-rebleed-or-retreatment. We modeled for heterogeneity of treatment effect by adding interaction terms of treatment with prespecified predictors and with baseline risk of the outcome. We predicted outcome with both treatments and calculated absolute treatment benefit. We described the patient characteristics of patients with ≥ 5% point difference in the predicted probability of favorable functional outcome (modified Rankin Score 0–2) and of no rebleed or retreatment within 10 years. Model performance was expressed with the c-statistic and calibration plots. We performed bootstrapping and leave-one-cluster-out cross-validation and pooled cluster-specific c-statistics with random effects meta-analysis. Results: The pooled c-statistics were 0.72 (95% CI: 0.69–0.75) for the prediction of 2-month favorable functional outcome and 0.67 (95% CI: 0.63–0.71) for prediction of no rebleed or retreatment within 10 years. We found no significant interaction between predictors and treatment. The average predicted benefit in favorable functional outcome was 6% (95% CI: 3–10%) in favor of coiling, but 11% (95% CI: 9–13%) for no rebleed or retreatment in favor of clip-reconstruction. 134 patients (6%), young and in favorable clinical condition, had negligible functional outcome benefit of coiling but had a ≥ 5% point benefit of clip-reconstruction in terms of durability of treatment. Conclusio

Published
2024

28. Propofol anesthesia improves stroke outcomes over isoflurane anesthesia: a longitudinal multiparametric MRI study in a rodent model of transient middle cerebral artery occlusion

Author

In Vivo NMR ISI, Brain, Circulatory Health, MS Radiologie, Stroke, Franx, Bart A.A., van Tilborg, Geralda A.F., van der Toorn, Annette, van Heijningen, Caroline L., Dippel, Diederik W.J., van der Schaaf, Irene C., Dijkhuizen, Rick M., In Vivo NMR ISI, Brain, Circulatory Health, MS Radiologie, Stroke, Franx, Bart A.A., van Tilborg, Geralda A.F., van der Toorn, Annette, van Heijningen, Caroline L., Dippel, Diederik W.J., van der Schaaf, Irene C., and Dijkhuizen, Rick M.

Published
2024

29. Impact of Intracranial Volume and Brain Volume on the Prognostic Value of Computed Tomography Perfusion Core Volume in Acute Ischemic Stroke

Author

Hoving, Jan W., Konduri, Praneeta R., Tolhuisen, Manon L., Koopman, Miou S., van Voorst, Henk, Van Poppel, Laura M., Daems, Jasper D., van Es, Adriaan C.G.M., van Walderveen, Marianne A.A., Lingsma, Hester F., Dippel, Diederik W.J., Van Zwam, Wim H., Marquering, Henk A., Majoie, Charles B.L.M., Emmer, Bart J., Hoving, Jan W., Konduri, Praneeta R., Tolhuisen, Manon L., Koopman, Miou S., van Voorst, Henk, Van Poppel, Laura M., Daems, Jasper D., van Es, Adriaan C.G.M., van Walderveen, Marianne A.A., Lingsma, Hester F., Dippel, Diederik W.J., Van Zwam, Wim H., Marquering, Henk A., Majoie, Charles B.L.M., and Emmer, Bart J.

Abstract

Background: Computed tomography perfusion (CTP)-estimated core volume is associated with functional outcomes in acute ischemic stroke. This relationship might differ among patients, depending on brain volume. Materials and Methods: We retrospectively included patients from the MR CLEAN Registry. Cerebrospinal fluid (CSF) and intracranial volume (ICV) were automatically segmented on NCCT. We defined the proportion of the ICV and total brain volume (TBV) affected by the ischemic core as ICVcore and TBVcore. Associations between the core volume, ICVcore, TBVcore, and functional outcome are reported per interquartile range (IQR). We calculated the area under the curve (AUC) to assess diagnostic accuracy.Results: In 200 patients, the median core volume was 13 (5–41) mL. Median ICV and TBV were 1377 (1283–1456) mL and 1108 (1020–1197) mL. Median ICVcore and TBVcore were 0.9 (0.4–2.8)% and 1.7 (0.5–3.6)%. Core volume (acOR per IQR 0.48 [95%CI 0.33–0.69]), ICVcore (acOR per IQR 0.50 [95%CI 0.35–0.69]), and TBVcore (acOR per IQR 0.41 95%CI 0.33–0.67]) showed a lower likelihood of achieving improved functional outcomes after 90 days. The AUC was 0.80 for the prediction of functional independence at 90 days for the CTP-estimated core volume, the ICVcore, and the TBVcore. Conclusion:Correcting the CTP-estimated core volume for the intracranial or total brain volume did not improve the association with functional outcomes in patients who underwent EVT.

Published
2024

30. Propofol anesthesia improves stroke outcomes over isoflurane anesthesia—a longitudinal multiparametric MRI study in a rodent model of transient middle cerebral artery occlusion

Author

Franx, Bart A.A., van Tilborg, Geralda A.F., van der Toorn, Annette, van Heijningen, Caroline L., Dippel, Diederik W.J., van der Schaaf, Irene C., Dijkhuizen, Rick M., Franx, Bart A.A., van Tilborg, Geralda A.F., van der Toorn, Annette, van Heijningen, Caroline L., Dippel, Diederik W.J., van der Schaaf, Irene C., and Dijkhuizen, Rick M.

Abstract

General anesthesia is routinely used in endovascular thrombectomy procedures, for which volatile gas and/or intravenous propofol are recommended. Emerging evidence suggests propofol may have superior effects on disability and/or mortality rates, but a mode-of-action underlying these class-specific effects remains unknown. Here, a moderate isoflurane or propofol dosage on experimental stroke outcomes was retrospectively compared using serial multiparametric MRI and behavioral testing. Adult male rats (N = 26) were subjected to 90-min filament-induced transient middle cerebral artery occlusion. Diffusion-, T2- and perfusion-weighted MRI was performed during occlusion, 0.5 h after recanalization, and four days into the subacute phase. Sequels of ischemic damage—blood–brain barrier integrity, cerebrovascular reactivity and sensorimotor functioning—were assessed after four days. While size and severity of ischemia was comparable between groups during occlusion, isoflurane anesthesia was associated with larger lesion sizes and worsened sensorimotor functioning at follow-up. MRI markers indicated that cytotoxic edema persisted locally in the isoflurane group early after recanalization, coinciding with burgeoning vasogenic edema. At follow-up, sequels of ischemia were further aggravated in the post-ischemic lesion, manifesting as increased blood–brain barrier leakage, cerebrovascular paralysis and cerebral hyperperfusion. These findings shed new light on how isoflurane, and possibly similar volatile agents, associate with persisting injurious processes after recanalization that contribute to suboptimal treatment outcome.

Published
2024

31. Value of Automatically Derived Full Thrombus Characteristics:An Explorative Study of Their Associations with Outcomes in Ischemic Stroke Patients

Author

Mojtahedi, Mahsa, Bruggeman, Agnetha E., van Voorst, Henk, Ponomareva, Elena, Kappelhof, Manon, van der Lugt, Aad, Hoving, Jan W., Dutra, Bruna G., Dippel, Diederik, Cavalcante, Fabiano, Yo, Lonneke, Coutinho, Jonathan, Brouwer, Josje, Treurniet, Kilian, Tolhuisen, Manon L., LeCouffe, Natalie, Arrarte Terreros, Nerea, Konduri, Praneeta R., van Zwam, Wim, Roos, Yvo, Majoie, Charles B.L.M., Emmer, Bart J., Marquering, Henk A., Mojtahedi, Mahsa, Bruggeman, Agnetha E., van Voorst, Henk, Ponomareva, Elena, Kappelhof, Manon, van der Lugt, Aad, Hoving, Jan W., Dutra, Bruna G., Dippel, Diederik, Cavalcante, Fabiano, Yo, Lonneke, Coutinho, Jonathan, Brouwer, Josje, Treurniet, Kilian, Tolhuisen, Manon L., LeCouffe, Natalie, Arrarte Terreros, Nerea, Konduri, Praneeta R., van Zwam, Wim, Roos, Yvo, Majoie, Charles B.L.M., Emmer, Bart J., and Marquering, Henk A.

Abstract

(1) Background: For acute ischemic strokes caused by large vessel occlusion, manually assessed thrombus volume and perviousness have been associated with treatment outcomes. However, the manual assessment of these characteristics is time-consuming and subject to inter-observer bias. Alternatively, a recently introduced fully automated deep learning-based algorithm can be used to consistently estimate full thrombus characteristics. Here, we exploratively assess the value of these novel biomarkers in terms of their association with stroke outcomes. (2) Methods: We studied two applications of automated full thrombus characterization as follows: one in a randomized trial, MR CLEAN-NO IV (n = 314), and another in a Dutch nationwide registry, MR CLEAN Registry (n = 1839). We used an automatic pipeline to determine the thrombus volume, perviousness, density, and heterogeneity. We assessed their relationship with the functional outcome defined as the modified Rankin Scale (mRS) at 90 days and two technical success measures as follows: successful final reperfusion, which is defined as an eTICI score of 2b-3, and successful first-pass reperfusion (FPS). (3) Results: Higher perviousness was significantly related to a better mRS in both MR CLEAN-NO IV and the MR CLEAN Registry. A lower thrombus volume and lower heterogeneity were only significantly related to better mRS scores in the MR CLEAN Registry. Only lower thrombus heterogeneity was significantly related to technical success; it was significantly related to a higher chance of FPS in the MR CLEAN-NO IV trial (OR = 0.55, 95% CI: 0.31–0.98) and successful reperfusion in the MR CLEAN Registry (OR = 0.88, 95% CI: 0.78–0.99). (4) Conclusions: Thrombus characteristics derived from automatic entire thrombus segmentations are significantly related to stroke outcomes.

Published
2024

32. Sex Differences in Prehospital Identification of Large Vessel Occlusion in Patients with Suspected Stroke

Author

Ali, Mariam, Dekker, Luuk, Daems, Jasper D., Ali, Mahsoem, Van Zwet, Erik W., Steyerberg, Ewout W., Duvekot, Martijne H.C., Nguyen, T. Truc My, Moudrous, Walid, Van De Wijdeven, Ruben M., Visser, Marieke C., De Laat, Karlijn F., Kerkhoff, Henk, Van Den Wijngaard, Ido R., Dippel, Diederik W.J., Roozenbeek, Bob, Kruyt, Nyika D., Wermer, Marieke J.H., Ali, Mariam, Dekker, Luuk, Daems, Jasper D., Ali, Mahsoem, Van Zwet, Erik W., Steyerberg, Ewout W., Duvekot, Martijne H.C., Nguyen, T. Truc My, Moudrous, Walid, Van De Wijdeven, Ruben M., Visser, Marieke C., De Laat, Karlijn F., Kerkhoff, Henk, Van Den Wijngaard, Ido R., Dippel, Diederik W.J., Roozenbeek, Bob, Kruyt, Nyika D., and Wermer, Marieke J.H.

Abstract

BACKGROUND: Differences in clinical presentation of acute ischemic stroke between men and women may affect prehospital identification of anterior circulation large vessel occlusion (aLVO). We assessed sex differences in diagnostic performance of 8 prehospital scales to detect aLVO. METHODS: We analyzed pooled individual patient data from 2 prospective cohort studies (LPSS [Leiden Prehospital Stroke Study] and PRESTO [Prehospital Triage of Patients With Suspected Stroke Study]) conducted in the Netherlands between 2018 and 2019, including consecutive patients ≥18 years suspected of acute stroke who presented within 6 hours after symptom onset. Ambulance paramedics assessed clinical items from 8 prehospital aLVO detection scales: Los Angeles Motor Scale, Rapid Arterial Occlusion Evaluation, Cincinnati Stroke Triage Assessment Tool, Cincinnati Prehospital Stroke Scale, Prehospital Acute Stroke Severity, gaze-face-arm-speech-time, Conveniently Grasped Field Assessment Stroke Triage, and Face-Arm-Speech-Time Plus Severe Arm or Leg Motor Deficit. We assessed the diagnostic performance of these scales for identifying aLVO at prespecified cut points for men and women.RESULTS: Of 2358 patients with suspected stroke (median age, 73 years; 47% women), 231 (10%) had aLVO (100/1114 [9%] women and 131/1244 [11%] men). The area under the curve of the scales ranged from 0.70 (95% CI, 0.65-0.75) to 0.77 (95% CI, 0.73-0.82) in women versus 0.69 (95% CI, 0.64-0.73) to 0.75 (95% CI, 0.71-0.79) in men. Positive predictive values ranged from 0.23 (95% CI, 0.20-0.27) to 0.29 (95% CI, 0.26-0.31) in women versus 0.29 (95% CI, 0.24-0.33) to 0.37 (95% CI, 0.32-0.43) in men. Negative predictive values were similar (0.95 [95% CI, 0.94-0.96] to 0.98 [95% CI, 0.97-0.98] in women versus 0.94 [95% CI, 0.93-0.95] to 0.96 [95% CI, 0.94-0.97] in men). Sensitivity of the scales was slightly higher in women than in men (0.53 [95% CI, 0.43-0.63]

Published
2024

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

Author

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

Published
2022
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36. Effect of CAD on performance in ASPECTS reading

Author

Ernst, Marielle, Bernhardt, Martina, Bechstein, Matthias, Schön, Gerhard, Fiehler, Jens, Majoie, Charles B.L.M., Marquering, Henk A., van Zwam, Wim H., Dippel, Diederik W.J., van Oostenbrugge, Robert J., and Goebell, Einar

Published
2020
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37. Value of Automatically Derived Full Thrombus Characteristics: An Explorative Study of Their Associations with Outcomes in Ischemic Stroke Patients

Author

Mojtahedi, Mahsa, primary, Bruggeman, Agnetha E., additional, van Voorst, Henk, additional, Ponomareva, Elena, additional, Kappelhof, Manon, additional, van der Lugt, Aad, additional, Hoving, Jan W., additional, Dutra, Bruna G., additional, Dippel, Diederik, additional, Cavalcante, Fabiano, additional, Yo, Lonneke, additional, Coutinho, Jonathan, additional, Brouwer, Josje, additional, Treurniet, Kilian, additional, Tolhuisen, Manon L., additional, LeCouffe, Natalie, additional, Arrarte Terreros, Nerea, additional, Konduri, Praneeta R., additional, van Zwam, Wim, additional, Roos, Yvo, additional, Majoie, Charles B. L. M., additional, Emmer, Bart J., additional, and Marquering, Henk A., additional

Published
2024
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38. Impact of Intracranial Volume and Brain Volume on the Prognostic Value of Computed Tomography Perfusion Core Volume in Acute Ischemic Stroke

Author

Hoving, Jan W., primary, Konduri, Praneeta R., additional, Tolhuisen, Manon L., additional, Koopman, Miou S., additional, van Voorst, Henk, additional, Van Poppel, Laura M., additional, Daems, Jasper D., additional, van Es, Adriaan C. G. M., additional, van Walderveen, Marianne A. A., additional, Lingsma, Hester F., additional, Dippel, Diederik W. J., additional, Van Zwam, Wim H., additional, Marquering, Henk A., additional, Majoie, Charles B. L. M., additional, and Emmer, Bart J., additional

Published
2024
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39. A Qualitative Study of Patients’ Perspectives regarding Digital Health Technology to Support Self-management and to Improve Integrated Stroke Care: The ValueCare study.

Author

Bally, Esmee, primary, Cheng, Demi, additional, Van Grieken, Amy, additional, Ferri Sanz, Mireia, additional, Zanutto, Oscar, additional, Carroll, Áine, additional, Darley, Andrew, additional, Roozenbeek, Bob, additional, Dippel, Diederik, additional, and Raat, Hein, additional

Published
2023
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42. Economic Evaluation of Endovascular Treatment for Acute Ischemic Stroke

Author

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

Published
2021
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47. Endovascular Treatment for Posterior Circulation Stroke in Routine Clinical Practice: Results of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry

Author

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

Published
2022
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48. Association between thrombus composition and stroke etiology in the MR CLEAN Registry biobank

Author

Hund, Hajo M., Boodt, Nikki, Hansen, Daniel, Haffmans, Willem A., Lycklama à Nijeholt, Geert J., Hofmeijer, Jeannette, Dippel, Diederik W. J., van der Lugt, Aad, van Es, Adriaan C. G. M., van Beusekom, Heleen M. M., Majoie, Charles B. L. M., Roos, Yvo B. W. E. M., van Oostenbrugge, Robert J., van Zwam, Wim H., Boiten, Jelis, Vos, Jan Albert, Jansen, Ivo G. H., Mulder, Maxim J. H. L., Goldhoorn, Robert- Jan B., Compagne, Kars C. J., Kappelhof, Manon, Brouwer, Josje, den Hartog, Sanne J., Hinsenveld, Wouter H., Roozenbeek, Bob, Emmer, Bart J., Coutinho, Jonathan M., Schonewille, Wouter J., Wermer, Marieke J. H., van Walderveen, Marianne A. A., Staals, Julie, Martens, Jasper M., de Bruijn, Sebastiaan F., van Dijk, Lukas C., van der Worp, H. Bart, Lo, Rob H., van Dijk, Ewoud J., Boogaarts, Hieronymus D., de Vries, J., de Kort, Paul L. M., van Tuijl, Julia, Peluso, Jo P., Fransen, Puck, van den Berg, Jan S. P., van Hasselt, Boudewijn A. A. M., Aerden, Leo A. M., Dallinga, René J., Uyttenboogaart, Maarten, Eschgi, Omid, Bokkers, Reinoud P. H., Schreuder, Tobien H. C. M. L., Heijboer, Roel J. J., Keizer, Koos, Yo, Lonneke S. F., den Hertog, Heleen M., Bulut, Tomas, Brouwers, Paul J. A. M., Sprengers, Marieke E. S., Jenniskens, Sjoerd F. M., van den Berg, René, Yoo, Albert J., Beenen, Ludo F. M., Postma, Alida A., Roosendaal, Stefan D., van der Kallen, Bas F. W., van den Wijngaard, Ido R., Bot, Joost, van Doormaal, Pieter-Jan, Meijer, Anton, Ghariq, Elyas, van Proosdij, Marc P., Krietemeijer, G. Menno, Dinkelaar, Wouter, Appelman, Auke P. A., Hammer, Bas, Pegge, Sjoert, van der Hoorn, Anouk, Vinke, Saman, Flach, H. Zwenneke, Lingsma, Hester F., el Ghannouti, Naziha, Sterrenberg, Martin, Pellikaan, Wilma, Sprengers, Rita, Elfrink, Marjan, Simons, Michelle, Vossers, Marjolein, de Meris, Joke, Vermeulen, Tamara, Geerlings, Annet, van Vemde, Gina, Simons, Tiny, Messchendorp, Gert, Nicolaij, Nynke, Bongenaar, Hester, Bodde, Karin, Kleijn, Sandra, Lodico, Jasmijn, Droste, Hanneke, Wollaert, Maureen, Verheesen, Sabrina, Jeurrissen, D., Bos, Erna, Drabbe, Yvonne, Sandiman, Michelle, Aaldering, Nicoline, Zweedijk, Berber, Vervoort, Jocova, Ponjee, Eva, Romviel, Sharon, Kanselaar, Karin, Barning, Denn, Venema, Esmee, Chalos, Vicky, Geuskens, Ralph R., van Straaten, Tim, Ergezen, Saliha, Harmsma, Roger R. M., Muijres, Daan, de Jong, Anouk, Berkhemer, Olvert A., Boers, Anna M. M., Huguet, J., Groot, P. F. C., Mens, Marieke A., van Kranendonk, Katinka R., Treurniet, Kilian M., Tolhuisen, Manon L., Alves, Heitor, Weterings, Annick J., Kirkels, Eleonora L.F., Voogd, Eva J. H. F., Schupp, Lieve M., Collette, Sabine L., Groot, Adrien E. D., LeCouffe, Natalie E., Konduri, Praneeta R., Prasetya, Haryadi, Arrarte-Terreros, Nerea, Ramos, Lucas A., Radiology and Nuclear Medicine, ACS - Microcirculation, ANS - Neurovascular Disorders, Neurology, ACS - Atherosclerosis & ischemic syndromes, ANS - Cellular & Molecular Mechanisms, ANS - Compulsivity, Impulsivity & Attention, Graduate School, Biomedical Engineering and Physics, AMS - Amsterdam Movement Sciences, ANS - Brain Imaging, Adult Psychiatry, APH - Methodology, ​Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Damage and Repair in Cancer Development and Cancer Treatment (DARE), Cardiology, Radiology & Nuclear Medicine, Radiology and nuclear medicine, Internal medicine, Pediatrics, Amsterdam Neuroscience - Neurovascular Disorders, and CCA - Imaging and biomarkers

Subjects
Microscopy, Ischemic stroke, Radiology, Nuclear Medicine and imaging, Endovascular treatment, Neurology (clinical), Cardiology and Cardiovascular Medicine, Mechanical thrombectomy, Stent-retriever, Thrombus
Abstract

Purpose The composition of thrombi retrieved during endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) due to large vessel occlusion (LVO) may differ depending on their origin. In this study, we investigated the association between thrombus composition and stroke etiology in a large population of patients from the Dutch MR CLEAN Registry treated with EVT in daily clinical practice. Methods The thrombi of 332 patients with AIS were histologically analyzed for red blood cells (RBC), fibrin/platelets (F/P), and white blood cells (leukocytes) using a machine learning algorithm. Stroke etiology was assessed using the Trial of Org 10,172 in acute stroke treatment (TOAST) classification. Results The thrombi of cardioembolic origin contained less RBC and more F/P than those of non-cardioembolic origin (25.8% vs 41.2% RBC [p = 0.003] and 67.1% vs 54.5% F/P [p = 0.004]). The likelihood of a non-cardioembolic source of stroke increased with increasing thrombus RBC content (OR 1.02; [95% CI 1.00–1.06] for each percent increase) and decreased with a higher F/P content (OR 1.02; [95% CI 1.00–1.06]). Thrombus composition in patients with a cardioembolic origin and undetermined origin was similar. Conclusion Thrombus composition is significantly associated with stroke etiology, with an increase in RBC and a decrease in F/P raising the odds for a non-cardioembolic cause. No difference between composition of cardioembolic thrombi and of undetermined origin was seen. This emphasizes the need for more extensive monitoring for arrhythmias and/or extended cardiac analysis in case of an undetermined origin.

Published
2023

49. Disentangling the Association Between Neurologic Deficits, Patient-Reported Impairments, and Quality of Life After Ischemic Stroke

Author

van der Ende, Nadinda A M, den Hartog, Sanne J, Broderick, Joseph P, Khatri, Pooja, Visser-Meily, Johanna, van Leeuwen, Nikki, Lingsma, Hester F, Roozenbeek, Bob, Dippel, Diederik W J, Neurology, Radiology & Nuclear Medicine, and Public Health

Subjects
Neurology (clinical)
Abstract

Background and ObjectivesThe EuroQol Group 5-Dimension Self-Reported Questionnaire (EQ-5D) is a well-established instrument to assess quality of life and generates generic utility values for health states reported by patients, derived from assessments by the general public. We hypothesized that language problems and other nonmotor deficits are not captured as well as motor deficits by this system. We aimed to quantify the association between disabling neurologic deficits and the EQ-5D dimension scores and the utility score in patients with ischemic stroke.MethodsWe used data of the Interventional Management of Stroke III trial. Missing data were imputed by multiple imputation. The association between neurologic deficits (individual NIH Stroke Scale [NIHSS] item scores) and the EQ-5D-3L (5 three-level dimension scores and utility score) at 90 days was assessed with ordinal logistic regression and Tobit regression, respectively. The explained variance of each model was estimated with Nagelkerke pseudo-R2or R2.ResultsIn total, 525 surviving patients were included. Complete data on both the NIHSS and EQ-5D were available for 481/525 (91.6%) patients. At 90 days, 161/491 (32.8%) patients had aphasia and 226/491 (46.0%) patients had paresis of at least 1 limb. Limb paresis, facial palsy, sensory loss, and dysarthria explained most of the variance in all EQ-5D dimension scores and the utility score. In the utility score, 8.9% of the variance was explained by neglect, 10.0% by aphasia, 10.8% by hemianopia, and 17.5%–24.1% by limb paresis.DiscussionThe impact of neurologic deficits on the EQ-5D in patients with ischemic stroke is mostly due to limb paresis, while the EQ-5D is less sensitive to other nonmotor deficits such as hemianopia, aphasia, and neglect. This may lead to overestimation of quality of life and, consequently, underestimation of the (cost-)effectiveness of treatments and interventions.Trial Registration InformationClinicalTrials.gov. Unique identifier:NCT00359424.

Published
2023

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