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2. Workflow Intervals of Endovascular Acute Stroke Therapy During On- Versus Off-Hours: The MR CLEAN Registry

Author

Hinsenveld, Wouter H., de Ridder, Inger R., van Oostenbrugge, Robert J., Vos, Jan A., Groot, Adrien E., Coutinho, Jonathan M., Lycklama à Nijeholt, Geert J., Boiten, Jelis, Schonewille, Wouter J., Dippel, Diederik W.J., van der Lugt, Aad, Majoie, Charles B.L.M., Roos, Yvo B.W.E.M., van Zwam, Wim H., Jansen, Ivo G.H., Mulder, Maxim J.H.L., Goldhoorn, Robert-Jan B., Compagne, Kars C.J., Kappelhof, Manon, Majoie, Charles B.L.M., Wermer, Marieke J.H., van Walderveen, Marianne A.A., Staals, Julie, van Zwam, Wim H., Hofmeijer, Jeannette, Martens, Jasper M., Roozenbeek, Bob, Emmer, Bart 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 Kort, Paul L.M., Peluso, Jo J.P., van den Berg, Jan S.P., van Hasselt, Boudewijn A.A.M., Aerden, Leo A.M., Dallinga, René J., Uyttenboogaart, Maarten, Eshghi, Omid, Schreuder, Tobien H.C.M.L., Heijboer, Roel J.J., Keizer, Koos, Yo, Lonneke S.F., den Hertog, Heleen M., Sturm, Emiel J.C., Majoie, Charles B.L.M., van Zwam, Wim H., van der Lugt, Aad, van Walderveen, Marianne A.A., 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., van Es, Adriaan C.G.M., Emmer, Bart J., Martens, Jasper M., Yo, Lonneke S.F., Bot, Joost, van Doormaal, Pieter-Jan, Dippel, Diederik W.J., van der Lugt, Aad, Majoie, Charles B.L.M., Roos, Yvo B.W.E.M., van Zwam, Wim H., Hofmeijer, Jeannette, Martens, Jasper M., van der Worp, H. Bart, Lo, Rob H., Hofmeijer, Jeannette, Flach, H. Zwenneke, Lingsma, Hester F., el Ghannouti, Naziha, Sterrenberg, Martin, Puppels, Corina, Pellikaan, Wilma, Sprengers, Rita, Elfrink, Marjan, de Meris, Joke, Vermeulen, Tamara, Geerlings, Annet, van Vemde, Gina, Simons, Tiny, van Rijswijk, Cathelijn, Messchendorp, Gert, Bongenaar, Hester, Bodde, Karin, Kleijn, Sandra, Lodico, Jasmijn, Droste, Hanneke, Wollaert, M., Jeurrissen, D., Bos, Ernas, Drabbe, Yvonne, Aaldering, Nicoline, Zweedijk, Berber, Khalilzada, Mostafa, Venema, Esmee, Chalos, Vicky, Geuskens, Ralph R., van Straaten, Tim, Ergezen, Saliha, Harmsma, Roger R.M., Muijres, Daan, de Jong, Anouk, Berkhemer, Olvert A., Boersc, Anna M.M., Huguet, J., Groot, P.F.C., Mens, Marieke A., van Kranendonk, Katinka R., Treurniet, Kilian M., Tolhuijsen, Manon L., and Alves, Heitor

Published
2019
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3. Does Sex Modify the Effect of Endovascular Treatment for Ischemic Stroke?: A Subgroup Analysis of 7 Randomized Trials

Author

Chalos, Vicky, de Ridder, Inger R., Lingsma, Hester F., Brown, Scott, van Oostenbrugge, Robert J., Goyal, Mayank, Campbell, Bruce C.V., Muir, Keith W., Guillemin, Francis, Bracard, Serge, White, Philip, Dávalos, Antoni, Jovin, Tudor G., Hill, Michael D., Mitchell, Peter J., Demchuk, Andrew M., Saver, Jeffrey L., van Zwam, Wim H., and Dippel, Diederik W.J.

Published
2019
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5. Association between type of intervention center and outcomes after endovascular treatment for acute ischemic stroke: Results from the MR CLEAN Registry

Author

Olthuis, Susanne GH, primary, Hinsenveld, Wouter H, additional, Pinckaers, Florentina ME, additional, Amini, Marzyeh, additional, Lingsma, Hester F, additional, Staals, Julie, additional, HCML Schreuder, Tobien, additional, Schonewille, Wouter J, additional, Yo, Lonneke SF, additional, BWEM Roos, Yvo, additional, Postma, Alida A, additional, Dippel, Diederik WJ, additional, van Zwam, Wim H, additional, van Oostenbrugge, Robert J, additional, and de Ridder, Inger R, additional

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

Author

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

Published
2022
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7. sj-docx-1-eso-10.1177_23969873221145771 – Supplemental material for Association between type of intervention center and outcomes after endovascular treatment for acute ischemic stroke: Results from the MR CLEAN Registry

Author

Olthuis, Susanne GH, Hinsenveld, Wouter H, Pinckaers, Florentina ME, Amini, Marzyeh, Lingsma, Hester F, Staals, Julie, HCML Schreuder, Tobien, Schonewille, Wouter J, Yo, Lonneke SF, BWEM Roos, Yvo, Postma, Alida A, Dippel, Diederik WJ, van Zwam, Wim H, van Oostenbrugge, Robert J, and de Ridder, Inger R

Subjects
FOS: Clinical medicine, Cardiology, Medicine, 110904 Neurology and Neuromuscular Diseases
Abstract

Supplemental material, sj-docx-1-eso-10.1177_23969873221145771 for Association between type of intervention center and outcomes after endovascular treatment for acute ischemic stroke: Results from the MR CLEAN Registry by Susanne GH Olthuis, Wouter H Hinsenveld, Florentina ME Pinckaers, Marzyeh Amini, Hester F Lingsma, Julie Staals, Tobien HCML Schreuder, Wouter J Schonewille, Lonneke SF Yo, Yvo BWEM Roos, Alida A Postma, Diederik WJ Dippel, Wim H van Zwam, Robert J van Oostenbrugge and Inger R de Ridder in European Stroke Journal

Published
2022
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9. PAIS 2 (Paracetamol [Acetaminophen] in Stroke 2): Results of a Randomized, Double-Blind Placebo-Controlled Clinical Trial

Author

de Ridder, Inger R., den Hertog, Heleen M., van Gemert, H. Maarten A., Schreuder, A.H.C.M.L. (Tobien), Ruitenberg, Annemieke, Maasland, E. (Lisette), Saxena, Ritu, van Tuijl, Jordie H., Jansen, Ben P.W., Van den Berg-Vos, Renske M., Vermeij, Frederique, Koudstaal, Peter J., Kappelle, L. Jaap, Algra, Ale, van der Worp, H. Bart, Dippel, Diederik W.J., Lingsma, H.F., El Ghannouti, N., Vermey, F., Vermeulen, M., Tijssen, J.G.P., and van Dijk, E.J.

Published
2017
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10. Association between type of intervention center and outcomes after endovascular treatment for acute ischemic stroke: Results from the MR CLEAN Registry.

Author

Olthuis, Susanne GH, Hinsenveld, Wouter H, Pinckaers, Florentina ME, Amini, Marzyeh, Lingsma, Hester F, Staals, Julie, HCML Schreuder, Tobien, Schonewille, Wouter J, Yo, Lonneke SF, BWEM Roos, Yvo, Postma, Alida A, Dippel, Diederik WJ, van Zwam, Wim H, van Oostenbrugge, Robert J, and de Ridder, Inger R

Published
2023
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11. The Role of the Glycocalyx in the Pathophysiology of Subarachnoid Hemorrhage-Induced Delayed Cerebral Ischemia

Author

Schenck, Hanna, Netti, Eliisa, Teernstra, Onno, De Ridder, Inger, Dings, Jim, Niemelae, Mika, Temel, Yasin, Hoogland, Govert, Haeren, Roel, Neurokirurgian yksikkö, and HUS Neurocenter

Subjects
NITRIC-OXIDE, subarachnoid hemorrhage, VASOSPASM, review, LEUKOCYTE ADHESION, NEUROLOGICAL DEFICITS, MOUSE MODEL, SMOKING-CESSATION, BARRIER, MICROCIRCULATION, aneurysm, delayed cerebral ischemia, 1182 Biochemistry, cell and molecular biology, ENDOTHELIAL SURFACE GLYCOCALYX, BRAIN, glycocalyx, pathophysiology
Abstract

The glycocalyx is an important constituent of blood vessels located between the bloodstream and the endothelium. It plays a pivotal role in intercellular interactions in neuroinflammation, reduction of vascular oxidative stress, and provides a barrier regulating vascular permeability. In the brain, the glycocalyx is closely related to functions of the blood-brain barrier and neurovascular unit, both responsible for adequate neurovascular responses to potential threats to cerebral homeostasis. An aneurysmal subarachnoid hemorrhage (aSAH) occurs following rupture of an intracranial aneurysm and leads to immediate brain damage (early brain injury). In some cases, this can result in secondary brain damage, also known as delayed cerebral ischemia (DCI). DCI is a life-threatening condition that affects up to 30% of all aSAH patients. As such, it is associated with substantial societal and healthcare-related costs. Causes of DCI are multifactorial and thought to involve neuroinflammation, oxidative stress, neuroinflammation, thrombosis, and neurovascular uncoupling. To date, prediction of DCI is limited, and preventive and effective treatment strategies of DCI are scarce. There is increasing evidence that the glycocalyx is disrupted following an aSAH, and that glycocalyx disruption could precipitate or aggravate DCI. This review explores the potential role of the glycocalyx in the pathophysiological mechanisms contributing to DCI following aSAH. Understanding the role of the glycocalyx in DCI could advance the development of improved methods to predict DCI or identify patients at risk for DCI. This knowledge may also alter the methods and timing of preventive and treatment strategies of DCI. To this end, we review the potential and limitations of methods currently used to evaluate the glycocalyx, and strategies to restore or prevent glycocalyx shedding.

Published
2021

13. Peripheral Artery Disease in Acute Ischemic Stroke Patients Treated With Endovascular Thrombectomy; Results From the MR CLEAN Registry

Author

Pirson, France A. V., primary, Hinsenveld, Wouter H., additional, Staals, Julie, additional, de Ridder, Inger R., additional, van Zwam, Wim H., additional, Schreuder, Tobien H. C. M. L., additional, Roos, Yvo B. W. E. M., additional, Majoie, Charles B. L. M., additional, van der Worp, H. Bart, additional, Uyttenboogaart, Maarten, additional, Lycklama à Nijeholt, Geert J., additional, Schonewille, Wouter J., additional, and van Oostenbrugge, Robert J., additional

Published
2020
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16. Does sex modify the effect of endovascular treatment for ischemic stroke? A subgroup analysis of seven randomized trials

Author

Chalos, Vicky, de Ridder, Inger R., Lingsma, Hester, Brown, Scott, van Oostenbruggge, Robert J., Goyal, Mayank, Campbell, Bruce C.V., Muir, Keith W., Guillemin, Francis, Bracard, Serge, White, Philip, Dávalos, Antoni, Jovin, Tudor G., Hill, Michael D., Mitchell, Peter J., Demchuck, Andrew M., Saver, Jeffrey L., van Zwam, Wim H., and Dippel, Diederik W.J.

Abstract

Background and Purpose:\ud Previous studies have reported less favorable outcome and less effect of endovascular treatment (EVT) after ischemic stroke in women than in men. Our aim was to study the influence of sex on outcome and on the effect of EVT for ischemic stroke in recent randomized trials on EVT.\ud \ud Methods:\ud We used data from 7 randomized controlled trials on EVT within the HERMES collaboration. The primary outcome was 90-day functional outcome (modified Rankin Scale). We compared baseline characteristics and outcomes between men and women. With ordinal logistic regression, we evaluated the association between EVT and 90-day functional outcome for men and women separately, adjusted for potential confounders. We tested for interaction between sex and EVT.\ud \ud Results:\ud We included 1762 patients in the analyses, of whom 833 (47%) were women. Women were older (median, 70 versus 66 years; P

Published
2019

17. MR CLEAN-LATE, a multicenter randomized clinical trial of endovascular treatment of acute ischemic stroke in The Netherlands for late arrivals: study protocol for a randomized controlled trial.

Author

Pirson, F. A. V. (Anne), Hinsenveld, Wouter H., Goldhoorn, Robert-Jan B., Staals, Julie, de Ridder, Inger R., van Zwam, Wim H., van Walderveen, Marianne A. A., Lycklama à Nijeholt, Geert J., Uyttenboogaart, Maarten, Schonewille, Wouter J., van der Lugt, Aad, Dippel, Diederik W. J., Roos, Yvo B. W. E. M., Majoie, Charles B. L. M., van Oostenbrugge, Robert J., Lycklama À Nijeholt, Geert J, and MR CLEAN-LATE investigators

Subjects
ENDOVASCULAR surgery, CLINICAL trials, RANDOMIZED controlled trials, DRUG efficacy, ISCHEMIC preconditioning
Abstract

Background: Endovascular therapy (EVT) for acute ischemic stroke due to proximal occlusion of the anterior intracranial circulation, started within 6 h from symptom onset, has been proven safe and effective. Recently, EVT has been proven effective beyond the 6-h time window in a highly selected population using CT perfusion or MR diffusion. Unfortunately, these imaging modalities are not available in every hospital, and strict selection criteria might exclude patients who could still benefit from EVT. The presence of collaterals on CT angiography (CTA) may offer a more pragmatic imaging criterion that predicts possible benefit from EVT beyond 6 h from time last known well. The aim of this study is to assess the safety and efficacy of EVT for patients treated between 6 and 24 h from time last known well after selection based on the presence of collateral flow.Methods: The MR CLEAN-LATE trial is a multicenter, randomized, open-label, blinded endpoint trial, aiming to enroll 500 patients. We will investigate the efficacy of EVT between 6 and 24 h from time last known well in acute ischemic stroke due to a proximal intracranial anterior circulation occlusion confirmed by CTA or MRA. Patients with any collateral flow (poor, moderate, or good collaterals) on CTA will be included. The inclusion of poor collateral status will be restricted to a maximum of 100 patients. In line with the current Dutch guidelines, patients who fulfill the characteristics of included patients in DAWN and DEFUSE 3 will be excluded as they are eligible for EVT as standard care. The primary endpoint is functional outcome at 90 days, assessed with the modified Rankin Scale (mRS) score. Treatment effect will be estimated with ordinal logistic regression (shift analysis) on the mRS at 90 days. Secondary endpoints include clinical stroke severity at 24 h and 5-7 days assessed by the NIHSS, symptomatic intracranial hemorrhage, recanalization at 24 h, follow-up infarct size, and mortality at 90 days, DISCUSSION: This study will provide insight into whether EVT is safe and effective for patients treated between 6 and 24 h from time last known well after selection based on the presence of collateral flow on CTA.Trial Registration: NL58246.078.17 , ISRCTN19922220 , Registered on 11 December 2017. [ABSTRACT FROM AUTHOR]

Published
2021
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18. MR CLEAN-NO IV: intravenous treatment followed by endovascular treatment versus direct endovascular treatment for acute ischemic stroke caused by a proximal intracranial occlusion-study protocol for a randomized clinical trial.

Author

Treurniet, Kilian M., LeCouffe, Natalie E., Kappelhof, Manon, Emmer, Bart J., van Es, Adriaan C. G. M., Boiten, Jelis, Lycklama, Geert J., Keizer, Koos, Yo, Lonneke S. F., Lingsma, Hester F., van Zwam, Wim H., de Ridder, Inger, van Oostenbrugge, Robert J., van der Lugt, Aad, Dippel, Diederik W. J., Coutinho, Jonathan M., Roos, Yvo B. W. E. M., Majoie, Charles B. L. M., and MR CLEAN-NO IV Investigators

Subjects
RESEARCH protocols, ENDOVASCULAR surgery, ISCHEMIC preconditioning, OCCLUSION (Chemistry), DRUG efficacy, ISCHEMIC stroke, CLINICAL trials
Abstract

Background: Endovascular treatment (EVT) has greatly improved the prognosis of acute ischemic stroke (AIS) patients with a proximal intracranial large vessel occlusion (LVO) of the anterior circulation. Currently, there is clinical equipoise concerning the added benefit of intravenous alteplase administration (IVT) prior to EVT. The aim of this study is to assess the efficacy and safety of omitting IVT before EVT in patients with AIS caused by an anterior circulation LVO.Methods: MR CLEAN-NO IV is a multicenter randomized open-label clinical trial with blinded outcome assessment (PROBE design). Patients ≥ 18 years of age with a pre-stroke mRS < 3 with an LVO confirmed on CT angiography/MR angiography eligible for both IVT and EVT are randomized to receive either IVT (0.9 mg/kg) followed by EVT, or direct EVT in a 1:1 ratio. The primary objective is to assess superiority of direct EVT. Secondarily, non-inferiority of direct EVT compared to IVT before EVT will be explored. The primary outcome is the score on the modified Rankin Scale at 90 days. Ordinal regression with adjustment for prognostic variables will be used to estimate treatment effect. Secondary outcomes include reperfusion graded with the eTICI scale after EVT and stroke severity (National Institutes of Health Stroke Scale) at 24 h. Safety outcomes include intracranial hemorrhages scored according to the Heidelberg criteria. A total of 540 patients will be included.Discussion: IVT prior to EVT might facilitate early reperfusion before EVT or improved reperfusion rates during EVT. Conversely, among other potential adverse effects, the increased risk of bleeding could nullify the beneficial effects of IVT. MR CLEAN-NO IV will provide insight into whether IVT is still of added value in patients eligible for EVT.Trial Registration: www.isrctn.com : ISRCTN80619088 . Registered on 31 October 2017. [ABSTRACT FROM AUTHOR]

Published
2021
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19. Development and validation of the Dutch Stroke Score for predicting disability and functional outcome after ischemic stroke: A tool to support efficient discharge planning

Author

de Ridder, Inger R, primary, Dijkland, Simone A, additional, Scheele, Maaike, additional, den Hertog, Heleen M, additional, Dirks, Maaike, additional, Westendorp, Willeke F, additional, Nederkoorn, Paul J, additional, van de Beek, Diederik, additional, Ribbers, Gerard M, additional, Steyerberg, Ewout W, additional, Lingsma, Hester F, additional, and Dippel, Diederik WJ, additional

Published
2018
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20. Is Intra-Arterial Treatment for Acute Ischemic Stroke Less Effective in Women than in Men?

Author

de Ridder, Inger R., Fransen, Puck S.S., Beumer, Debbie, Berkhemer, Olvert A., van den Berg, Lucie A., Wermer, Marieke J., Lingsma, Hester, van Zwam, Wim H., Roos, Yvo B., van Oostenbrugge, Robert J., Majoie, Charles B., van der Lugt, Aad, and Dippel, Diederik W.J.

Abstract

Introduction:Stroke etiology and outcome after ischemic stroke differ between men and women. We examined if sex modifies the effect of intra-arterial treatment (IAT) in a randomized clinical trial of IAT for acute ischemic stroke in the Netherlands (MR CLEAN). Patients and Methods:The primary outcome was the score on the modified Rankin scale at 90 days. We tested for interaction between sex and treatment and estimated the treatment effect by sex with multiple ordinal logistic regression with adjustment for prognostic factors. Results:All 500 patients were included in the analysis; 292 (58.4%) were men. The treatment effect (adjusted common odds ratio) was 2.39 [95% confidence interval (CI) 1.55-3.68] in men and 0.99 (95% CI 0.60-1.66) in women (pinteraction= 0.016). In women, mortality was higher in the intervention group than in the control group (24 vs. 15%, p = 0.07). Serious adverse events occurred more often in women than in men undergoing intervention. There were no differences in neuro-imaging outcomes. Discussion and Conclusion:Contrary to other studies, we found a significant interaction between sex and treatment effect in the MR CLEAN trial. Pooled analyses of all published thrombectomy trials did not confirm this finding. In MR CLEAN, women seem to have a slightly more unfavorable profile, causing higher mortality and more serious adverse events, but insufficient to explain the absence of an overall effect. This suggests a play of chance and makes it clear that IAT should not be withheld in women.

Published
2016
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