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1. Standardized mortality ratios for regionalized acute cardiovascular care

Author: den Hartog, Sanne J., Roozenbeek, Bob, van der Bij, Sjoukje, Amini, Marzyeh, van Leeuwen, Nikki, Boersma, Eric, Dirven, Clemens M.F., Dippel, Diederik W.J., and Lingsma, Hester F.
Published: 2023
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2. 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

3. 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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4. Endovascular treatment of patients with stroke caused by anterior cerebral artery occlusions

Author: Neurologen, Brain, Circulatory Health, Stroke, 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., Neurologen, Brain, Circulatory Health, Stroke, 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.
Published: 2024

5. 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

6. Performance feedback on the quality of care in hospitals performing thrombectomy for ischemic stroke (PERFEQTOS): protocol of a stepped wedge cluster randomized trial

Author: Amini, Marzyeh, den Hartog, Sanne J., van Leeuwen, Nikki, Eijkenaar, Frank, Kuhrij, Laurien S., Stolze, Lotte J., Nederkoorn, Paul J., Lingsma, Hester F., van Es, Adriaan C. G. M., van den Wijngaard, Ido R., van der Lugt, Aad, Dippel, Diederik W. J., and Roozenbeek, Bob
Published: 2021
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7. 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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8. 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

9. 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

10. Validity of Early Outcomes as Indicators for Comparing Hospitals on Quality of Stroke Care

Author: Amini, Marzyeh, primary, Eijkenaar, Frank, additional, Lingsma, Hester F., additional, den Hartog, Sanne J., additional, Olthuis, Susanne G. H., additional, Martens, Jasper, additional, van der Worp, Bart, additional, van Zwam, Wim, additional, van der Hoorn, Anouk, additional, Roosendaal, Stefan D., additional, Roozenbeek, Bob, additional, Dippel, Diederik, additional, van Leeuwen, Nikki, additional, Dippel, Diederik W. J., additional, van der Lugt, Aad, additional, Majoie, Charles B. L. M., additional, Roos, Yvo B. W. E. M., additional, van Oostenbrugge, Robert J., additional, van Zwam, Wim H., additional, Boiten, Jelis, additional, Vos, Jan Albert, additional, Brouwer, Josje, additional, Hinsenveld, Wouter H., additional, Kappelhof, Manon, additional, Compagne, Kars C. J., additional, Goldhoorn, Robert‐Jan B., additional, Mulder, Maxim J. H. L., additional, Jansen, Ivo G. H., additional, van Es, Adriaan C. G. M., additional, Emmer, Bart J., additional, Coutinho, Jonathan M., additional, Schonewille, Wouter J., additional, Wermer, Marieke J. H., additional, van Walderveen, Marianne A. A., additional, Staals, Julie, additional, Hofmeijer, Jeannette, additional, Martens, Jasper M., additional, Lycklama à Nijeholt, Geert J., additional, de Bruijn, Sebastiaan F., additional, van Dijk, Lukas C., additional, van der Worp, H. Bart, additional, Lo, Rob H., additional, van Dijk, Ewoud J., additional, Boogaarts, Hieronymus D., additional, de Vries, J., additional, de Kort, Paul L. M., additional, van Tuijl, Julia, additional, Peluso, Jo Jo P., additional, Fransen, Puck, additional, van den Berg, Jan S. P., additional, van Hasselt, Boudewijn A. A. M., additional, Aerden, Leo A. M., additional, Dallinga, René J., additional, Uyttenboogaart, Maarten, additional, Eschgi, Omid, additional, Bokkers, Reinoud P. H., additional, Schreuder, Tobien H. C. M. L., additional, Heijboer, Roel J. J., additional, Keizer, Koos, additional, Yo, Lonneke S. F., additional, den Hertog, Heleen M., additional, Sturm, Emiel J. C., additional, Brouwers, Paul, additional, Sprengers, Marieke E. S., additional, Jenniskens, Sjoerd F. M., additional, van den Berg, René, additional, Yoo, Albert J., additional, Beenen, Ludo F. M., additional, Postma, Alida A., additional, van der Kallen, Bas F. W., additional, van den Wijngaard, Ido R., additional, Bot, Joost, additional, van Doormaal, Pieter‐Jan, additional, Meijer, Anton, additional, Ghariq, Elyas, additional, van Proosdij, Marc P., additional, Krietemeijer, G. Menno, additional, Peluso, Jo P., additional, Lo, Rob, additional, Dinkelaar, Wouter, additional, Appelman, Auke P. A., additional, Hammer, Bas, additional, Pegge, Sjoert, additional, Vinke, Saman, additional, Flach, H. Zwenneke, additional, el Ghannouti, Naziha, additional, Sterrenberg, Martin, additional, Puppels, Corina, additional, Pellikaan, Wilma, additional, Sprengers, Rita, additional, Elfrink, Marjan, additional, Simons, Michelle, additional, Vossers, Marjolein, additional, de Meris, Joke, additional, Vermeulen, Tamara, additional, Geerlings, Annet, additional, van Vemde, Gina, additional, Simons, Tiny, additional, van Rijswijk, Cathelijn, additional, Messchendorp, Gert, additional, Nicolaij, Nynke, additional, Bongenaar, Hester, additional, Bodde, Karin, additional, Kleijn, Sandra, additional, Lodico, Jasmijn, additional, Droste, Hanneke, additional, Wollaert, Maureen, additional, Verheesen, Sabrina, additional, Jeurrissen, D., additional, Bos, Erna, additional, Drabbe, Yvonne, additional, Sandiman, Michelle, additional, Aaldering, Nicoline, additional, Zweedijk, Berber, additional, Khalilzada, Mostafa, additional, Vervoort, Jocova, additional, Ponjee, Eva, additional, Romviel, Sharon, additional, Kanselaar, Karin, additional, Barning, Denn, additional, Venema, Esmee, additional, Chalos, Vicky, additional, Geuskens, Ralph R., additional, van Straaten, Tim, additional, Ergezen, Saliha, additional, Harmsma, Roger R. M., additional, Muijres, Daan, additional, de Jong, Anouk, additional, Berkhemer, Olvert A., additional, Boers, Anna M. M., additional, Huguet, J., additional, Groot, P. F. C., additional, Mens, Marieke A., additional, van Kranendonk, Katinka R., additional, Treurniet, Kilian M., additional, Tolhuisen, Manon L., additional, Alves, Heitor, additional, Weterings, Annick J., additional, Kirkels, Eleonora L. F., additional, Voogd, Eva J. H. F., additional, Schupp, Lieve M., additional, Collette, Sabine, additional, Groot, Adrien E. D., additional, LeCouffe, Natalie E., additional, Konduri, Praneeta R., additional, Prasetya, Haryadi, additional, Arrarte‐Terreros, Nerea, additional, and Ramos, Lucas A., additional
Published: 2023
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11. Endovascular treatment for isolated posterior cerebral artery occlusion stroke in the MR CLEAN registry

Author: Brouwer, Josje, Ergezen, Saliha, Mulder, Maxim Johan Heymen Laurence, Nijeholt, Geert J.Lycklama A., Van Es, Adriaan C.G.M., Van Der Lugt, Aad, Dippel, Diederik W.J., Majoie, Charles B.L.M., Roos, Yvo B.W.E.M., Coutinho, J. M., Emmer, Bart J., Van Oostenbrugge, Robert J., Van Zwam, Wim H., Boiten, Jelis, Vos, Jan Albert, Jansen, Ivo G.H., Goldhoorn, Robert Jan B., Compagne, Kars C.J., Kappelhof, Manon, Den Hartog, Sanne J., Hinsenveld, Wouter H., Roozenbeek, Bob, Schonewille, Wouter J., Wermer, Marieke J.H., Van Walderveen, Marianne A.A., 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., 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., Postma, Alida A., Van Der Leij, Christiaan, Brans, Rutger, Pirson, Anne-France, MR CLEAN Registry Investigators, Brouwer, Josje, Ergezen, Saliha, Mulder, Maxim Johan Heymen Laurence, Nijeholt, Geert J.Lycklama A., Van Es, Adriaan C.G.M., Van Der Lugt, Aad, Dippel, Diederik W.J., Majoie, Charles B.L.M., Roos, Yvo B.W.E.M., Coutinho, J. M., Emmer, Bart J., Van Oostenbrugge, Robert J., Van Zwam, Wim H., Boiten, Jelis, Vos, Jan Albert, Jansen, Ivo G.H., Goldhoorn, Robert Jan B., Compagne, Kars C.J., Kappelhof, Manon, Den Hartog, Sanne J., Hinsenveld, Wouter H., Roozenbeek, Bob, Schonewille, Wouter J., Wermer, Marieke J.H., Van Walderveen, Marianne A.A., 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., 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., Postma, Alida A., Van Der Leij, Christiaan, Brans, Rutger, Pirson, Anne-France, and MR CLEAN Registry Investigators
Abstract: Background Endovascular treatment (EVT) is standard of care in anterior circulation large vessel occlusions. In posterior circulation occlusions, data on EVT in isolated posterior cerebral artery (PCA) occlusions are limited, although PCA occlusions can cause severe neurological deficit. Objective To describe in a prospective study the clinical manifestations, outcomes, and safety of EVT in isolated PCA occlusions. Methods We used data (2014-2017) from the MR CLEAN Registry, a nationwide, prospective cohort of EVT-treated patients in the Netherlands. We included patients with acute ischemic stroke (AIS) due to an isolated PCA occlusion on CT angiography. Patients with concurrent occlusion of the basilar artery were excluded. Outcomes included change in National Institutes of Health Stroke Scale (?NIHSS) score, modified Rankin Scale (mRS) score 0-3 after 90 days, mortality, expanded Thrombolysis in Cerebral Infarction (eTICI), and periprocedural complications. Results Twenty (12%) of 162 patients with posterior circulation occlusions had an isolated PCA occlusion. Median age was 72 years; 13 (65%) were women. Median baseline NIHSS score was 13 (IQR 5-21). Six (30%) patients were comatose. Twelve patients (60%) received IVT. Median ?NIHSS was -4 (IQR -11-+1). At follow-up, nine patients (45%) had mRS score 0-3. Seven (35%) died. eTICI 2b-3 was achieved in 13 patients (65%). Nine patients (45%) had periprocedural complications. No symptomatic intracranial hemorrhages (sICH) occurred. Conclusions EVT should be considered in selected patients with AIS with an isolated PCA occlusion, presenting with moderate-severe neurological deficits, as EVT was technically feasible in most of our patients and about half had good clinical outcome. In case of lower NIHSS score, a more conservative approach seems warranted, since periprocedural complications are not uncommon. Nonetheless, EVT seems reasonably safe considering the absence of sICH in our study.
Published: 2023

12. Prognostic Value of Thrombus Volume and Interaction With First-Line Endovascular Treatment Device Choice

Author: Neurologen, Brain, Circulatory Health, Stroke, MS Radiologie, 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., Roozenbeek, Bob, Van Es, Adriaan C.G.M., Coutinho, Jonathan M., Schonewille, Wouter J., Wermer, Marieke J.H., Van Walderveen, Marianne A.A., Staals, Julie, 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., 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., Bot, Joost, Van Doormaal, Pieter Jan, Meijer, Anton, Ghariq, Elyas, Van Proosdij, Marc P., Krietemeijer, G. Menno, Gerrits, Dick, Dinkelaar, Wouter, Appelman, Auke P.A., Hammer, Bas, Pegge, Sjoert, 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, Groot, Adrien E.D., Lecouffe, Natalie E., Prasetya, Haryadi, Ramos, Lucas A., Neurologen, Brain, Circulatory Health, Stroke, MS Radiologie, 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., Roozenbeek, Bob, Van Es, Adriaan C.G.M., Coutinho, Jonathan M., Schonewille, Wouter J., Wermer, Marieke J.H., Van Walderveen, Marianne A.A., Staals, Julie, 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., 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., Bot, Joost, Van Doormaal, Pieter Jan, Meijer, Anton, Ghariq, Elyas, Van Proosdij, Marc P., Krietemeijer, G. Menno, Gerrits, Dick, Dinkelaar, Wouter, Appelman, Auke P.A., Hammer, Bas, Pegge, Sjoert, 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, Groot, Adrien E.D., Lecouffe, Natalie E., Prasetya, Haryadi, and Ramos, Lucas A.
Published: 2023

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

Author: van Linschoten, Reinier C A, Amini, Marzyeh, van Leeuwen, Nikki, Eijkenaar, Frank, den Hartog, Sanne J, Nederkoorn, Paul J, Hofmeijer, Jeannette, Emmer, Bart J, Postma, Alida A, van Zwam, Wim, Roozenbeek, Bob, Dippel, Diederik, Lingsma, Hester F, MR CLEAN Registry Investigators, van Linschoten, Reinier C A, Amini, Marzyeh, van Leeuwen, Nikki, Eijkenaar, Frank, den Hartog, Sanne J, Nederkoorn, Paul J, Hofmeijer, Jeannette, Emmer, Bart J, Postma, Alida A, van Zwam, Wim, Roozenbeek, Bob, Dippel, Diederik, Lingsma, Hester F, and MR CLEAN Registry Investigators
Abstract: Missing data are frequently encountered in registries that are used to compare performance across hospitals. The most appropriate method for handling missing data when analysing differences in outcomes between hospitals with a generalised linear mixed model is unclear. We aimed to compare methods for handling missing data when comparing hospitals on ordinal and dichotomous outcomes. We performed a simulation study using data from the Multicentre Randomised Controlled Trial of Endovascular Treatment for Acute Ischaemic Stroke in the Netherlands (MR CLEAN) Registry, a prospective cohort study in 17 hospitals performing endovascular therapy for ischaemic stroke in the Netherlands. The investigated methods for handling missing data, both case-mix adjustment variables and outcomes, were complete case analysis, single imputation, multiple imputation, single imputation with deletion of imputed outcomes and multiple imputation with deletion of imputed outcomes. Data were generated as missing completely at random (MCAR), missing at random and missing not at random (MNAR) in three scenarios: (1) 10% missing data in case-mix and outcome; (2) 40% missing data in case-mix and outcome; and (3) 40% missing data in case-mix and outcome with varying degree of missing data among hospitals. Bias and reliability of the methods were compared on the mean squared error (MSE, a summary measure combining bias and reliability) relative to the hospital effect estimates from the complete reference data set. For both the ordinal outcome (ie, the modified Rankin Scale) and a common dichotomised version thereof, all methods of handling missing data were biased, likely due to shrinkage of the random effects. The MSE of all methods was on average lowest under MCAR and with fewer missing data, and highest with more missing data and under MNAR. The 'multiple imputation, then deletion' method had the lowest MSE for both outcomes under all simulated patterns of missing data. Thus, when estimating hospi
Published: 2023

14. Determinants of Symptomatic Intracranial Hemorrhage After Endovascular Stroke Treatment: A Retrospective Cohort Study

Author: van der Steen, Wouter, primary, van der Ende, Nadinda A.M., additional, van Kranendonk, Katinka R., additional, Chalos, Vicky, additional, van Oostenbrugge, Robert J., additional, van Zwam, Wim H., additional, Roos, Yvo B.W.E.M., additional, van Doormaal, Pieter J., additional, van Es, Adriaan C.G.M., additional, Lingsma, Hester F., additional, Majoie, Charles B.L.M., additional, van der Lugt, Aad, additional, Dippel, Diederik W.J., additional, Roozenbeek, Bob, additional, Boiten, Jelis, additional, Albert Vos, Jan, additional, Jansen, Ivo G.H., additional, Mulder, Maxim J.H.L., additional, Goldhoorn, Robert- Jan B., additional, Compagne, Kars C.J., additional, Kappelhof, Manon, additional, Brouwer, Josje, additional, den Hartog, Sanne J., additional, Emmer, Bart J., additional, Coutinho, Jonathan M., additional, Schonewille, Wouter J., additional, Wermer, Marieke J.H., additional, van Walderveen, Marianne A.A., additional, Staals, Julie, additional, Hofmeijer, Jeannette, additional, Martens, Jasper M., additional, Lycklama à Nijeholt, Geert J., additional, de Bruijn, Sebastiaan F., additional, van Dijk, Lukas C., additional, van der Worp, H. Bart, additional, Lo, Rob H., additional, van Dijk, Ewoud J., additional, Boogaarts, Hieronymus D., additional, de Vries, J., additional, de Kort, Paul L.M., additional, van Tuijl, Julia, additional, Peluso, Jo P., additional, Fransen, Puck, additional, van den Berg, Jan S.P., additional, van Hasselt, Boudewijn A.A.M., additional, Aerden, Leo A.M., additional, Dallinga, René J., additional, Uyttenboogaart, Maarten, additional, Eschgi, Omid, additional, Bokkers, Reinoud P.H., additional, Schreuder, Tobien H.C.M.L., additional, Heijboer, Roel J.J., additional, Keizer, Koos, additional, Yo, Lonneke S.F., additional, den Hertog, Heleen M., additional, Bulut, Tomas, additional, Brouwers, Paul J.A.M., additional, Lycklama, Geert J., additional, Sprengers, Marieke E.S., additional, Jenniskens, Sjoerd F.M., additional, van den Berg, René, additional, Yoo, Albert J., additional, Beenen, Ludo F.M., additional, Postma, Alida A., additional, Roosendaal, Stefan D., additional, van der Kallen, Bas F.W., additional, van den Wijngaard, Ido R., additional, Vos, Jan Albert, additional, Bot, Joost, additional, Meijer, Anton, additional, Ghariq, Elyas, additional, van Proosdij, Marc P., additional, Krietemeijer, G. Menno, additional, Lo, Rob, additional, Dinkelaar, Wouter, additional, Auke, P.A., additional, Hammer, Bas, additional, Pegge, Sjoert, additional, van der Hoorn, Anouk, additional, Vinke, Saman, additional, Flach, H. Zwenneke, additional, el Ghannouti, Naziha, additional, Sterrenberg, Martin, additional, Pellikaan, Wilma, additional, Sprengers, Rita, additional, Elfrink, Marjan, additional, Simons, Michelle, additional, Vossers, Marjolein, additional, de Meris, Joke, additional, Vermeulen, Tamara, additional, Geerlings, Annet, additional, van Vemde, Gina, additional, Simons, Tiny, additional, Messchendorp, Gert, additional, Nicolaij, Nynke, additional, Bongenaar, Hester, additional, Bodde, Karin, additional, Kleijn, Sandra, additional, Lodico, Jasmijn, additional, Droste, Hanneke, additional, Wollaert, Maureen, additional, Verheesen, Sabrina, additional, Jeurrissen, D., additional, Bos, Erna, additional, Drabbe, Yvonne, additional, Sandiman, Michelle, additional, Aaldering, Nicoline, additional, Zweedijk, Berber, additional, Vervoort, Jocova, additional, Ponjee, Eva, additional, Romviel, Sharon, additional, Kanselaar, Karin, additional, Barning, Denn, additional, Venema, Esmee, additional, Geuskens, Ralph R., additional, van Straaten, Tim, additional, Ergezen, Saliha, additional, Harmsma, Roger R.M., additional, Muijres, Daan, additional, de Jong, Anouk, additional, Berkhemer, Olvert A., additional, Boers, Anna M.M., additional, Huguet, J., additional, Groot, P.F.C., additional, Mens, Marieke A., additional, Treurniet, Kilian M., additional, Tolhuisen, Manon L., additional, Alves, Heitor, additional, Weterings, Annick J., additional, Kirkels, Eleonora L.F., additional, Voogd, Eva J.H.F., additional, Schupp, Lieve M., additional, Collette, Sabine L., additional, Groot, Adrien E.D., additional, LeCouffe, Natalie E., additional, Konduri, Praneeta R., additional, Prasetya, Haryadi, additional, Arrarte- Terreros, Nerea, additional, Ramos, Lucas A., additional, Brown, Martin M., additional, Liebig, Thomas, additional, van der Heijden, Esther, additional, Ghannouti, Naziha, additional, Fleitour, Nadine, additional, Hooijenga, Imke, additional, Puppels, Corina, additional, Geerling, Annet, additional, Lindl-Velema, Annemieke, additional, de Ridder, Ans, additional, Greebe, Paut, additional, de Bont- Stikkelbroeck, Jose, additional, Haaglanden, MC, additional, Janssen, Kirsten, additional, Licher, Silvan, additional, Boodt, Nikki, additional, Ros, Adriaan, additional, Slokkers, Ilse, additional, Ganpat, Raymie-Jayce, additional, Mulder, Maxim, additional, Saiedie, Nawid, additional, Heshmatollah, Alis, additional, Schipperen, Stefanie, additional, Vinken, Stefan, additional, van Boxtel, Tiemen, additional, Koets, Jeroen, additional, Boers, Merel, additional, Santos, Emilie, additional, Borst, Jordi, additional, Jansen, Ivo, additional, Lucas, Marit, additional, Geuskens, Ralph Renan, additional, and Sales Barros, Roeland, additional
Published: 2022
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15. Hospital Variation in Time to Endovascular Treatment for Ischemic Stroke: What Is the Optimal Target for Improvement?

Author: den Hartog, Sanne J., primary, Lingsma, Hester F., additional, van Doormaal, Pieter‐Jan, additional, Hofmeijer, Jeannette, additional, Yo, Lonneke S. F., additional, Majoie, Charles B. L. M., additional, Dippel, Diederik W. J., additional, van der Lugt, Aad, additional, Roozenbeek, Bob, additional, Roos, Yvo B. W. E. M., additional, van Oostenbrugge, Robert J., additional, van Zwam, Wim H., additional, Boiten, Jelis, additional, Vos, Jan Albert, additional, Jansen, Ivo G. H., additional, Mulder, Maxim J. H. L., additional, Goldhoorn, Robert‐ Jan B., additional, Compagne, Kars C. J., additional, Kappelhof, Manon, additional, Brouwer, Josje, additional, den Hartog, Sanne J., additional, Hinsenveld, Wouter H., additional, van Es, Adriaan C. G. M., additional, Emmer, Bart J., additional, Coutinho, Jonathan M., additional, Schonewille, Wouter J., additional, Wermer, Marieke J. H., additional, van Walderveen, Marianne A. A., additional, Staals, Julie, additional, Martens, Jasper M., additional, Lycklama à Nijeholt, Geert J., additional, de Bruijn, Sebastiaan F., additional, van Dijk, Lukas C., additional, van der Worp, H. Bart, additional, Lo, Rob H., additional, van Dijk, Ewoud J., additional, Boogaarts, Hieronymus D., additional, de Vries, J., additional, de Kort, Paul L. M., additional, van Tuijl, Julia, additional, Peluso, Jo P., additional, Fransen, Puck, additional, van den Berg, Jan S. P., additional, van Hasselt, Boudewijn A. A. M., additional, Aerden, Leo A. M., additional, Dallinga, René J., additional, Uyttenboogaart, Maarten, additional, Eschgi, Omid, additional, Bokkers, Reinoud P. H., additional, Schreuder, Tobien H. C. M. L., additional, Heijboer, Roel J. J., additional, Keizer, Koos, additional, den Hertog, Heleen M., additional, Sturm, Emiel J. C., additional, Brouwers, Paul J. A. M., additional, Sprengers, Marieke E. S., additional, Jenniskens, Sjoerd F. M., additional, van den Berg, René, additional, Yoo, Albert J., additional, Beenen, Ludo F. M., additional, Postma, Alida A., additional, Roosendaal, Stefan D., additional, van der Kallen, Bas F. W., additional, van den Wijngaard, Ido R., additional, Bot, Joost, additional, Meijer, Anton, additional, Ghariq, Elyas, additional, van Proosdij, Marc P., additional, Menno Krietemeijer, G., additional, Gerrits, Dick, additional, Dinkelaar, Wouter, additional, Appelman, Auke P. A., additional, Hammer, Bas, additional, Pegge, Sjoert, additional, van der Hoorn, Anouk, additional, Vinke, Saman, additional, Zwenneke Flach, H, additional, Ghannouti, Naziha el, additional, Sterrenberg, Martin, additional, Pellikaan, Wilma, additional, Sprengers, Rita, additional, Elfrink, Marjan, additional, Simons, Michelle, additional, Vossers, Marjolein, additional, de Meris, Joke, additional, Vermeulen, Tamara, additional, Geerlings, Annet, additional, van Vemde, Gina, additional, Simons, Tiny, additional, Messchendorp, Gert, additional, Nicolaij, Nynke, additional, Bongenaar, Hester, additional, Bodde, Karin, additional, Kleijn, Sandra, additional, Lodico, Jasmijn, additional, Droste, Hanneke, additional, Wollaert, Maureen, additional, Verheesen, Sabrina, additional, Jeurrissen, D., additional, Bos, Erna, additional, Drabbe, Yvonne, additional, Sandiman, Michelle, additional, Aaldering, Nicoline, additional, Zweedijk, Berber, additional, Vervoort, Jocova, additional, Ponjee, Eva, additional, Romviel, Sharon, additional, Kanselaar, Karin, additional, Barning, Denn, additional, Venema, Esmee, additional, Chalos, Vicky, additional, Geuskens, Ralph R., additional, van Straaten, Tim, additional, Ergezen, Saliha, additional, Harmsma, Roger R. M., additional, Muijres, Daan, additional, de Jong, Anouk, additional, Berkhemer, Olvert A., additional, Boers, Anna M. M., additional, Huguet, J., additional, Groot, P. F. C., additional, Mens, Marieke A., additional, van Kranendonk, Katinka R., additional, Treurniet, Kilian M., additional, Tolhuisen, Manon L., additional, Alves, Heitor, additional, Weterings, Annick J., additional, Kirkels, Eleonora L. F., additional, Voogd, Eva J. H. F., additional, Schupp, Lieve M., additional, Collette, Sabine L., additional, Groot, Adrien E. D., additional, LeCouffe, Natalie E., additional, Konduri, Praneeta R., additional, Prasetya, Haryadi, additional, Arrarte‐Terreros, Nerea, additional, and Ramos, Lucas A., additional
Published: 2021
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16. Etiology of Large Vessel Occlusion Posterior Circulation Stroke: Results of the MR CLEAN Registry

Author: Pirson, F.A.V. (Anne), primary, Boodt, Nikki, additional, Brouwer, Josje, additional, Bruggeman, Agnetha A.E., additional, Hinsenveld, Wouter H., additional, Staals, Julie, additional, van Zwam, Wim H., additional, van der Leij, Christiaan, additional, Brans, Rutger J.B., additional, Majoie, Charles B.L.M., additional, Dippel, Diederik W.J., additional, van der Lugt, Aad, additional, Schonewille, Wouter J., additional, van Oostenbrugge, Robert J., additional, Roos, Yvo B.W.E.M., additional, Boiten, Jelis, additional, Albert Vos, Jan, additional, Jansen, Ivo G.H., additional, Mulder, Maxim J.H.L., additional, Goldhoorn, Robert- Jan B., additional, Compagne, Kars C.J., additional, Kappelhof, Manon, additional, den Hartog, Sanne J., additional, Roozenbeek, Bob, additional, Emmer, Bart J., additional, Coutinho, Jonathan M., additional, Vos, Jan Albert, additional, Wermer, Marieke J.H., additional, van Walderveen, Marianne A.A., additional, van Es, Adriaan C.G.M., additional, Hofmeijer, Jeannette, additional, Martens, Jasper M., additional, Lycklama à Nijeholt, Geert J., additional, de Bruijn, Sebastiaan F., additional, van Dijk, Lukas C., additional, Bart van der Worp, H., additional, Lo, Rob H., additional, van Dijk, Ewoud J., additional, Boogaarts, Hieronymus D., additional, de Vries, J., additional, de Kort, Paul L.M., additional, van Tuijl, Julia, additional, Peluso, Jo P., additional, Fransen, Puck, additional, van den Berg, Jan S.P., additional, van Hasselt, Boudewijn A.A.M., additional, Aerden, Leo A.M., additional, Dallinga, René J., additional, Uyttenboogaart, Maarten, additional, Eschgi, Omid, additional, Bokkers, Reinoud P.H., additional, Schreuder, Tobien H.C.M.L., additional, Heijboer, Roel J.J., additional, Keizer, Koos, additional, Yo, Lonneke S.F., additional, den Hertog, Heleen M., additional, Sturm, Emiel J.C., additional, Brouwers, Paul J.A.M., additional, Sprengers, Marieke E.S., additional, Jenniskens, Sjoerd F.M., additional, van den Berg, René, additional, Yoo, Albert J., additional, Beenen, Ludo F.M., additional, Postma, Alida A., additional, Roosendaal, Stefan D., additional, van der Kallen, Bas F.W., additional, van den Wijngaard, Ido R., additional, Bot, Joost, additional, van Doormaal, Pieter-Jan, additional, Meijer, Anton, additional, Ghariq, Elyas, additional, van Proosdij, Marc P., additional, Menno Krietemeijer, G., additional, Lo, Rob, additional, Gerrits, Dick, additional, Dinkelaar, Wouter, additional, Appelman, Auke P.A., additional, Hammer, Bas, additional, Pegge, Sjoert, additional, van der Hoorn, Anouk, additional, Vinke, Saman, additional, Cornelissen, Sandra, additional, Brans, Rutger, additional, Zwenneke Flach, H., additional, Lingsma, Hester F., additional, Ghannouti, Naziha el, additional, Sterrenberg, Martin, additional, Pellikaan, Wilma, additional, Sprengers, Rita, additional, Elfrink, Marjan, additional, Simons, Michelle, additional, Vossers, Marjolein, additional, de Meris, Joke, additional, Vermeulen, Tamara, additional, Geerlings, Annet, additional, van Vemde, Gina, additional, Simons, Tiny, additional, Messchendorp, Gert, additional, Nicolaij, Nynke, additional, Bongenaar, Hester, additional, Bodde, Karin, additional, Kleijn, Sandra, additional, Lodico, Jasmijn, additional, Droste, Hanneke, additional, Wollaert, Maureen, additional, Verheesen, Sabrina, additional, Jeurrissen, D., additional, Bos, Erna, additional, Drabbe, Yvonne, additional, Sandiman, Michelle, additional, Aaldering, Nicoline, additional, Zweedijk, Berber, additional, Vervoort, Jocova, additional, Ponjee, Eva, additional, Romviel, Sharon, additional, Kanselaar, Karin, additional, Barning, Denn, additional, Venema, Esmee, additional, Chalos, Vicky, additional, Geuskens, Ralph R., additional, van Straaten, Tim, additional, Ergezen, Saliha, additional, Harmsma, Roger R.M., additional, Muijres, Daan, additional, de Jong, Anouk, additional, Berkhemer, Olvert A., additional, Boers, Anna M.M., additional, Huguet, J., additional, Groot, P.F.C., additional, Mens, Marieke A., additional, van Kranendonk, Katinka R., additional, Treurniet, Kilian M., additional, Tolhuisen, Manon L., additional, Alves, Heitor, additional, Weterings, Annick J., additional, Kirkels, Eleonora L.F., additional, Voogd, Eva J.H.F., additional, Schupp, Lieve M., additional, Collette, Sabine L., additional, Groot, Adrien E.D., additional, LeCouffe, Natalie E., additional, Konduri, Praneeta R., additional, Prasetya, Haryadi, additional, Arrarte-Terreros, Nerea, additional, Ramos, Lucas A., additional, and Pirson, Anne F.A.V., additional
Published: 2022
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17. Improvements in Endovascular Treatment for Acute Ischemic Stroke: A Longitudinal Study in the MR CLEAN Registry

Author: Compagne, Kars C.J., primary, Kappelhof, Manon, additional, Hinsenveld, Wouter H., additional, Brouwer, Josje, additional, Goldhoorn, Robert-Jan B., additional, Uyttenboogaart, Maarten, additional, Bokkers, Reinoud P.H., additional, Schonewille, Wouter J., additional, Martens, Jasper M., additional, Hofmeijer, Jeannette, additional, van der Worp, H. Bart, additional, Lo, Rob T.H., additional, Keizer, Koos, additional, Yo, Lonneke S.F., additional, Lycklama à Nijeholt, Geert J., additional, den Hertog, Heleen M., additional, Sturm, Emiel J.C., additional, Brouwers, Paul J.A.M., additional, van Walderveen, Marianne A.A., additional, Wermer, Marieke J.H., additional, de Bruijn, Sebastiaan F., additional, van Dijk, Lukas C., additional, Boogaarts, Hieronymus D., additional, van Dijk, Ewout J., additional, van Tuijl, Julia H., additional, Peluso, Jo P.P., additional, de Kort, Paul L.M., additional, van Hasselt, Boudewijn A.A.M., additional, Fransen, Puck S., additional, Schreuder, Tobien H.C.M.L., additional, Heijboer, Roel J.J., additional, Jenniskens, Sjoerd F.M., additional, Sprengers, Marieke E.S., additional, Ghariq, Elias, additional, van den Wijngaard, Ido R., additional, Roosendaal, Stefan D., additional, Meijer, Anton F.J.A., additional, Beenen, Ludo F.M., additional, Postma, Alida A., additional, van den Berg, René, additional, Yoo, Albert J., additional, van Doormaal, Pieter Jan, additional, van Proosdij, Marc P., additional, Krietemeijer, Menno G.M., additional, Gerrits, Dick G., additional, Hammer, Sebastiaan, additional, Vos, Jan Albert, additional, Boiten, Jelis, additional, Coutinho, Jonathan M., additional, Emmer, Bart J., additional, van Es, Ad C.G.M., additional, Roozenbeek, Bob, additional, Roos, Yvo B.W.E.M., additional, van Zwam, Wim H., additional, van Oostenbrugge, Robert J., additional, Majoie, Charles B.L.M., additional, Dippel, Diederik W.J., additional, van der Lugt, Aad, additional, Jansen, Ivo G.H., additional, Mulder, Maxim J.H.L., additional, den Hartog, Sanne J., additional, Albert Vos, Jan, additional, Staals, Julie, additional, Lo, Rob H., additional, van Dijk, Ewoud J., additional, de Vries, J., additional, van Tuijl, Julia, additional, Peluso, Jo P., additional, Fransen, Puck, additional, van den Berg, Jan S.P., additional, Aerden, Leo A.M., additional, Dallinga, René J., additional, Eschgi, Omid, additional, Bulut, Tomas, additional, van der Kallen, Bas F.W., additional, Bot, Joost, additional, van Doormaal, Pieter-Jan, additional, Meijer, Anton, additional, Ghariq, Elyas, additional, Lo, Rob, additional, Dinkelaar, Wouter, additional, Appelman, Auke P.A., additional, Hammer, Bas, additional, Pegge, Sjoert, additional, van der Hoorn, Anouk, additional, Vinke, Saman, additional, Flach, H. Zwenneke, additional, Lingsma, Hester F., additional, el Ghannouti, Naziha, additional, Sterrenberg, Martin, additional, Pellikaan, Wilma, additional, Sprengers, Rita, additional, Elfrink, Marjan, additional, Simons, Michelle, additional, Vossers, Marjolein, additional, de Meris, Joke, additional, Vermeulen, Tamara, additional, Geerlings, Annet, additional, van Vemde, Gina, additional, Simons, Tiny, additional, Messchendorp, Gert, additional, Nicolaij, Nynke, additional, Bongenaar, Hester, additional, Bodde, Karin, additional, Kleijn, Sandra, additional, Lodico, Jasmijn, additional, Droste, Hanneke, additional, Wollaert, Maureen, additional, Verheesen, Sabrina, additional, Jeurrissen, D., additional, Bos, Erna, additional, Drabbe, Yvonne, additional, Sandiman, Michelle, additional, Aaldering, Nicoline, additional, Zweedijk, Berber, additional, Vervoort, Jocova, additional, Ponjee, Eva, additional, Romviel, Sharon, additional, Kanselaar, Karin, additional, Barning, Denn, additional, Venema, Esmee, additional, Chalos, Vicky, additional, Geuskens, Ralph R., additional, van Straaten, Tim, additional, Ergezen, Saliha, additional, Harmsma, Roger R.M., additional, Muijres, Daan, additional, de Jong, Anouk, additional, Berkhemer, Olvert A., additional, Boers, Anna M.M., additional, Huguet, J., additional, Groot, P.F.C., additional, Mens, Marieke A., additional, van Kranendonk, Katinka R., additional, Treurniet, Kilian M., additional, Tolhuisen, Manon L., additional, Alves, Heitor, additional, Weterings, Annick J., additional, Kirkels, Eleonora L.F., additional, Voogd, Eva J.H.F., additional, Schupp, Lieve M., additional, Collette, Sabine L., additional, Groot, Adrien E.D., additional, LeCouffe, Natalie E., additional, Konduri, Praneeta R., additional, Prasetya, Haryadi, additional, Arrarte-Terreros, Nerea, additional, and Ramos, Lucas A., additional
Published: 2022
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18. Estimation of treatment effects in observational stroke care data: comparison of statistical approaches

Author: Amini, Marzyeh, van Leeuwen, Nikki, Eijkenaar, Frank, van de Graaf, Rob, Samuels, Noor, van Doormaal, Pieter Jan, Roozenbeek, Bob, Dippel, Diederik W.J., Lingsma, Hester F., van der Lugt, Aad, Vos, Jan Albert, Brouwer, Josje, den Hartog, Sanne J., Hinsenveld, Wouter H., Kappelhof, Manon, Compagne, Kars C.J., Goldhoorn, Robert Jan B., Mulder, Maxim J.H.L., Jansen, Ivo G.H., Emmer, Bart J., de Bruijn, Sebastiaan F., de Vries, J., Fransen, Puck, den Hertog, Heleen M., Brouwers, Paul, Jenniskens, Sjoerd F.M., Roosendaal, Stefan D., Ghariq, Elyas, Dinkelaar, Wouter, el Ghannouti, Naziha, Sterrenberg, Martin, Sprengers, Rita, Verheesen, Sabrina, Khalilzada, Mostafa, Venema, Esmee, Chalos, Vicky, Ergezen, Saliha, Harmsma, Roger R.M., Muijres, Daan, de Jong, Anouk, Berkhemer, Olvert A., Treurniet, Kilian M., LeCouffe, Natalie E., Radiology and nuclear medicine, ACS - Atherosclerosis & ischemic syndromes, Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Damage and Repair in Cancer Development and Cancer Treatment (DARE), MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, MUMC+: Hersen en Zenuw Centrum (3), RS: Carim - B05 Cerebral small vessel disease, Clinical Neurophysiology, TechMed Centre, Public Health, Health Systems and Insurance (HSI), Radiology & Nuclear Medicine, Neurology, Neurosciences, Erasmus School of Law, General Practice, Emergency Medicine, Intensive Care, Erasmus MC other, Medical Oncology, Amsterdam Neuroscience - Neurovascular Disorders, Radiology and Nuclear Medicine, and ACS - Microcirculation
Subjects: Epidemiology, Acute ischemic stroke, General anesthesia, Health Informatics, ADJUSTMENT, Intravenous thrombolysis, GENERAL-ANESTHESIA, Fibrinolytic Agents, CONSCIOUS SEDATION, Humans, Thrombolytic Therapy, ACUTE ISCHEMIC-STROKE, Unmeasured confounding, OUTCOMES, Confounding by indication, BINARY DATA, Fibrinolytic Agents/therapeutic use, Endovascular Procedures, Other Research Radboud Institute for Health Sciences [Radboudumc 0], THROMBECTOMY, INSTRUMENTAL VARIABLE METHODS, Stroke, Endovascular Procedures/methods, PROPENSITY SCORE, Instrumental variable, Treatment Outcome, ENDOVASCULAR TREATMENT, Statistical approaches, Ecological-analysis, Stroke/drug therapy
Abstract: Introduction Various statistical approaches can be used to deal with unmeasured confounding when estimating treatment effects in observational studies, each with its own pros and cons. This study aimed to compare treatment effects as estimated by different statistical approaches for two interventions in observational stroke care data. Patients and methods We used prospectively collected data from the MR CLEAN registry including all patients (n = 3279) with ischemic stroke who underwent endovascular treatment (EVT) from 2014 to 2017 in 17 Dutch hospitals. Treatment effects of two interventions – i.e., receiving an intravenous thrombolytic (IVT) and undergoing general anesthesia (GA) before EVT – on good functional outcome (modified Rankin Scale ≤2) were estimated. We used three statistical regression-based approaches that vary in assumptions regarding the source of unmeasured confounding: individual-level (two subtypes), ecological, and instrumental variable analyses. In the latter, the preference for using the interventions in each hospital was used as an instrument. Results Use of IVT (range 66–87%) and GA (range 0–93%) varied substantially between hospitals. For IVT, the individual-level (OR ~ 1.33) resulted in significant positive effect estimates whereas in instrumental variable analysis no significant treatment effect was found (OR 1.11; 95% CI 0.58–1.56). The ecological analysis indicated no statistically significant different likelihood (β = − 0.002%; P = 0.99) of good functional outcome at hospitals using IVT 1% more frequently. For GA, we found non-significant opposite directions of points estimates the treatment effect in the individual-level (ORs ~ 0.60) versus the instrumental variable approach (OR = 1.04). The ecological analysis also resulted in a non-significant negative association (0.03% lower probability). Discussion and conclusion Both magnitude and direction of the estimated treatment effects for both interventions depend strongly on the statistical approach and thus on the source of (unmeasured) confounding. These issues should be understood concerning the specific characteristics of data, before applying an approach and interpreting the results. Instrumental variable analysis might be considered when unobserved confounding and practice variation is expected in observational multicenter studies.
Published: 2022

19. 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, Schonewille, Wouter J, MR CLEAN Registry Investigators, 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, Schonewille, Wouter J, and MR CLEAN Registry Investigators
Abstract: BACKGROUND AND PURPOSE: The benefit of endovascular treatment (EVT) for posterior circulation stroke (PCS) remains uncertain, and little is known on treatment outcomes in clinical practice. This study evaluates outcomes of a large PCS cohort treated with EVT in clinical practice. Simultaneous to this observational study, several intervention centers participated in the BASICS trial (Basilar Artery International Cooperation Study), which tested the efficacy of EVT for basilar artery occlusion in a randomized setting. We additionally compared characteristics and outcomes of patients treated outside BASICS in trial centers to those from nontrial centers.METHODS: We included patients with PCS from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry: a prospective, multicenter, observational study of patients who underwent EVT in the Netherlands between 2014 and 2018. Primary outcome was a score of 0 to 3 on the modified Rankin Scale at 90 days. Secondary outcomes included reperfusion status and symptomatic intracranial hemorrhage. For outcome comparison between patients treated in trial versus nontrial centers, we used ordinal logistic regression analysis.RESULTS: We included 264 patients of whom 135 (51%) had received intravenous thrombolysis. The basilar artery was most often involved (77%). Favorable outcome (modified Rankin Scale score 0-3) was observed in 115/252 (46%) patients, and 109/252 (43%) patients died. Successful reperfusion was achieved in 178/238 (75%), and symptomatic intracranial hemorrhage occurred in 9/264 (3%). The 154 nontrial patients receiving EVT in BASICS trial centers had similar characteristics and outcomes as the 110 patients treated in nontrial centers (modified Rankin Scale adjusted cOR: 0.77 [95% CI, 0.5-1.2]).CONCLUSIONS: Our study shows that high rates of favorable clinical outcome and successful reperfusion can be achieved with EVT for PCS, de
Published: 2022

20. Deep-Learning-Based Thrombus Localization and Segmentation in Patients with Posterior Circulation Stroke

Author: Zoetmulder, Riaan, Bruggeman, Agnetha A.E., Išgum, Ivana, Gavves, Efstratios, Majoie, Charles B.L.M., Beenen, Ludo F.M., Dippel, Diederik W.J., Boodt, Nikkie, Den Hartog, Sanne J., Van Doormaal, Pieter J., Cornelissen, Sandra A.P., Roos, Yvo B.W.E.M., Brouwer, Josje, Schonewille, Wouter J., Pirson, Anne F.V., Van Zwam, Wim H., Leij, Christiaan Van Der, Brans, Rutger J.B., Adriaan, Adriaan C.G., Marquering, Henk A., Zoetmulder, Riaan, Bruggeman, Agnetha A.E., Išgum, Ivana, Gavves, Efstratios, Majoie, Charles B.L.M., Beenen, Ludo F.M., Dippel, Diederik W.J., Boodt, Nikkie, Den Hartog, Sanne J., Van Doormaal, Pieter J., Cornelissen, Sandra A.P., Roos, Yvo B.W.E.M., Brouwer, Josje, Schonewille, Wouter J., Pirson, Anne F.V., Van Zwam, Wim H., Leij, Christiaan Van Der, Brans, Rutger J.B., Adriaan, Adriaan C.G., and Marquering, Henk A.
Abstract: Thrombus volume in posterior circulation stroke (PCS) has been associated with outcome, through recanalization. Manual thrombus segmentation is impractical for large scale analysis of image characteristics. Hence, in this study we develop the first automatic method for thrombus localization and segmentation on CT in patients with PCS. In this multi-center retrospective study, 187 patients with PCS from the MR CLEAN Registry were included. We developed a convolutional neural network (CNN) that segments thrombi and restricts the volume-of-interest (VOI) to the brainstem (Polar-UNet). Furthermore, we reduced false positive localization by removing small-volume objects, referred to as volume-based removal (VBR). Polar-UNet is benchmarked against a CNN that does not restrict the VOI (BL-UNet). Performance metrics included the intra-class correlation coefficient (ICC) between automated and manually segmented thrombus volumes, the thrombus localization precision and recall, and the Dice coefficient. The majority of the thrombi were localized. Without VBR, Polar-UNet achieved a thrombus localization recall of 0.82, versus 0.78 achieved by BL-UNet. This high recall was accompanied by a low precision of 0.14 and 0.09. VBR improved precision to 0.65 and 0.56 for Polar-UNet and BL-UNet, respectively, with a small reduction in recall to 0.75 and 0.69. The Dice coefficient achieved by Polar-UNet was 0.44, versus 0.38 achieved by BL-UNet with VBR. Both methods achieved ICCs of 0.41 (95% CI: 0.27–0.54). Restricting the VOI to the brainstem improved the thrombus localization precision, recall, and segmentation overlap compared to the benchmark. VBR improved thrombus localization precision but lowered recall.
Published: 2022

21. 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, Schonewille, Wouter J, 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
Abstract: BACKGROUND AND PURPOSE: The benefit of endovascular treatment (EVT) for posterior circulation stroke (PCS) remains uncertain, and little is known on treatment outcomes in clinical practice. This study evaluates outcomes of a large PCS cohort treated with EVT in clinical practice. Simultaneous to this observational study, several intervention centers participated in the BASICS trial (Basilar Artery International Cooperation Study), which tested the efficacy of EVT for basilar artery occlusion in a randomized setting. We additionally compared characteristics and outcomes of patients treated outside BASICS in trial centers to those from nontrial centers.METHODS: We included patients with PCS from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry: a prospective, multicenter, observational study of patients who underwent EVT in the Netherlands between 2014 and 2018. Primary outcome was a score of 0 to 3 on the modified Rankin Scale at 90 days. Secondary outcomes included reperfusion status and symptomatic intracranial hemorrhage. For outcome comparison between patients treated in trial versus nontrial centers, we used ordinal logistic regression analysis.RESULTS: We included 264 patients of whom 135 (51%) had received intravenous thrombolysis. The basilar artery was most often involved (77%). Favorable outcome (modified Rankin Scale score 0-3) was observed in 115/252 (46%) patients, and 109/252 (43%) patients died. Successful reperfusion was achieved in 178/238 (75%), and symptomatic intracranial hemorrhage occurred in 9/264 (3%). The 154 nontrial patients receiving EVT in BASICS trial centers had similar characteristics and outcomes as the 110 patients treated in nontrial centers (modified Rankin Scale adjusted cOR: 0.77 [95% CI, 0.5-1.2]).CONCLUSIONS: Our study shows that high rates of favorable clinical outcome and successful reperfusion can be achieved with EVT for PCS, de
Published: 2022

22. Effect of first pass reperfusion on outcome in patients with posterior circulation ischemic stroke

Author: den Hartog, Sanne J, Roozenbeek, Bob, Boodt, Nikki, Bruggeman, Agnetha A E, van Es, Adriaan C G M, Emmer, Bart J, Majoie, Charles B L M, van den Wijngaard, Ido R, van Doormaal, Pieter Jan, van Zwam, Wim H, Lingsma, Hester F, Dippel, Diederik W J, den Hartog, Sanne J, Roozenbeek, Bob, Boodt, Nikki, Bruggeman, Agnetha A E, van Es, Adriaan C G M, Emmer, Bart J, Majoie, Charles B L M, van den Wijngaard, Ido R, van Doormaal, Pieter Jan, van Zwam, Wim H, Lingsma, Hester F, and Dippel, Diederik W J
Abstract: BACKGROUND: First pass reperfusion (FPR), that is, excellent reperfusion (expanded treatment in cerebral ischemia (eTICI) 2C-3) in one pass, after endovascular treatment (EVT) of an occluded artery in the anterior circulation, is associated with favorable clinical outcome, even when compared with multiple pass excellent reperfusion (MPR). In patients with posterior circulation ischemic stroke (PCS), the same association is expected, but currently unknown. We aimed to assess characteristics associated with FPR and the influence of FPR versus MPR on outcomes in patients with PCS.METHODS: We used data from the MR CLEAN Registry, a prospective observational study. The effect of FPR on 24-hour National Institutes of Health Stroke Scale (NIHSS) score, as percentage reduction, and on modified Rankin Scale (mRS) scores at 3 months, was tested with linear and ordinal logistic regression models.RESULTS: Of 224 patients with PCS, 45 patients had FPR, 47 had MPR, and 90 had no excellent reperfusion (eTICI <2C). We did not find an association between any of the patient, imaging, or treatment characteristics and FPR. FPR was associated with better NIHSS (-45% (95% CI: -65% to -12%)) and better mRS scores (adjusted common odds ratio (acOR): 2.16 (95% CI: 1.23 to 3.79)) compared with no FPR. Outcomes after FPR were also more favorable compared with MPR, but the effect was smaller and not statistically significant (NIHSS: -14% (95% CI: -51% to 49%), mRS acOR: 1.50 (95% CI: 0.75 to 3.00)).CONCLUSIONS: FPR in patients with PCS is associated with favorable clinical outcome in comparison with no FPR. In comparison with MPR, the effect of FPR was no longer statistically significant. Nevertheless, our data support the notion that FPR should be the treatment target to pursue in every patient treated with EVT.
Published: 2022

23. Hospital Variation in Time to Endovascular Treatment for Ischemic Stroke:What Is the Optimal Target for Improvement?

Author: Den Hartog, Sanne J., Lingsma, Hester F., van Doormaal, Pieter Jan, Hofmeijer, Jeannette, Yo, Lonneke S.F., Majoie, Charles B.L.M., Dippel, Diederik W.J., van der Lugt, Aad, Roozenbeek, Bob, Den Hartog, Sanne J., Lingsma, Hester F., van Doormaal, Pieter Jan, Hofmeijer, Jeannette, Yo, Lonneke S.F., Majoie, Charles B.L.M., Dippel, Diederik W.J., van der Lugt, Aad, and Roozenbeek, Bob
Abstract: BACKGROUND: Time to reperfusion in patients with ischemic stroke is strongly associated with functional outcome and may differ between hospitals and between patients within hospitals. Improvement in time to reperfusion can be guided by between-hospital and within-hospital comparisons and requires insight in specific targets for improvement. We aimed to quantify the variation in door-to-reperfusion time between and within Dutch intervention hospitals and to assess the contribution of different time intervals to this variation. METHODS AND RESULTS: We used data from the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry. The door-to-reperfusion time was subdivided into time intervals, separately for direct patients (door-to-computed tomography, computed tomography-to-computed tomography angiography [CTA], CTA-to-groin, and groin-to-reperfusion times) and for transferred patients (door-to-groin and groin-to-reperfusion times). We used linear mixed models to distinguish the variation in door-to-reperfusion time between hospitals and between patients. The proportional change in variance was used to estimate the amount of variance explained by each time interval. We included 2855 patients of 17 hospitals providing endovascular treatment. Of these patients, 44% arrived directly at an endovascular treatment hospital. The between-hospital variation in door-to-reperfusion time was 9%, and the within-hospital variation was 91%. The contribution of case-mix variables on the variation in door-to-reperfusion time was marginal (2%– 7%). Of the between-hospital variation, CTA-to-groin time explained 83%, whereas groin-to-reperfusion time explained 15%. Within-hospital variation was mostly explained by CTA-to-groin time (33%) and groin-to-reperfusion time (42%). Similar results were found for transferred patients. CONCLUSIONS: Door-to-reperfusion time varies between, but even more within, hospitals prov
Published: 2022

24. Relationship between primary stroke center volume and time to endovascular thrombectomy in acute ischemic stroke

Author: van Meenen, Laura C C, den Hartog, Sanne J, Groot, Adrien E, Emmer, Bart J, Smeekes, Martin D, Siegers, Arjen, Kommer, Geert Jan, Majoie, Charles B L M, Roos, Yvo B W E M, van Es, Adriaan C G M, Dippel, Diederik W, van der Worp, H Bart, Lingsma, Hester F, Roozenbeek, Bob, Coutinho, Jonathan M, van Oostenbrugge, Robert Jan, van Zwam, Wim, Hinsenveld, Wouter, Goldhoorn, Robert-Jan, Staals, Julie, Postma - Jacobi, Linda, MUMC+: Hersen en Zenuw Centrum (3), RS: Carim - B05 Cerebral small vessel disease, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, RS: Carim - B06 Imaging, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), MUMC+: MA Niet Med Staf Neurologie (9), MUMC+: MA AIOS Neurologie (9), MUMC+: MA Med Staf Spec Neurologie (9), RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, MUMC+: DA BV AIOS Radiologie (9), MUMC+: DA BV AIOS Nucleaire Geneeskunde (9), Radiology & Nuclear Medicine, Public Health, Neurology, Graduate School, ANS - Neurovascular Disorders, Radiology and Nuclear Medicine, ACS - Microcirculation, and ACS - Atherosclerosis & ischemic syndromes
Subjects: medicine.medical_specialty, Time Factors, Referral, IMPACT, workflow, medicine.medical_treatment, law.invention, Brain Ischemia, Randomized controlled trial, low-volume hospitals, Modified Rankin Scale, Interquartile range, law, Internal medicine, HOSPITAL CASE-VOLUME, medicine, ischemic stroke, Humans, Registries, Stroke, Aged, OUTCOMES, business.industry, MORTALITY, Endovascular Procedures, Thrombolysis, Odds ratio, medicine.disease, Confidence interval, Treatment Outcome, Neurology, thrombectomy, Cardiology, SURVIVAL, Neurology (clinical), THROMBOLYSIS VOLUME, high-volume hospitals, business
Abstract: Background and purposeWe investigated whether the annual volume of patients with acute ischemic stroke referred from a primary stroke center (PSC) for endovascular treatment (EVT) is associated with treatment times and functional outcome.MethodsWe used data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) registry (2014–2017). We included patients with acute ischemic stroke of the anterior circulation who were transferred from a PSC to a comprehensive stroke center (CSC) for EVT. We examined the association between EVT referral volume of PSCs and treatment times and functional outcome using multivariable regression modeling. The main outcomes were time from arrival at the PSC to groin puncture (PSC-door-to-groin time), adjusted for estimated ambulance travel times, time from arrival at the CSC to groin puncture (CSC-door-to-groin time), and modified Rankin Scale (mRS) score at 90 days after stroke.ResultsOf the 3637 patients in the registry, 1541 patients (42%) from 65 PSCs were included. Mean age was 71 years (SD ± 13.3), median National Institutes of Health Stroke Scale score was 16 (interquartile range [IQR]: 12–19), and median time from stroke onset to arrival at the PSC was 53 min (IQR: 38–90). Eighty-three percent had received intravenous thrombolysis. EVT referral volume was not associated with PSC-door-to-groin time (adjusted coefficient: −0.49 min/annual referral, 95% confidence interval [CI]: −1.27 to 0.29), CSC-door-to-groin time (adjusted coefficient: −0.34 min/annual referral, 95% CI: −0.69 to 0.01) or 90-day mRS score (adjusted common odds ratio: 0.99, 95% CI: 0.96–1.01).ConclusionsIn patients transferred from a PSC for EVT, higher PSC volumes do not seem to translate into better workflow metrics or patient outcome.
Published: 2021

25. White Matter Lesions and Outcomes After Endovascular Treatment for Acute Ischemic Stroke: MR CLEAN Registry Results

Author: Uniken Venema, Simone M., primary, Postma, Alida A., additional, van den Wijngaard, Ido R., additional, Vos, Jan Albert, additional, Lingsma, Hester F., additional, Bokkers, Reinoud P.H., additional, Hofmeijer, Jeannette, additional, Dippel, Diederik W.J., additional, Majoie, Charles B., additional, van der Worp, H. Bart, additional, Lugt, Aad van der, additional, Roos, Yvo B.W.E.M., additional, van Oostenbrugge, Robert J., additional, van Zwam, Wim H., additional, Boiten, Jelis, additional, Jansen, Ivo G.H., additional, Mulder, Maxim J.H.L., additional, Goldhoorn, Robert- Jan B., additional, Compagne, Kars C.J., additional, Kappelhof, Manon, additional, Brouwer, Josje, additional, den Hartog, Sanne J., additional, Hinsenveld, Wouter H., additional, Roozenbeek, Bob, additional, van Es, Adriaan C.G.M., additional, Emmer, Bart J., additional, Coutinho, Jonathan M., additional, Schonewille, Wouter J., additional, Wermer, Marieke J.H., additional, van Walderveen, Marianne A.A., additional, Staals, Julie, additional, Martens, Jasper M., additional, Lycklama à Nijeholt, Geert J., additional, de Bruijn, Sebastiaan F., additional, van Dijk, Lukas C., additional, Lo, Rob H., additional, van Dijk, Ewoud J., additional, Boogaarts, Hieronymus D., additional, de Vries, J., additional, de Kort, Paul L.M., additional, van Tuijl, Julia, additional, Peluso, Jo P., additional, Fransen, Puck, additional, van den Berg, Jan S.P., additional, van Hasselt, Boudewijn A.A.M., additional, Aerden, Leo A.M., additional, Dallinga, René J., additional, Uyttenboogaart, Maarten, additional, Eschgi, Omid, additional, Schreuder, Tobien H.C.M.L., additional, Heijboer, Roel J.J., additional, Keizer, Koos, additional, Yo, Lonneke S.F., additional, den Hertog, Heleen M., additional, Sturm, Emiel J.C., additional, Brouwers, Paul J.A.M., additional, van der Lugt, Aad, additional, Sprengers, Marieke E.S., additional, Jenniskens, Sjoerd F.M., additional, van den Berg, René, additional, Yoo, Albert J., additional, Beenen, Ludo F.M., additional, Roosendaal, Stefan D., additional, van der Kallen, Bas F.W., additional, Bot, Joost, additional, van Doormaal, Pieter-Jan, additional, Meijer, Anton, additional, Ghariq, Elyas, additional, van Proosdij, Marc P., additional, Krietemeijer, G. Menno, additional, Lo, Rob, additional, Gerrits, Dick, additional, Dinkelaar, Wouter, additional, Appelman, Auke P.A., additional, Hammer, Bas, additional, Pegge, Sjoert, additional, van der Hoorn, Anouk, additional, Vinke, Saman, additional, Flach, H. Zwenneke, additional, el Ghannouti, Naziha, additional, Sterrenberg, Martin, additional, Pellikaan, Wilma, additional, Sprengers, Rita, additional, Elfrink, Marjan, additional, Simons, Michelle, additional, Vossers, Marjolein, additional, de Meris, Joke, additional, Vermeulen, Tamara, additional, Geerlings, Annet, additional, van Vemde, Gina, additional, Simons, Tiny, additional, Messchendorp, Gert, additional, Nicolaij, Nynke, additional, Bongenaar, Hester, additional, Bodde, Karin, additional, Kleijn, Sandra, additional, Lodico, Jasmijn, additional, Droste, Hanneke, additional, Wollaert, Maureen, additional, Verheesen, Sabrina, additional, Jeurrissen, D., additional, Bos, Erna, additional, Drabbe, Yvonne, additional, Sandiman, Michelle, additional, Aaldering, Nicoline, additional, Zweedijk, Berber, additional, Vervoort, Jocova, additional, Ponjee, Eva, additional, Romviel, Sharon, additional, Kanselaar, Karin, additional, Barning, Denn, additional, Venema, Esmee, additional, Chalos, Vicky, additional, Geuskens, Ralph R., additional, van Straaten, Tim, additional, Ergezen, Saliha, additional, Harmsma, Roger R.M., additional, Muijres, Daan, additional, de Jong, Anouk, additional, Berkhemer, Olvert A., additional, Boers, Anna M.M., additional, Huguet, J., additional, Groot, P.F.C., additional, Mens, Marieke A., additional, van Kranendonk, Katinka R., additional, Treurniet, Kilian M., additional, Tolhuisen, Manon L., additional, Alves, Heitor, additional, Weterings, Annick J., additional, Kirkels, Eleonora L.F., additional, Voogd, Eva J.H.F., additional, Schupp, Lieve M., additional, Collette, Sabine L., additional, Groot, Adrien E.D., additional, LeCouffe, Natalie E., additional, Konduri, Praneeta R., additional, Prasetya, Haryadi, additional, Arrarte-Terreros, Nerea, additional, and Ramos, Lucas A., additional
Published: 2021
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26. Patient-Reported Experience Measures in Stroke Care

Author: Cornelis, Cosette, primary, den Hartog, Sanne J., additional, Bastemeijer, Carla M., additional, Roozenbeek, Bob, additional, Nederkoorn, Paul J., additional, and Van den Berg-Vos, Renske M., additional
Published: 2021
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27. Additional file 1 of Performance feedback on the quality of care in hospitals performing thrombectomy for ischemic stroke (PERFEQTOS): protocol of a stepped wedge cluster randomized trial

Author: Amini, Marzyeh, den Hartog, Sanne J., van Leeuwen, Nikki, Eijkenaar, Frank, Kuhrij, Laurien S., Stolze, Lotte J., Nederkoorn, Paul J., Lingsma, Hester F., van Es, Adriaan C. G. M., van den Wijngaard, Ido R., van der Lugt, Aad, Dippel, Diederik W. J., and Roozenbeek, Bob
Abstract: Additional file 1. SPIRIT Checklist.
Published: 2021
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28. Effect of first-pass reperfusion on outcome after endovascular treatment for ischemic stroke

Author: Venema, Esmee, Den Hartog, Sanne J., Zaidat, Osama, Roozenbeek, Bob, van Es, Adriaan C.G.M., Bruggeman, Agnetha A.E., Emmer, Bart J., Majoie, Charles B.L.M., van Zwam, Wim H., van den Wijngaard, Ido R., van Doormaal, Pieter Jan, Lingsma, Hester F., Burke, James F., Dippel, Diederik W.J., van der Lugt, Aad, Mulder, Maxim, Compagne, Kars, Dinkelaar, Wouter, El Ghannouti, Naziha, Sterrenberg, Martin, Chalos, Vicky, Ergezen, Saliha, Harmsma, Roger, de Jong, Anouk, Berkhemer, Olvert, Venema, Esmee, Den Hartog, Sanne J., Zaidat, Osama, Roozenbeek, Bob, van Es, Adriaan C.G.M., Bruggeman, Agnetha A.E., Emmer, Bart J., Majoie, Charles B.L.M., van Zwam, Wim H., van den Wijngaard, Ido R., van Doormaal, Pieter Jan, Lingsma, Hester F., Burke, James F., Dippel, Diederik W.J., van der Lugt, Aad, Mulder, Maxim, Compagne, Kars, Dinkelaar, Wouter, El Ghannouti, Naziha, Sterrenberg, Martin, Chalos, Vicky, Ergezen, Saliha, Harmsma, Roger, de Jong, Anouk, and Berkhemer, Olvert
Abstract: BACKGROUND: First-pass reperfusion (FPR) is associated with favorable outcome after endovascular treatment. It is unknown whether this effect is independent of patient characteristics and whether FPR has better outcomes compared with excellent reperfusion (Expanded Thrombolysis in Cerebral Infarction [eTICI] 2C-3) after multiple-passes reperfusion. We aimed to evaluate the association between FPR and outcome with adjustment for patient, imaging, and treatment characteristics to single out the contribution of FPR. METHODS AND RESULTS: FPR was defined as eTICI 2C-3 after 1 pass. Multivariable regression models were used to investigate characteristics associated with FPR and to investigate the effect of FPR on outcomes. We included 2686 patients of the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry. Factors associated with FPR were as follows: history of hyperlipidemia (adjusted odds ratio [OR], 1.05; 95% CI, 1.01–1.10), middle cerebral artery versus intracranial carotid artery occlusion (adjusted OR, 1.11; 95% CI, 1.06–1.16), and aspiration versus stent thrombectomy (adjusted OR, 1.07; 95% CI, 1.03–1.11). Interventionist experience increased the likelihood of FPR (adjusted OR, 1.03 per 50 patients previously treated; 95% CI, 1.01–1.06). Adjusted for patient, imaging, and treatment characteristics, FPR remained associated with a better 24-hour National Institutes of Health Stroke Scale (NIHSS) score (−37%; 95% CI, −43% to −31%) and a better modified Rankin Scale (mRS) score at 3 months (adjusted common OR, 2.16; 95% CI, 1.83–2.54) compared with no FPR (multiple-passes reperfusion+no excellent reperfusion), and compared with multiple-passes reperfusion alone (24hour NIHSS score, (−23%; 95% CI, −31% to −14%), and mRS score (adjusted common OR, 1.45; 95% CI, 1.19–1.78)). CONCLUSIONS: FPR compared with multiple-passes reperfusion is associated with favorable outcome, independently of patie
Published: 2021

29. Relationship between primary stroke center volume and time to endovascular thrombectomy in acute ischemic stroke

Author: van Meenen, Laura C. C., den Hartog, Sanne J., Groot, Adrien E., Emmer, Bart J., Smeekes, Martin D., Siegers, Arjen, Kommer, Geert Jan, Majoie, Charles B. L. M., Roos, Yvo B. W. E. M., van Es, Adriaan C. G. M., Dippel, Diederik W., van der Worp, H. Bart, Lingsma, Hester F., Roozenbeek, Bob, Coutinho, Jonathan M., van Meenen, Laura C. C., den Hartog, Sanne J., Groot, Adrien E., Emmer, Bart J., Smeekes, Martin D., Siegers, Arjen, Kommer, Geert Jan, Majoie, Charles B. L. M., Roos, Yvo B. W. E. M., van Es, Adriaan C. G. M., Dippel, Diederik W., van der Worp, H. Bart, Lingsma, Hester F., Roozenbeek, Bob, and Coutinho, Jonathan M.
Abstract: Background and purpose We investigated whether the annual volume of patients with acute ischemic stroke referred from a primary stroke center (PSC) for endovascular treatment (EVT) is associated with treatment times and functional outcome. Methods We used data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) registry (2014–2017). We included patients with acute ischemic stroke of the anterior circulation who were transferred from a PSC to a comprehensive stroke center (CSC) for EVT. We examined the association between EVT referral volume of PSCs and treatment times and functional outcome using multivariable regression modeling. The main outcomes were time from arrival at the PSC to groin puncture (PSC-door-to-groin time), adjusted for estimated ambulance travel times, time from arrival at the CSC to groin puncture (CSC-door-to-groin time), and modified Rankin Scale (mRS) score at 90 days after stroke. Results Of the 3637 patients in the registry, 1541 patients (42%) from 65 PSCs were included. Mean age was 71 years (SD ± 13.3), median National Institutes of Health Stroke Scale score was 16 (interquartile range [IQR]: 12–19), and median time from stroke onset to arrival at the PSC was 53 min (IQR: 38–90). Eighty-three percent had received intravenous thrombolysis. EVT referral volume was not associated with PSC-door-to-groin time (adjusted coefficient: −0.49 min/annual referral, 95% confidence interval [CI]: −1.27 to 0.29), CSC-door-to-groin time (adjusted coefficient: −0.34 min/annual referral, 95% CI: −0.69 to 0.01) or 90-day mRS score (adjusted common odds ratio: 0.99, 95% CI: 0.96–1.01). Conclusions In patients transferred from a PSC for EVT, higher PSC volumes do not seem to translate into better workflow metrics or patient outcome.
Published: 2021

30. Performance feedback on the quality of care in hospitals performing thrombectomy for ischemic stroke (PERFEQTOS):protocol of a stepped wedge cluster randomized trial

Author: Amini, Marzyeh, den Hartog, Sanne J., van Leeuwen, Nikki, Eijkenaar, Frank, Kuhrij, Laurien S., Stolze, Lotte J., Nederkoorn, Paul J., Lingsma, Hester F., van Es, Adriaan C.G.M., van den Wijngaard, Ido R., van der Lugt, Aad, Dippel, Diederik W.J., Roozenbeek, Bob, Amini, Marzyeh, den Hartog, Sanne J., van Leeuwen, Nikki, Eijkenaar, Frank, Kuhrij, Laurien S., Stolze, Lotte J., Nederkoorn, Paul J., Lingsma, Hester F., van Es, Adriaan C.G.M., van den Wijngaard, Ido R., van der Lugt, Aad, Dippel, Diederik W.J., and Roozenbeek, Bob
Abstract: Background: Although the provision of performance feedback to healthcare professionals based on data from quality registries is common practice in many fields of medicine, observational studies of its effect on the quality of care have shown mixed results. The objective of this study is to evaluate the effect of performance feedback on the quality of care for acute ischemic stroke. Methods: PERFEQTOS is a stepped wedge cluster randomized trial in 13 hospitals in the Netherlands providing endovascular thrombectomy for ischemic stroke. The primary outcome is the hospital’s door-to-groin time. The study starts with a 6-month period in which none of the hospitals receives the performance feedback intervention. Subsequently, every 6 months, three or four hospitals are randomized to cross over from the control to the intervention conditions, until all hospitals receive the feedback intervention. The feedback intervention consists of a dashboard with quarterly reports on patient characteristics, structure, process, and outcome indicators related to patients with ischemic stroke treated with endovascular thrombectomy. Hospitals can compare their present performance with their own performance in the past and with other hospitals. The performance feedback is provided to local quality improvement teams in each hospital, who define their own targets on specific indicators and develop performance improvement plans. The impact of the performance feedback and improvement plans will be evaluated by comparing the primary outcome before and after the intervention. Discussion: This study will provide evidence on the effectiveness of performance feedback to healthcare providers. The results will be actively disseminated through peer-reviewed journals, conference presentations, and various stakeholder engagement activities. Trial registration: Netherlands Trial Register NL9090. Registered on December 3, 2020.
Published: 2021

31. Effect of First‐Pass Reperfusion on Outcome After Endovascular Treatment for Ischemic Stroke

Author: den Hartog, Sanne J., primary, Zaidat, Osama, additional, Roozenbeek, Bob, additional, van Es, Adriaan C. G. M., additional, Bruggeman, Agnetha A. E., additional, Emmer, Bart J., additional, Majoie, Charles B. L. M., additional, van Zwam, Wim H., additional, van den Wijngaard, Ido R., additional, van Doormaal, Pieter Jan, additional, Lingsma, Hester F., additional, Burke, James F., additional, Dippel, Diederik W. J., additional, van der Lugt, Aad, additional, Roos, Yvo B. W. E. M., additional, van Oostenbrugge, Robert J., additional, Boiten, Jelis, additional, Vos, Jan Albert, additional, Jansen, Ivo G. H., additional, Mulder, Maxim J. H. L., additional, Goldhoorn, Robert‐Jan B., additional, Compagne, Kars C. J., additional, Kappelhof, Manon, additional, Brouwer, Josje, additional, Hinsenveld, Wouter H., additional, Coutinho, Jonathan M., additional, Schonewille, Wouter J., additional, Wermer, Marieke J. H., additional, van Walderveen, Marianne A. A., additional, Staals, Julie, additional, Hofmeijer, Jeannette, additional, Martens, Jasper M., additional, Lycklama à Nijeholt, Geert J., additional, de Bruijn, Sebastiaan F., additional, van Dijk, Lukas C., additional, van der Worp, H. Bart, additional, Lo, Rob H., additional, van Dijk, Ewoud J., additional, Boogaarts, Hieronymus D., additional, de Vries, J., additional, de Kort, Paul L. M., additional, van Tuijl, Julia, additional, Peluso, Jo P., additional, Fransen, Puck, additional, van den Berg, Jan S. P., additional, van Hasselt, Boudewijn A. A. M., additional, Aerden, Leo A. M., additional, Dallinga, René J., additional, Uyttenboogaart, Maarten, additional, Eschgi, Omid, additional, Bokkers, Reinoud P. H., additional, Schreuder, Tobien H. C. M. L., additional, Heijboer, Roel J. J., additional, Keizer, Koos, additional, Yo, Lonneke S. F., additional, den Hertog, Heleen M., additional, Sturm, Emiel J. C., additional, Brouwers, Paul J. A. M., additional, Sprengers, Marieke E. S., additional, Jenniskens, Sjoerd F. M., additional, van den Berg, René, additional, Yoo, Albert J., additional, Beenen, Ludo F. M., additional, Postma, Alida A., additional, Roosendaal, Stefan D., additional, van der Kallen, Bas F. W., additional, Bot, Joost, additional, Meijer, Anton, additional, Ghariq, Elyas, additional, van Proosdij, Marc P., additional, Krietemeijer, G. Menno, additional, Gerrits, Dick, additional, Dinkelaar, Wouter, additional, Appelman, Auke P. A., additional, Hammer, Bas, additional, Pegge, Sjoert, additional, van der Hoorn, Anouk, additional, Vinke, Saman, additional, Flach, H. Zwenneke, additional, el Ghannouti, Naziha, additional, Sterrenberg, Martin, additional, Pellikaan, Wilma, additional, Sprengers, Rita, additional, Elfrink, Marjan, additional, Simons, Michelle, additional, Vossers, Marjolein, additional, de Meris, Joke, additional, Vermeulen, Tamara, additional, Geerlings, Annet, additional, van Vemde, Gina, additional, Simons, Tiny, additional, Messchendorp, Gert, additional, Nicolaij, Nynke, additional, Bongenaar, Hester, additional, Bodde, Karin, additional, Kleijn, Sandra, additional, Lodico, Jasmijn, additional, Droste, Hanneke, additional, Wollaert, Maureen, additional, Verheesen, Sabrina, additional, Jeurrissen, D., additional, Bos, Erna, additional, Drabbe, Yvonne, additional, Sandiman, Michelle, additional, Aaldering, Nicoline, additional, Zweedijk, Berber, additional, Vervoort, Jocova, additional, Ponjee, Eva, additional, Romviel, Sharon, additional, Kanselaar, Karin, additional, Barning, Denn, additional, Venema, Esmee, additional, Chalos, Vicky, additional, Geuskens, Ralph R., additional, van Straaten, Tim, additional, Ergezen, Saliha, additional, Harmsma, Roger R. M., additional, Muijres, Daan, additional, de Jong, Anouk, additional, Berkhemer, Olvert A., additional, Boers, Anna M. M., additional, Huguet, J., additional, Groot, P. F. C., additional, Mens, Marieke A., additional, van Kranendonk, Katinka R., additional, Treurniet, Kilian M., additional, Tolhuisen, Manon L., additional, Alves, Heitor, additional, Weterings, Annick J., additional, Kirkels, Eleonora L. F., additional, Voogd, Eva J. H. F., additional, Schupp, Lieve M., additional, Collette, Sabine L., additional, Groot, Adrien E. D., additional, LeCouffe, Natalie E., additional, Konduri, Praneeta R., additional, Prasetya, Haryadi, additional, Arrarte‐Terreros, Nerea, additional, and Ramos, Lucas A., additional
Published: 2021
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32. Pathology-proven extradural (“distant”) metastases of gliomas in adults in the Netherlands between 1971 and 2018: a systematic case series

Author: den Hartog, Sanne J, primary, van der Kolk, Anja, additional, Bruggink, Annette, additional, Seute, Tatjana, additional, Wesseling, Pieter, additional, and Wilbers, Joyce, additional
Published: 2021
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33. Importance of Occlusion Site for Thrombectomy Technique in Stroke

Author: Bernsen, Marie Louise E., primary, Goldhoorn, Robert-Jan B., additional, Lingsma, Hester F., additional, van Oostenbrugge, Robert J., additional, van Zwam, Wim H., additional, Uyttenboogaart, Maarten, additional, Roos, Yvo B.W.E.M., additional, Martens, Jasper M., additional, Hofmeijer, Jeannette, additional, Dippel, Diederik W.J., additional, van der Lugt, Aad, additional, Majoie, Charles B.L.M., additional, Boiten, Jelis, additional, Albert Vos, Jan, additional, Jansen, Ivo G.H., additional, Mulder, Maxim J.H.L., additional, Goldhoorn, Robert- Jan B., additional, Compagne, Kars C.J., additional, Kappelhof, Manon, additional, Brouwer, Josje, additional, den Hartog, Sanne J., additional, Hinsenveld, Wouter H., additional, Roozenbeek, Bob, additional, van Es, Adriaan C.G.M., additional, Emmer, Bart J., additional, Coutinho, Jonathan M., additional, Schonewille, Wouter J., additional, Wermer, Marieke J.H., additional, van Walderveen, Marianne A.A., additional, Staals, Julie, additional, Lycklama, Geert J., additional, Nijeholt, à, additional, de Bruijn, Sebastiaan F., additional, van Dijk, Lukas C., additional, van der Worp, H. Bart, additional, Lo, Rob H., additional, van Dijk, Ewoud J., additional, Boogaarts, Hieronymus D., additional, Vries, J. de, additional, de Kort, Paul L.M., additional, van Tuijl, Julia, additional, Peluso, Jo P., additional, Fransen, Puck, additional, van den Berg, Jan S.P., additional, van Hasselt, Boudewijn A.A.M., additional, Aerden, Leo A.M., additional, Dallinga, René J., additional, Eschgi, Omid, additional, Bokkers, Reinoud P.H., additional, Schreuder, Tobien H.C.M.L., additional, Heijboer, Roel J.J., additional, Keizer, Koos, additional, Yo, Lonneke S.F., additional, den Hertog, Heleen M., additional, Bulut, Tomas, additional, Brouwers, Paul J.A.M., additional, Sprengers, Marieke E.S., additional, Jenniskens, Sjoerd F.M., additional, van den Berg, René, additional, Yoo, Albert J., additional, Beenen, Ludo F.M., additional, Postma, Alida A., additional, Roosendaal, Stefan D., additional, der Kallen, Bas F.W. van, additional, van den Wijngaard, Ido R., additional, Bot, Joost, additional, van Doormaal, Pieter-Jan, additional, Meijer, Anton, additional, Ghariq, Elyas, additional, van Proosdij, Marc P., additional, Krietemeijer, G. Menno, additional, Lo, Rob, additional, Gerrits, Dick, additional, Dinkelaar, Wouter, additional, Appelman, Auke P.A., additional, Hammer, Bas, additional, Pegge, Sjoert, additional, van der Hoorn, Anouk, additional, Vinke, Saman, additional, Flach, H. Zwenneke, additional, el Ghannouti, Naziha, additional, Sterrenberg, Martin, additional, Pellikaan, Wilma, additional, Sprengers, Rita, additional, Elfrink, Marjan, additional, Simons, Michelle, additional, Vossers, Marjolein, additional, de Meris, Joke, additional, Vermeulen, Tamara, additional, Geerlings, Annet, additional, van Vemde, Gina, additional, Simons, Tiny, additional, Messchendorp, Gert, additional, Nicolaij, Nynke, additional, Bongenaar, Hester, additional, Bodde, Karin, additional, Kleijn, Sandra, additional, Lodico, Jasmijn, additional, Droste, Hanneke, additional, Wollaert, Maureen, additional, Verheesen, Sabrina, additional, Jeurrissen, D., additional, Bos, Erna, additional, Drabbe, Yvonne, additional, Sandiman, Michelle, additional, Aaldering, Nicoline, additional, Zweedijk, Berber, additional, Vervoort, Jocova, additional, Ponjee, Eva, additional, Romviel, Sharon, additional, Kanselaar, Karin, additional, Barning, Denn, additional, Venema, Esmee, additional, Chalos, Vicky, additional, Geuskens, Ralph R., additional, van Straaten, Tim, additional, Ergezen, Saliha, additional, Harmsma, Roger R.M., additional, Muijres, Daan, additional, de Jong, Anouk, additional, Berkhemer, Olvert A., additional, Boers, Anna M.M., additional, Huguet, J., additional, Groot, P.F.C., additional, Mens, Marieke A., additional, van Kranendonk, Katinka R., additional, Treurniet, Kilian M., additional, Tolhuisen, Manon L., additional, Alves, Heitor, additional, Weterings, Annick J., additional, Kirkels, Eleonora L.F., additional, Voogd, Eva J.H.F., additional, Schupp, Lieve M., additional, Collette, Sabine L., additional, Groot, Adrien E.D., additional, LeCouffe, Natalie E., additional, Konduri, Praneeta R., additional, Prasetya, Haryadi, additional, Arrarte-Terreros, Nerea, additional, and Ramos, Lucas A., additional
Published: 2021
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34. Combined Effect of Age and Baseline Alberta Stroke Program Early Computed Tomography Score on Post-Thrombectomy Clinical Outcomes in the MR CLEAN Registry

Author: Ospel, Johanna, primary, Kappelhof, Manon, additional, Groot, Adrien E., additional, LeCouffe, Natalie E., additional, Coutinho, Jonathan M., additional, Yoo, Albert J., additional, Yo, Lonneke S.F., additional, Beenen, Ludo F.M., additional, van Zwam, Wim H., additional, van der Lugt, Aad, additional, Postma, Alida A., additional, Roos, Yvo B.W.E.M., additional, Goyal, Mayank, additional, Majoie, Charles B.L.M., additional, Dippel, Diederik W.J., additional, van Oostenbrugge, Robert J., additional, Boiten, Jelis, additional, Albert Vos, Jan, additional, Jansen, Ivo G.H., additional, Mulder, Maxim J.H.L., additional, Goldhoorn, Robert- Jan B., additional, Compagne, Kars C.J., additional, Brouwer, Josje, additional, den Hartog, Sanne J., additional, Hinsenveld, Wouter H., additional, Roozenbeek, Bob, additional, van Es, Adriaan C.G.M., additional, Emmer, Bart J., additional, Schonewille, Wouter J., additional, Wermer, Marieke J.H., additional, van Walderveen, Marianne A.A., additional, Staals, Julie, additional, Hofmeijer, Jeannette, additional, Martens, Jasper M., additional, Lycklama à Nijeholt, Geert J., additional, de Bruijn, Sebastiaan F., additional, van Dijk, Lukas C., additional, van der Worp, H. Bart, additional, Lo, Rob H., additional, van Dijk, Ewoud J., additional, Boogaarts, Hieronymus D., additional, de Vries, J., additional, de Kort, Paul L.M., additional, van Tuijl, Julia, additional, Peluso, Jo P., additional, Fransen, Puck, additional, van den Berg, Jan S.P., additional, van Hasselt, Boudewijn A.A.M., additional, Aerden, Leo A.M., additional, Dallinga, René J., additional, Uyttenboogaart, Maarten, additional, Eschgi, Omid, additional, Bokkers, Reinoud P.H., additional, Schreuder, Tobien H.C.M.L., additional, Heijboer, Roel J.J., additional, Keizer, Koos, additional, den Hertog, Heleen M., additional, Sturm, Emiel J.C., additional, Brouwers, Paul J.A.M., additional, Sprengers, Marieke E.S., additional, Jenniskens, Sjoerd F.M., additional, van den Berg, René, additional, Roosendaal, Stefan D., additional, van der Kallen, Bas F.W., additional, van den Wijngaard, Ido R., additional, Bot, Joost, additional, van Doormaal, Pieter-Jan, additional, Meijer, Anton, additional, Ghariq, Elyas, additional, van Proosdij, Marc P., additional, Krietemeijer, G. Menno, additional, Lo, Rob, additional, Gerrits, Dick, additional, Dinkelaar, Wouter, additional, Appelman, Auke P.A., additional, Hammer, Bas, additional, Pegge, Sjoert, additional, van der Hoorn, Anouk, additional, Vinke, Saman, additional, Flach, H. Zwenneke, additional, Lingsma, Hester F., additional, Ghannouti, Naziha el, additional, Sterrenberg, Martin, additional, Pellikaan, Wilma, additional, Sprengers, Rita, additional, Elfrink, Marjan, additional, Simons, Michelle, additional, Vossers, Marjolein, additional, de Meris, Joke, additional, Vermeulen, Tamara, additional, Geerlings, Annet, additional, van Vemde, Gina, additional, Simons, Tiny, additional, Messchendorp, Gert, additional, Nicolaij, Nynke, additional, Bongenaar, Hester, additional, Bodde, Karin, additional, Kleijn, Sandra, additional, Lodico, Jasmijn, additional, Droste, Hanneke, additional, Wollaert, Maureen, additional, Verheesen, Sabrina, additional, Jeurrissen, D., additional, Bos, Erna, additional, Drabbe, Yvonne, additional, Sandiman, Michelle, additional, Aaldering, Nicoline, additional, Zweedijk, Berber, additional, Vervoort, Jocova, additional, Ponjee, Eva, additional, Romviel, Sharon, additional, Kanselaar, Karin, additional, Barning, Denn, additional, Venema, Esmee, additional, Chalos, Vicky, additional, Geuskens, Ralph R., additional, van Straaten, Tim, additional, Ergezen, Saliha, additional, Harmsma, Roger R.M., additional, Muijres, Daan, additional, de Jong, Anouk, additional, Berkhemer, Olvert A., additional, Boers, Anna M.M., additional, Huguet, J., additional, Groot, P.F.C., additional, Mens, Marieke A., additional, van Kranendonk, Katinka R., additional, Treurniet, Kilian M., additional, Tolhuisen, Manon L., additional, Alves, Heitor, additional, Weterings, Annick J., additional, Kirkels, Eleonora L.F., additional, Schupp, Lieve M., additional, Voogd, Eva J.H.F., additional, Collette, Sabine, additional, Konduri, Praneeta R., additional, Prasetya, Haryadi, additional, Arrarte-Terreros, Nerea, additional, and Ramos, Lucas A., additional
Published: 2020
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35. Admission Blood Pressure in Relation to Clinical Outcomes and Successful Reperfusion After Endovascular Stroke Treatment

Author: van den Berg, Sophie A., primary, Uniken Venema, Simone M., additional, Mulder, Maxim J.H.L., additional, Treurniet, Kilian M., additional, Samuels, Noor, additional, Lingsma, Hester F., additional, Goldhoorn, Robert-Jan B., additional, Jansen, Ivo G.H., additional, Coutinho, Jonathan M., additional, Roozenbeek, Bob, additional, Dippel, Diederik W.J., additional, Roos, Yvo B.W.E.M., additional, van der Worp, H. Bart, additional, Nederkoorn, Paul J., additional, van der Lugt, Aad, additional, Majoie, Charles B.L.M., additional, van Oostenbrugge, Robert J., additional, van Zwam, Wim H., additional, Vos, Jan Albert, additional, Brouwer, Josje, additional, den Hartog, Sanne J., additional, Hinsenveld, Wouter H., additional, Kappelhof, Manon, additional, Compagne, Kars C.J., additional, van Es, Adriaan C.G.M., additional, Emmer, Bart J., additional, Schonewille, Wouter J., additional, Wermer, Marieke J.H., additional, van Walderveen, Marianne A.A., additional, Staals, Julie, additional, Hofmeijer, Jeannette, additional, Martens, Jasper M., additional, Lycklama à Nijeholt, Geert J., additional, Boiten, Jelis, additional, de Bruijn, Sebastiaan F., additional, van Dijk, Lukas C., additional, Lo, Rob H., additional, van Dijk, Ewoud J., additional, Boogaarts, Hieronymus D., additional, de Vries, J., additional, de Kort, Paul L.M., additional, van Tuijl, Julia, additional, Peluso, Jo P., additional, Fransen, Puck, additional, van den Berg, Jan S.P., additional, van Hasselt, Boudewijn A.A.M., additional, Aerden, Leo A.M., additional, Dallinga, René J., additional, Uyttenboogaart, Maarten, additional, Eschgi, Omid, additional, Bokkers, Reinoud P.H., additional, Schreuder, Tobien H.C.M.L., additional, Heijboer, Roel J.J., additional, Keizer, Koos, additional, Yo, Lonneke S.F., additional, den Hertog, Heleen M., additional, Sturm, Emiel J.C., additional, Brouwers, Paul, additional, Sprengers, Marieke E.S., additional, Jenniskens, Sjoerd F.M., additional, van den Berg, René, additional, Yoo, Albert J., additional, Beenen, Ludo F.M., additional, Postma, Alida A., additional, Roosendaal, Stefan D., additional, van der Kallen, Bas F.W., additional, van den Wijngaard, Ido R., additional, Bot, Joost, additional, van Doormaal, Pieter-Jan, additional, Meijer, Anton, additional, Ghariq, Elyas, additional, van Proosdij, Marc P., additional, Krietemeijer, G. Menno, additional, Lo, Rob, additional, Gerrits, Dick, additional, Dinkelaar, Wouter, additional, Appelman, Auke P.A., additional, Hammer, Bas, additional, Pegge, Sjoert, additional, van der Hoorn, Anouk, additional, Vinke, Saman, additional, Flach, H. Zwenneke, additional, Ghannouti, Naziha el, additional, Sterrenberg, Martin, additional, Puppels, Corina, additional, Pellikaan, Wilma, additional, Sprengers, Rita, additional, Elfrink, Marjan, additional, Simons, Michelle, additional, Vossers, Marjolein, additional, de Meris, Joke, additional, Vermeulen, Tamara, additional, Geerlings, Annet, additional, van Vemde, Gina, additional, Simons, Tiny, additional, van Rijswijk, Cathelijn, additional, Messchendorp, Gert, additional, Nicolaij, Nynke, additional, Bongenaar, Hester, additional, Bodde, Karin, additional, Kleijn, Sandra, additional, Lodico, Jasmijn, additional, Droste, Hanneke, additional, Wollaert, Maureen, additional, Verheesen, Sabrina, additional, Jeurrissen, D., additional, Bos, Erna, additional, Drabbe, Yvonne, additional, Sandiman, Michelle, additional, Aaldering, Nicoline, additional, Zweedijk, Berber, additional, Khalilzada, Mostafa, additional, Vervoort, Jocova, additional, Ponjee, Eva, additional, Romviel, Sharon, additional, Kanselaar, Karin, additional, Barning, Denn, additional, Venema, Esmee, additional, Chalos, Vicky, additional, Geuskens, Ralph R., additional, van Straaten, Tim, additional, Ergezen, Saliha, additional, Harmsma, Roger R.M., additional, Muijres, Daan, additional, de Jong, Anouk, additional, Berkhemer, Olvert A., additional, Boers, Anna M.M., additional, Huguet, J., additional, Groot, P.F.C., additional, Mens, Marieke A., additional, van Kranendonk, Katinka R., additional, Tolhuisen, Manon L., additional, Alves, Heitor, additional, Weterings, Annick J., additional, Kirkels, Eleonora L.F., additional, Voogd, Eva J.H.F., additional, Schupp, Lieve M., additional, Collette, Sabine, additional, Groot, Adrien E.D., additional, LeCouffe, Natalie E., additional, Konduri, Praneeta R., additional, Prasetya, Haryadi, additional, Arrarte-Terreros, Nerea, additional, and Ramos, Lucas A., additional
Published: 2020
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36. Path From Clinical Research to Implementation

Author: Wiegers, Eveline J.A., primary, Compagne, Kars C.J., additional, Janssen, Paula M., additional, Venema, Esmee, additional, Deckers, Jaap W., additional, Schonewille, Wouter J., additional, Albert Vos, Jan, additional, Lycklama à Nijeholt, Geert J., additional, Roozenbeek, Bob, additional, Martens, Jasper M., additional, Hofmeijer, Jeannette, additional, van Oostenbrugge, Robert-Jan, additional, van Zwam, Wim H., additional, Majoie, Charles B.L.M., additional, van der Lugt, Aad, additional, Lingsma, H.F., additional, Roos, Yvo B.W.E.M., additional, Dippel, Diederik W.J., additional, Boiten, Jelis, additional, Brouwer, Josje, additional, den Hartog, Sanne J., additional, Hinsenveld, Wouter H., additional, Kappelhof, Manon, additional, Goldhoorn, Robert-Jan B., additional, Mulder, Maxim J.H.L., additional, Jansen, Ivo G.H., additional, van Es, Adriaan C.G.M., additional, Emmer, Bart J., additional, Coutinho, Jonathan M., additional, Wermer, Marieke J.H., additional, van Walderveen, Marianne A.A., additional, Staals, Julie, additional, de Bruijn, Sebastiaan F., additional, van Dijk, Lukas C., additional, van der Worp, H. Bart, additional, Lo, Rob H., additional, van Dijk, Ewoud J., additional, Boogaarts, Hieronymus D., additional, Vries, J. de, additional, de Kort, Paul L.M., additional, van Tuijl, Julia, additional, Peluso, Jo Jo P., additional, Fransen, Puck, additional, van den Berg, Jan S.P., additional, van Hasselt, Boudewijn A.A.M., additional, Aerden, Leo A.M., additional, Dallinga, René J., additional, Uyttenboogaart, Maarten, additional, Eschgi, Omid, additional, Bokkers, Reinoud P.H., additional, Schreuder, Tobien H.C.M.L., additional, Heijboer, Roel J.J., additional, Keizer, Koos, additional, Yo, Lonneke S.F., additional, den Hertog, Heleen M., additional, Sturm, Emiel J.C., additional, Brouwers, Paul, additional, Sprengers, Marieke E.S., additional, Jenniskens, Sjoerd F.M., additional, van den Berg, René, additional, Yoo, Albert J., additional, Beenen, Ludo F.M., additional, Postma, Alida A., additional, Roosendaal, Stefan D., additional, van der Kallen, Bas F.W., additional, van den Wijngaard, Ido R., additional, Bot, Joost, additional, van Doormaal, Pieter-Jan, additional, Meijer, Anton, additional, Ghariq, Elyas, additional, van Proosdij, Marc P., additional, Krietemeijer, G. Menno, additional, Peluso, Jo P., additional, Lo, Rob, additional, Gerrits, Dick, additional, Dinkelaar, Wouter, additional, Appelman, Auke P.A., additional, Hammer, Bas, additional, Pegge, Sjoert, additional, van der Hoorn, Anouk, additional, Vinke, Saman, additional, Flach, H. Zwenneke, additional, Ghannouti, Naziha el, additional, Sterrenberg, Martin, additional, Puppels, Corina, additional, Pellikaan, Wilma, additional, Sprengers, Rita, additional, Elfrink, Marjan, additional, Simons, Michelle, additional, Vossers, Marjolein, additional, de Meris, Joke, additional, Vermeulen, Tamara, additional, Geerlings, Annet, additional, van Vemde, Gina, additional, Simons, Tiny, additional, van Rijswijk, Cathelijn, additional, Messchendorp, Gert, additional, Nicolaij, Nynke, additional, Bongenaar, Hester, additional, Bodde, Karin, additional, Kleijn, Sandra, additional, Lodico, Jasmijn, additional, Droste, Hanneke, additional, Wollaert, Maureen, additional, Verheesen, Sabrina, additional, Jeurrissen, D., additional, Bos, Erna, additional, Drabbe, Yvonne, additional, Sandiman, Michelle, additional, Aaldering, Nicoline, additional, Zweedijk, Berber, additional, Khalilzada, Mostafa, additional, Vervoort, Jocova, additional, Ponjee, Eva, additional, Romviel, Sharon, additional, Kanselaar, Karin, additional, Barning, Denn, additional, Chalos, Vicky, additional, Geuskens, Ralph R., additional, van Straaten, Tim, additional, Ergezen, Saliha, additional, Harmsma, Roger R.M., additional, Muijres, Daan, additional, de Jong, Anouk, additional, Berkhemer, Olvert A., additional, Boers, Anna M.M., additional, Huguet, J., additional, Groot, P.F.C., additional, Mens, Marieke A., additional, van Kranendonk, Katinka R., additional, Treurniet, Kilian M., additional, Tolhuisen, Manon L., additional, Alves, Heitor, additional, Weterings, Annick J., additional, Kirkels, Eleonora L.F., additional, Voogd, Eva J.H.F., additional, Schupp, Lieve M., additional, Collette, Sabine, additional, Groot, Adrien E.D., additional, LeCouffe, Natalie E., additional, Konduri, Praneeta R., additional, Prasetya, Haryadi, additional, Arrarte-Terreros, Nerea, additional, and Ramos, Lucas A., additional
Published: 2020
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37. Clinical and Imaging Determinants of Collateral Status in Patients With Acute Ischemic Stroke in MR CLEAN Trial and Registry

Author: Wiegers, Eveline J.A., primary, Mulder, Maxim J.H.L., additional, Jansen, Ivo G.H., additional, Venema, Esmee, additional, Compagne, Kars C.J., additional, Berkhemer, Olvert A., additional, Emmer, Bart J., additional, Marquering, Henk A., additional, van Es, Adriaan C.G.M., additional, Sprengers, Marieke E., additional, van Zwam, Wim H., additional, van Oostenbrugge, Robert J., additional, Roos, Yvo B.W.E.M., additional, Majoie, Charles B.L.M., additional, Roozenbeek, Bob, additional, Lingsma, Hester F., additional, Dippel, Diederik W.J., additional, van der Lugt, Aad, additional, Boiten, Jelis, additional, Vos, Jan Albert, additional, Brouwer, Josje, additional, den Hartog, Sanne J., additional, Hinsenveld, Wouter H., additional, Kappelhof, Manon, additional, Goldhoorn, Robert-Jan B., additional, Coutinho, Jonathan M., additional, Schonewille, Wouter J., additional, Wermer, Marieke J.H., additional, van Walderveen, Marianne A.A., additional, Staals, Julie, additional, Hofmeijer, Jeannette, additional, Martens, Jasper M., additional, Lycklama à Nijeholt, Geert J., additional, de Bruijn, Sebastiaan F., additional, van Dijk, Lukas C., additional, van der Worp, H. Bart, additional, Lo, Rob H., additional, van Dijk, Ewoud J., additional, Boogaarts, Hieronymus D., additional, de Vries, J., additional, de Kort, Paul L.M., additional, van Tuijl, Julia, additional, Peluso, Jo Jo P., additional, Fransen, Puck, additional, van den Berg, Jan S.P., additional, van Hasselt, Boudewijn A.A.M., additional, Aerden, Leo A.M., additional, Dallinga, René J., additional, Uyttenboogaart, Maarten, additional, Eschgi, Omid, additional, Bokkers, Reinoud P.H., additional, Schreuder, Tobien H.C.M.L., additional, Heijboer, Roel J.J., additional, Keizer, Koos, additional, Yo, Lonneke S.F., additional, den Hertog, Heleen M., additional, Sturm, Emiel J.C., additional, Brouwers, Paul, additional, Jenniskens, Sjoerd F.M., additional, van den Berg, René, additional, Yoo, Albert J., additional, Beenen, Ludo F.M., additional, Postma, Alida A., additional, Roosendaal, Stefan D., additional, van der Kallen, Bas F.W., additional, van den Wijngaard, Ido R., additional, Bot, Joost, additional, van Doormaal, Pieter-Jan, additional, Meijer, Anton, additional, Ghariq, Elyas, additional, van Proosdij, Marc P., additional, Krietemeijer, G. Menno, additional, Peluso, Jo P., additional, Lo, Rob, additional, Gerrits, Dick, additional, Dinkelaar, Wouter, additional, Appelman, Auke P.A., additional, Hammer, Bas, additional, Pegge, Sjoert, additional, van der Hoorn, Anouk, additional, Vinke, Saman, additional, Flach, H. Zwenneke, additional, el Ghannouti, Naziha, additional, Sterrenberg, Martin, additional, Puppels, Corina, additional, Pellikaan, Wilma, additional, Sprengers, Rita, additional, Elfrink, Marjan, additional, Simons, Michelle, additional, Vossers, Marjolein, additional, de Meris, Joke, additional, Vermeulen, Tamara, additional, Geerlings, Annet, additional, van Vemde, Gina, additional, Simons, Tiny, additional, van Rijswijk, Cathelijn, additional, Messchendorp, Gert, additional, Nicolaij, Nynke, additional, Bongenaar, Hester, additional, Bodde, Karin, additional, Kleijn, Sandra, additional, Lodico, Jasmijn, additional, Droste, Hanneke, additional, Wollaert, Maureen, additional, Verheesen, Sabrina, additional, Jeurrissen, D., additional, Bos, Erna, additional, Drabbe, Yvonne, additional, Sandiman, Michelle, additional, Aaldering, Nicoline, additional, Zweedijk, Berber, additional, Khalilzada, Mostafa, additional, Vervoort, Jocova, additional, Ponjee, Eva, additional, Romviel, Sharon, additional, Kanselaar, Karin, additional, Barning, Denn, additional, Chalos, Vicky, additional, Geuskens, Ralph R., additional, van Straaten, Tim, additional, Ergezen, Saliha, additional, Harmsma, Roger R.M., additional, Muijres, Daan, additional, de Jong, Anouk, additional, Boers, Anna M.M., additional, Huguet, J., additional, Groot, P.F.C., additional, Mens, Marieke A., additional, van Kranendonk, Katinka R., additional, Treurniet, Kilian M., additional, Tolhuisen, Manon L., additional, Alves, Heitor, additional, Weterings, Annick J., additional, Kirkels, Eleonora L.F., additional, Voogd, Eva J.H.F., additional, Schupp, Lieve M., additional, Collette, Sabine, additional, Groot, Adrien E.D., additional, LeCouffe, Natalie E., additional, Konduri, Praneeta R., additional, Prasetya, Haryadi, additional, Arrarte-Terreros, Nerea, additional, and Ramos, Lucas A., additional
Published: 2020
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38. Hospital Variation in Time to Endovascular Treatment for Ischemic Stroke: What Is the Optimal Target for Improvement?

Author: den Hartog, Sanne J., Lingsma, Hester F., van Doormaal, Pieter-Jan, Hofmeijer, Jeannette, Yo, Lonneke S. F., Majoie, Charles B. L. M., Dippel, Diederik W. J., van der Lugt, Aad, Roozenbeek, Bob, and MR CLEAN Registry investigators *
Published: 2022
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39. Deep-Learning-Based Thrombus Localization and Segmentation in Patients with Posterior Circulation Stroke.

Author: Zoetmulder R, Bruggeman AAE, Išgum I, Gavves E, Majoie CBLM, Beenen LFM, Dippel DWJ, Boodt N, den Hartog SJ, van Doormaal PJ, Cornelissen SAP, Roos YBWEM, Brouwer J, Schonewille WJ, Pirson AFV, van Zwam WH, van der Leij C, Brans RJB, van Es ACGM, and Marquering HA
Abstract: Thrombus volume in posterior circulation stroke (PCS) has been associated with outcome, through recanalization. Manual thrombus segmentation is impractical for large scale analysis of image characteristics. Hence, in this study we develop the first automatic method for thrombus localization and segmentation on CT in patients with PCS. In this multi-center retrospective study, 187 patients with PCS from the MR CLEAN Registry were included. We developed a convolutional neural network (CNN) that segments thrombi and restricts the volume-of-interest (VOI) to the brainstem (Polar-UNet). Furthermore, we reduced false positive localization by removing small-volume objects, referred to as volume-based removal (VBR). Polar-UNet is benchmarked against a CNN that does not restrict the VOI (BL-UNet). Performance metrics included the intra-class correlation coefficient (ICC) between automated and manually segmented thrombus volumes, the thrombus localization precision and recall, and the Dice coefficient. The majority of the thrombi were localized. Without VBR, Polar-UNet achieved a thrombus localization recall of 0.82, versus 0.78 achieved by BL-UNet. This high recall was accompanied by a low precision of 0.14 and 0.09. VBR improved precision to 0.65 and 0.56 for Polar-UNet and BL-UNet, respectively, with a small reduction in recall to 0.75 and 0.69. The Dice coefficient achieved by Polar-UNet was 0.44, versus 0.38 achieved by BL-UNet with VBR. Both methods achieved ICCs of 0.41 (95% CI: 0.27-0.54). Restricting the VOI to the brainstem improved the thrombus localization precision, recall, and segmentation overlap compared to the benchmark. VBR improved thrombus localization precision but lowered recall.
Published: 2022
Full Text: View/download PDF

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