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1. 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

F. Anne V. Pirson, Nikki Boodt, Josje Brouwer, Agnetha A.E. Bruggeman, Sanne J. den Hartog, Robert-Jan B. Goldhoorn, Lucianne C.M. Langezaal, Julie Staals, Wim H. van Zwam, Christiaan van der Leij, Rutger J.B. Brans, Charles B.L.M. Majoie, Jonathan M. Coutinho, Bart J. Emmer, Diederik W.J. Dippel, Aad van der Lugt, Jan-Albert Vos, Robert J. van Oostenbrugge, Wouter J. Schonewille, Yvo B.W.E.M. Roos, Jelis Boiten, Jan Albert Vos, Ivo G.H. Jansen, Maxim J.H.L. Mulder, Kars C.J. Compagne, Manon Kappelhof, Wouter H. Hinsenveld, Bob Roozenbeek, Marieke J.H. Wermer, Marianne A.A. van Walderveen, Adriaan C.G.M. van Es, Jeannette Hofmeijer, Jasper M. Martens, Geert J. Lycklama à Nijeholt, Sebastiaan F. de Bruijn, Lukas C. van Dijk, H. Bart van der Worp, Rob H. Lo, Ewoud J. van Dijk, Hieronymus D. Boogaarts, J. de Vries, Paul L.M. de Kort, Julia van Tuijl, Jo P. Peluso, Puck Fransen, Jan S.P. van den Berg, Boudewijn A.A.M. van Hasselt, Leo A.M. Aerden, René J. Dallinga, Maarten Uyttenboogaart, Omid Eschgi, Reinoud P.H. Bokkers, Tobien H.C.M.L. Schreuder, Roel J.J. Heijboer, Koos Keizer, Lonneke S.F. Yo, Heleen M. den Hertog, Emiel J.C. Sturm, Paul J.A.M. Brouwers, Marieke E.S. Sprengers, Sjoerd F.M. Jenniskens, René van den Berg, Albert J. Yoo, Ludo F.M. Beenen, Alida A. Postma, Stefan D. Roosendaal, Bas F.W. van der Kallen, Ido R. van den Wijngaard, Joost Bot, Pieter-Jan van Doormaal, Anton Meijer, Elyas Ghariq, Marc P. van Proosdij, G. Menno Krietemeijer, Rob Lo, Dick Gerrits, Wouter Dinkelaar, Auke P.A. Appelman, Bas Hammer, Sjoert Pegge, Anouk van der Hoorn, Saman Vinke, Sandra Cornelissen, H. Zwenneke Flach, Hester F. Lingsma, Naziha el Ghannouti, Martin Sterrenberg, Wilma Pellikaan, Rita Sprengers, Marjan Elfrink, Michelle Simons, Marjolein Vossers, Joke de Meris, Tamara Vermeulen, Annet Geerlings, Gina van Vemde, Tiny Simons, Gert Messchendorp, Nynke Nicolaij, Hester Bongenaar, Karin Bodde, Sandra Kleijn, Jasmijn Lodico, Hanneke Droste, Maureen Wollaert, Sabrina Verheesen, D. Jeurrissen, Erna Bos, Yvonne Drabbe, Michelle Sandiman, Nicoline Aaldering, Berber Zweedijk, Jocova Vervoort, Eva Ponjee, Sharon Romviel, Karin Kanselaar, Denn Barning, Esmee Venema, Vicky Chalos, Ralph R. Geuskens, Tim van Straaten, Saliha Ergezen, Roger R.M. Harmsma, Daan Muijres, Anouk de Jong, Olvert A. Berkhemer, Anna M.M. Boers, J. Huguet, P.F.C. Groot, Marieke A. Mens, Katinka R. van Kranendonk, Kilian M. Treurniet, Manon L. Tolhuisen, Heitor Alves, Annick J. Weterings, Eleonora L.F. Kirkels, Eva J.H.F. Voogd, Lieve M. Schupp, Sabine L. Collette, Adrien E.D. Groot, Natalie E. LeCouffe, Praneeta R. Konduri, Haryadi Prasetya, Nerea Arrarte-Terreros, Lucas A. Ramos, Neurology, Graduate School, Radiology and Nuclear Medicine, ACS - Microcirculation, ANS - Brain Imaging, ACS - Atherosclerosis & ischemic syndromes, ANS - Neurovascular Disorders, Klinische Neurowetenschappen, MUMC+: MA Niet Med Staf Neurologie (9), RS: Carim - B05 Cerebral small vessel disease, MUMC+: MA AIOS Neurologie (9), MUMC+: MA Med Staf Spec Neurologie (9), Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: Carim - B06 Imaging, MUMC+: MA Neurologie (3), Radiology & Nuclear Medicine, Public Health, ​Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Damage and Repair in Cancer Development and Cancer Treatment (DARE), and Radiology and nuclear medicine

Subjects
Male, medicine.medical_specialty, Mechanical Thrombolysis, posterior stroke, Treatment outcome, law.invention, Postoperative Complications, Randomized controlled trial, law, large vessel occlusion, medicine, Humans, Routine clinical practice, Prospective Studies, Endovascular treatment, PREDICTORS, Stroke, Acute ischemic stroke, Aged, Ischemic Stroke, Netherlands, Advanced and Specialized Nursing, OUTCOMES, BASILAR ARTERY-OCCLUSION, business.industry, Endovascular Procedures, Other Research Radboud Institute for Health Sciences [Radboudumc 0], registries, Middle Aged, THROMBECTOMY, medicine.disease, reperfusion, Clinical Practice, Tissue Plasminogen Activator, Emergency medicine, treatment outcome, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Intracranial Hemorrhages, Large vessel occlusion
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, despite high mortality. Characteristics and outcomes of patients treated in trial versus nontrial centers were similar indicating that our cohort is representative of clinical practice in the Netherlands. Randomized studies using modern treatment approaches are needed for further insight in the benefit of EVT for PCS.

Published
2022
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2. Prediction of Outcome and Endovascular Treatment Benefit Validation and Update of the MR PREDICTS Decision Tool

Author

Esmee Venema, Bob Roozenbeek, Maxim J.H.L. Mulder, Scott Brown, Charles B.L.M. Majoie, Ewout W. Steyerberg, Andrew M. Demchuk, Keith W. Muir, Antoni Dávalos, Peter J. Mitchell, Serge Bracard, Olvert A. Berkhemer, Geert J. Lycklama à Nijeholt, Robert J. van Oostenbrugge, Yvo B.W.E.M. Roos, Wim H. van Zwam, Aad van der Lugt, Michael D. Hill, Philip White, Bruce C.V. Campbell, Francis Guillemin, Jeffrey L. Saver, Tudor G. Jovin, Mayank Goyal, Diederik W.J. Dippel, Hester F. Lingsma, Jelis Boiten, Jan Albert Vos, Ivo G.H. Jansen, Robert- Jan B. Goldhoorn, Kars C.J. Compagne, Manon Kappelhof, Josje Brouwer, Sanne J. den Hartog, Wouter H. Hinsenveld, Adriaan C.G.M. van Es, Bart J. Emmer, Jonathan M. Coutinho, Wouter J. Schonewille, Marieke J.H. Wermer, Marianne A.A. van Walderveen, Julie Staals, Jeannette Hofmeijer, Jasper M. Martens, Sebastiaan F. de Bruijn, Lukas C. van Dijk, H. Bart van der Worp, Rob H. Lo, Ewoud J. van Dijk, Hieronymus D. Boogaarts, J. de Vries, Paul L.M. de Kort, Julia van Tuijl, Jo P. Peluso, Puck Fransen, Jan S.P. van den Berg, Boudewijn A.A.M. van Hasselt, Leo A.M. Aerden, René J. Dallinga, Maarten Uyttenboogaart, Omid Eschgi, Reinoud P.H. Bokkers, Tobien H.C.M.L. Schreuder, Roel J.J. Heijboer, Koos Keizer, Lonneke S.F. Yo, Heleen M. den Hertog, Tomas Bulut, Paul J.A.M. Brouwers, Marieke E.S. Sprengers, Sjoerd F.M. Jenniskens, René van den Berg, Albert J. Yoo, Ludo F.M. Beenen, Alida A. Postma, Stefan D. Roosendaal, Bas F.W. van der Kallen, Ido R. van den Wijngaard, Joost Bot, Pieter-Jan van Doormaal, Anton Meijer, Elyas Ghariq, Marc P. van Proosdij, G. Menno Krietemeijer, Rob Lo, Dick Gerrits, Wouter Dinkelaar, Auke P.A. Appelman, Bas Hammer, Sjoert Pegge, Anouk van der Hoorn, Saman Vinke, H. Zwenneke Flach, Naziha el Ghannouti, Martin Sterrenberg, Wilma Pellikaan, Rita Sprengers, Marjan Elfrink, Michelle Simons, Marjolein Vossers, Joke de Meris, Tamara Vermeulen, Annet Geerlings, Gina van Vemde, Tiny Simons, Gert Messchendorp, Nynke Nicolaij, Hester Bongenaar, Karin Bodde, Sandra Kleijn, Jasmijn Lodico, Hanneke Droste, Maureen Wollaert, Sabrina Verheesen, D. Jeurrissen, Erna Bos, Yvonne Drabbe, Michelle Sandiman, Nicoline Aaldering, Berber Zweedijk, Jocova Vervoort, Eva Ponjee, Sharon Romviel, Karin Kanselaar, Denn Barning, Vicky Chalos, Ralph R. Geuskens, Tim van Straaten, Saliha Ergezen, Roger R.M. Harmsma, Daan Muijres, Anouk de Jong, Anna M.M. Boers, J. Huguet, P.F.C. Groot, Marieke A. Mens, Katinka R. van Kranendonk, Kilian M. Treurniet, Manon L. Tolhuisen, Heitor Alves, Annick J. Weterings, Eleonora L.F. Kirkels, Eva J.H.F. Voogd, Lieve M. Schupp, Sabine L. Collette, Adrien E.D. Groot, Natalie E. LeCouffe, Praneeta R. Konduri, Haryadi Prasetya, Nerea Arrarte- Terreros, Lucas A. Ramos, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, MUMC+: Hersen en Zenuw Centrum (3), RS: Carim - B05 Cerebral small vessel disease, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: Carim - B06 Imaging, Neurology, Public Health, Radiology & Nuclear Medicine, ​Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Damage and Repair in Cancer Development and Cancer Treatment (DARE), Radiology and Nuclear Medicine, ACS - Microcirculation, ANS - Neurovascular Disorders, ANS - Cellular & Molecular Mechanisms, and ACS - Atherosclerosis & ischemic syndromes

Subjects
Male, SELECTION, Original Contributions, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Cardiorespiratory Medicine and Haematology, registry, GUIDELINES, THERAPY, ANGIOGRAPHY, Brain Ischemia, law.invention, 0302 clinical medicine, Randomized controlled trial, Interquartile range, Modified Rankin Scale, law, 80 and over, Registries, 030212 general & internal medicine, ACUTE ISCHEMIC-STROKE, uncertainty, Stroke, ComputingMilieux_MISCELLANEOUS, Aged, 80 and over, Endovascular Procedures, Middle Aged, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], Outcome (probability), reperfusion, Treatment Outcome, thrombectomy, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, Cardiology and Cardiovascular Medicine, Rare cancers Radboud Institute for Health Sciences [Radboudumc 9], medicine.medical_specialty, Concordance, Clinical Trials and Supportive Activities, Clinical Sciences, Clinical and Population Sciences, 03 medical and health sciences, Clinical Research, medicine, ischemic stroke, Humans, Endovascular treatment, Aged, Advanced and Specialized Nursing, Neurology & Neurosurgery, business.industry, MECHANICAL THROMBECTOMY, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Neurosciences, medicine.disease, Brain Disorders, HERMES collaborators and MR CLEAN Registry Investigators, Emergency medicine, Observational study, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

Supplemental Digital Content is available in the text., Background and Purpose: Benefit 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. Methods: We 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. Results: We 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
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3. White matter lesions and outcomes after endovascular treatment for acute ischemic stroke MR CLEAN registry results

Author

Simone M. Uniken Venema, Alida A. Postma, Ido R. van den Wijngaard, Jan Albert Vos, Hester F. Lingsma, Reinoud P.H. Bokkers, Jeannette Hofmeijer, Diederik W.J. Dippel, Charles B. Majoie, H. Bart van der Worp, Aad van der Lugt, Yvo B.W.E.M. Roos, Robert J. van Oostenbrugge, Wim H. van Zwam, Jelis Boiten, Ivo G.H. Jansen, Maxim J.H.L. Mulder, Robert- Jan B. Goldhoorn, Kars C.J. Compagne, Manon Kappelhof, Josje Brouwer, Sanne J. den Hartog, Wouter H. Hinsenveld, Bob Roozenbeek, Adriaan C.G.M. van Es, Bart J. Emmer, Jonathan M. Coutinho, Wouter J. Schonewille, Marieke J.H. Wermer, Marianne A.A. van Walderveen, Julie Staals, Jasper M. Martens, Geert J. Lycklama à Nijeholt, Sebastiaan F. de Bruijn, Lukas C. van Dijk, Rob H. Lo, Ewoud J. van Dijk, Hieronymus D. Boogaarts, J. de Vries, Paul L.M. de Kort, Julia van Tuijl, Jo P. Peluso, Puck Fransen, Jan S.P. van den Berg, Boudewijn A.A.M. van Hasselt, Leo A.M. Aerden, René J. Dallinga, Maarten Uyttenboogaart, Omid Eschgi, Tobien H.C.M.L. Schreuder, Roel J.J. Heijboer, Koos Keizer, Lonneke S.F. Yo, Heleen M. den Hertog, Emiel J.C. Sturm, Paul J.A.M. Brouwers, Marieke E.S. Sprengers, Sjoerd F.M. Jenniskens, René van den Berg, Albert J. Yoo, Ludo F.M. Beenen, Stefan D. Roosendaal, Bas F.W. van der Kallen, Joost Bot, Pieter-Jan van Doormaal, Anton Meijer, Elyas Ghariq, Marc P. van Proosdij, G. Menno Krietemeijer, Rob Lo, Dick Gerrits, Wouter Dinkelaar, Auke P.A. Appelman, Bas Hammer, Sjoert Pegge, Anouk van der Hoorn, Saman Vinke, H. Zwenneke Flach, Naziha el Ghannouti, Martin Sterrenberg, Wilma Pellikaan, Rita Sprengers, Marjan Elfrink, Michelle Simons, Marjolein Vossers, Joke de Meris, Tamara Vermeulen, Annet Geerlings, Gina van Vemde, Tiny Simons, Gert Messchendorp, Nynke Nicolaij, Hester Bongenaar, Karin Bodde, Sandra Kleijn, Jasmijn Lodico, Hanneke Droste, Maureen Wollaert, Sabrina Verheesen, D. Jeurrissen, Erna Bos, Yvonne Drabbe, Michelle Sandiman, Nicoline Aaldering, Berber Zweedijk, Jocova Vervoort, Eva Ponjee, Sharon Romviel, Karin Kanselaar, Denn Barning, Esmee Venema, Vicky Chalos, Ralph R. Geuskens, Tim van Straaten, Saliha Ergezen, Roger R.M. Harmsma, Daan Muijres, Anouk de Jong, Olvert A. Berkhemer, Anna M.M. Boers, J. Huguet, P.F.C. Groot, Marieke A. Mens, Katinka R. van Kranendonk, Kilian M. Treurniet, Manon L. Tolhuisen, Heitor Alves, Annick J. Weterings, Eleonora L.F. Kirkels, Eva J.H.F. Voogd, Lieve M. Schupp, Sabine L. Collette, Adrien E.D. Groot, Natalie E. LeCouffe, Praneeta R. Konduri, Haryadi Prasetya, Nerea Arrarte-Terreros, Lucas A. Ramos, Radiology and Nuclear Medicine, ACS - Microcirculation, Amsterdam Neuroscience - Neurovascular Disorders, ACS - Atherosclerosis & ischemic syndromes, TechMed Centre, Clinical Neurophysiology, ​Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Damage and Repair in Cancer Development and Cancer Treatment (DARE), Neurology, Public Health, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, Beeldvorming, MUMC+: DA BV AIOS Nucleaire Geneeskunde (9), MUMC+: DA BV AIOS Radiologie (9), and MUMC+: DA BV Medisch Specialisten Radiologie (9)

Subjects
medicine.medical_treatment, Original Contributions, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], LEUKOARAIOSIS, Logistic regression, THERAPY, ANGIOGRAPHY, law.invention, Brain Ischemia, HEMORRHAGE, Randomized controlled trial, law, Modified Rankin Scale, odds ratio, Prospective Studies, ComputingMilieux_MISCELLANEOUS, Aged, 80 and over, Cerebral infarction, Endovascular Procedures, Thrombolysis, Middle Aged, THROMBECTOMY, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], White Matter, Stroke, COLLATERALS, AGREEMENT, Cardiology, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, cerebral small vessel diseases, Cardiology and Cardiovascular Medicine, Intracranial Hemorrhages, radiography, Cohort study, medicine.medical_specialty, acute ischemic stroke, FUTILE RECANALIZATION, SMALL-VESSEL DISEASE, Clinical and Population Sciences, Internal medicine, medicine, Humans, METAANALYSIS, Aged, Advanced and Specialized Nursing, business.industry, Other Research Radboud Institute for Health Sciences [Radboudumc 0], registries, Odds ratio, medicine.disease, Hyperintensity, Neurology (clinical), business
Abstract

Supplemental Digital Content is available in the text., Background: Cerebral white matter lesions (WMLs) have been associated with a greater risk of poor functional outcome after ischemic stroke. We assessed the relations between WML burden and radiological and clinical outcomes in patients treated with endovascular treatment in routine practice. Methods: We analyzed data from the MR CLEAN Registry (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischaemic Stroke in the Netherlands)—a prospective, multicenter, observational cohort study of patients treated with endovascular treatment in the Netherlands. WMLs were graded on baseline noncontrast computed tomography using a visual grading scale. The primary outcome was the score on the modified Rankin Scale at 90 days. Secondary outcomes included early neurological recovery, successful reperfusion (extended Thrombolysis in Cerebral Infarction ≥2b), futile recanalization (modified Rankin Scale score ≥3 despite successful reperfusion), and occurrence of symptomatic intracranial hemorrhage. We used multivariable logistic regression models to assess associations between WML severity and outcomes, taking the absence of WML on noncontrast computed tomography as the reference category. Results: Of 3180 patients included in the MR CLEAN Registry between March 2014 and November 2017, WMLs were graded for 3046 patients and categorized as none (n=1855; 61%), mild (n=608; 20%), or moderate to severe (n=588; 19%). Favorable outcome (modified Rankin Scale score, 0–2) was achieved in 838 patients (49%) without WML, 192 patients (34%) with mild WML, and 130 patients (24%) with moderate-to-severe WML. Increasing WML grades were associated with a shift toward poorer functional outcome in a dose-dependent manner (adjusted common odds ratio, 1.34 [95% CI, 1.13–1.60] for mild WML and 1.67 [95% CI, 1.39–2.01] for moderate-to-severe WML; Ptrend

Published
2021

4. Endovascular treatment in anterior circulation stroke beyond 6.5 hours after onset or time last seen well: results from the MR CLEAN Registry

Author

Robert J van Oostenbrugge, Wim H van Zwam, Maarten Uyttenboogaart, Yvo B W E M Roos, Jeannette Hofmeijer, Jasper M Martens, Ivo G H Jansen, Ludo F M Beenen, Hester F Lingsma, Albert J Yoo, Diederik W J Dippel, Charles B L M Majoie, Olvert A Berkhemer, Bart J Emmer, Marianne A A van Walderveen, Sjoerd F M Jenniskens, Wouter J Schonewille, Jan Albert Vos, Julie Staals, Geert J Lycklama à nijeholt, Jelis Boiten, Rob H Lo, Ewoud J Van Dijk, René J Dallinga, Koos Keizer, Heleen M Den Hertog, Katinka R van Kranendonk, Kilian M Treurniet, Esmee Venema, Bob Roozenbeek, Robin Lemmens, Robert-Jan B Goldhoorn, Ido R van den Wijngaard, Jonathan M Coutinho, Stefan D Roosendaal, Joost Bot, Naziha El Ghannouti, Martin Sterrenberg, Wilma Pellikaan, Rita Sprengers, Marjan Elfrink, Joke de Meris, Tamara Vermeulen, Annet Geerlings, Gina van Vemde, Tiny Simons, Gert Messchendorp, Hester Bongenaar, Karin Bodde, Sandra Kleijn, Jasmijn Lodico, D Jeurrissen, Erna Bos, Yvonne Drabbe, Berber Zweedijk, Daan Muijres, J Huguet, Marieke A Mens, Manon Kappelhof, Heitor Alves, Manon L Tolhuisen, Alida A Postma, Reinoud P H Bokkers, Maxim J H L Mulder, Kars C J Compagne, Josje Brouwer, Wouter H Hinsenveld, Marieke J H Wermer, J de Vries, Julia van Tuijl, Jo P Peluso, Puck Fransen, Leo A M Aerden, Omid Eschgi, Tobien H C M L Schreuder, Roel J J Heijboer, Lonneke S F Yo, Emiel J C Sturm, Paul J A M Brouwers, Marieke E S Sprengers, René van den Berg, Pieter-Jan van Doormaal, Anton Meijer, Elyas Ghariq, Dick Gerrits, Wouter Dinkelaar, Auke P A Appelman, Bas Hammer, Sjoert Pegge, Anouk van der Hoorn, Saman Vinke, Michelle Simons, Marjolein Vossers, Nynke Nicolaij, Hanneke Droste, Maureen Wollaert, Sabrina Verheesen, Michelle Sandiman, Nicoline Aaldering, Jocova Vervoort, Eva Ponjee, Sharon Romviel, Annick J Weterings, Lieve M Schupp, Sabine Collette, Natalie E LeCouffe, Praneeta R Konduri, Haryadi Prasetya, Nerea Arrarte-Terreros, Lucas A Ramos, C Lukas, Luuk Dekker, F Anne V Pirson, Adriaan C G M van Es, Sanne J den Hartog, Sebastiaan F de Bruijnl, H van Dijk, Bart van der Worp, D Boogaarts Hieronymus, Paul L M de Kort, Jan S P van den Berg, Boudewijn A A M van Hasselt, Bas F W van der Kallen, P Marc, G van Proosdij, Menno Krietemeijer, Roger R M Harmsma, M M Anna Boers, P F C Groot, Eleonora L F Kirkels, Eva J H F Voogd, Adrien E D Groot, Radiology and Nuclear Medicine, ACS - Microcirculation, ANS - Neurovascular Disorders, ACS - Atherosclerosis & ischemic syndromes, ANS - Cellular & Molecular Mechanisms, ANS - Compulsivity, Impulsivity & Attention, Neurology, Public Health, Klinische Neurowetenschappen, MUMC+: MA Niet Med Staf Neurologie (9), RS: Carim - B05 Cerebral small vessel disease, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), and RS: Carim - B06 Imaging

Subjects
medicine.medical_treatment, Perfusion scanning, GUIDELINES, lcsh:RC346-429, Brain Ischemia, EARLY MANAGEMENT, law.invention, 0302 clinical medicine, Randomized controlled trial, law, Modified Rankin Scale, Occlusion, Medicine, Prospective Studies, Registries, ACUTE ISCHEMIC-STROKE, 030212 general & internal medicine, Stroke, Original Research, Thrombectomy, OUTCOMES, medicine.diagnostic_test, Endovascular Procedures, Thrombolysis, THROMBECTOMY, Cardiology, INFARCTION, Cardiology and Cardiovascular Medicine, Life Sciences & Biomedicine, medicine.medical_specialty, Clinical Neurology, 03 medical and health sciences, Internal medicine, SCORE, Humans, lcsh:Neurology. Diseases of the nervous system, Ischemic Stroke, HEALTH-CARE PROFESSIONALS, Science & Technology, business.industry, Other Research Radboud Institute for Health Sciences [Radboudumc 0], CT ANGIOGRAPHY, medicine.disease, United States, Angiography, Propensity score matching, Neurosciences & Neurology, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

BackgroundRandomised controlled trials with perfusion selection have shown benefit of endovascular treatment (EVT) for ischaemic stroke between 6 and 24 hours after symptom onset or time last seen well. However, outcomes after EVT in these late window patients without perfusion imaging are largely unknown. We assessed their characteristics and outcomes in routine clinical practice.MethodsThe Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry, a prospective, multicentre study in the Netherlands, included patients with an anterior circulation occlusion who underwent EVT between 2014 and 2017. CT perfusion was no standard imaging modality. We used adjusted ordinal logistic regression analysis to compare patients treated within versus beyond 6.5 hours after propensity score matching on age, prestroke modified Rankin Scale (mRS), National Institutes of Health Stroke Scale, Alberta Stroke Programme Early CT Score (ASPECTS), collateral status, location of occlusion and treatment with intravenous thrombolysis. Outcomes included 3-month mRS score, functional independence (defined as mRS 0–2), and death.ResultsOf 3264 patients who underwent EVT, 106 (3.2%) were treated beyond 6.5 hours (median 8.5, IQR 6.9–10.6), of whom 93 (87.7%) had unknown time of stroke onset. CT perfusion was not performed in 87/106 (80.2%) late window patients. Late window patients were younger (mean 67 vs 70 years, pConclusionsWithout the use of CT perfusion selection criteria, EVT in the 6.5–24-hour time window was not associated with poorer outcome in selected patients with favourable clinical and CT/CT angiography characteristics. randomised controlled trials with lenient inclusion criteria are needed to identify more patients who can benefit from EVT in the late window.

Published
2021

5. Importance of Occlusion Site for Thrombectomy Technique in Stroke: Comparison Between Aspiration and Stent Retriever

Author

Marie Louise E. Bernsen, Robert-Jan B. Goldhoorn, Hester F. Lingsma, Robert J. van Oostenbrugge, Wim H. van Zwam, Maarten Uyttenboogaart, Yvo B.W.E.M. Roos, Jasper M. Martens, Jeannette Hofmeijer, Diederik W.J. Dippel, Aad van der Lugt, Charles B.L.M. Majoie, Jelis Boiten, Jan Albert Vos, Ivo G.H. Jansen, Maxim J.H.L. Mulder, Robert- Jan B. Goldhoorn, Kars C.J. Compagne, Manon Kappelhof, Josje Brouwer, Sanne J. den Hartog, Wouter H. Hinsenveld, Bob Roozenbeek, Adriaan C.G.M. van Es, Bart J. Emmer, Jonathan M. Coutinho, Wouter J. Schonewille, Marieke J.H. Wermer, Marianne A.A. van Walderveen, Julie Staals, Geert J. Lycklama, à Nijeholt, Sebastiaan F. de Bruijn, Lukas C. van Dijk, H. Bart van der Worp, Rob H. Lo, Ewoud J. van Dijk, Hieronymus D. Boogaarts, J. de Vries, Paul L.M. de Kort, Julia van Tuijl, Jo P. Peluso, Puck Fransen, Jan S.P. van den Berg, Boudewijn A.A.M. van Hasselt, Leo A.M. Aerden, René J. Dallinga, Omid Eschgi, Reinoud P.H. Bokkers, Tobien H.C.M.L. Schreuder, Roel J.J. Heijboer, Koos Keizer, Lonneke S.F. Yo, Heleen M. den Hertog, Tomas Bulut, Paul J.A.M. Brouwers, Marieke E.S. Sprengers, Sjoerd F.M. Jenniskens, René van den Berg, Albert J. Yoo, Ludo F.M. Beenen, Alida A. Postma, Stefan D. Roosendaal, Bas F.W. van der Kallen, Ido R. van den Wijngaard, Joost Bot, Pieter-Jan van Doormaal, Anton Meijer, Elyas Ghariq, Marc P. van Proosdij, G. Menno Krietemeijer, Rob Lo, Dick Gerrits, Wouter Dinkelaar, Auke P.A. Appelman, Bas Hammer, Sjoert Pegge, Anouk van der Hoorn, Saman Vinke, H. Zwenneke Flach, Naziha el Ghannouti, Martin Sterrenberg, Wilma Pellikaan, Rita Sprengers, Marjan Elfrink, Michelle Simons, Marjolein Vossers, Joke de Meris, Tamara Vermeulen, Annet Geerlings, Gina van Vemde, Tiny Simons, Gert Messchendorp, Nynke Nicolaij, Hester Bongenaar, Karin Bodde, Sandra Kleijn, Jasmijn Lodico, Hanneke Droste, Maureen Wollaert, Sabrina Verheesen, D. Jeurrissen, Erna Bos, Yvonne Drabbe, Michelle Sandiman, Nicoline Aaldering, Berber Zweedijk, Jocova Vervoort, Eva Ponjee, Sharon Romviel, Karin Kanselaar, Denn Barning, Esmee Venema, Vicky Chalos, Ralph R. Geuskens, Tim van Straaten, Saliha Ergezen, Roger R.M. Harmsma, Daan Muijres, Anouk de Jong, Olvert A. Berkhemer, Anna M.M. Boers, J. Huguet, P.F.C. Groot, Marieke A. Mens, Katinka R. van Kranendonk, Kilian M. Treurniet, Manon L. Tolhuisen, Heitor Alves, Annick J. Weterings, Eleonora L.F. Kirkels, Eva J.H.F. Voogd, Lieve M. Schupp, Sabine L. Collette, Adrien E.D. Groot, Natalie E. LeCouffe, Praneeta R. Konduri, Haryadi Prasetya, Nerea Arrarte-Terreros, Lucas A. Ramos, ​Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Damage and Repair in Cancer Development and Cancer Treatment (DARE), MUMC+: MA AIOS Neurologie (9), Klinische Neurowetenschappen, RS: Carim - B05 Cerebral small vessel disease, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, MUMC+: MA Neurologie (3), MUMC+: Hersen en Zenuw Centrum (3), Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: Carim - B06 Imaging, Clinical Neurophysiology, TechMed Centre, Public Health, Neurology, ACS - Atherosclerosis & ischemic syndromes, ANS - Neurovascular Disorders, ACS - Microcirculation, ACS - Pulmonary hypertension & thrombosis, Graduate School, and Radiology and Nuclear Medicine

Subjects
Male, medicine.medical_treatment, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], M2 SEGMENT, 030218 nuclear medicine & medical imaging, 0302 clinical medicine, carotid arteries, CONTACT ASPIRATION, Occlusion, ACUTE ISCHEMIC-STROKE, Stroke, Acute ischemic stroke, Netherlands, Aged, 80 and over, endovascular procedure, LARGE VESSEL OCCLUSION, Endovascular Procedures, Middle Aged, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], stroke, reperfusion, Treatment Outcome, thrombectomy, Middle cerebral artery, Female, Internal carotid artery, ADAPT, Cardiology and Cardiovascular Medicine, INTERNAL CAROTID-ARTERY, Rare cancers Radboud Institute for Health Sciences [Radboudumc 9], medicine.medical_specialty, 03 medical and health sciences, medicine.artery, MIDDLE CEREBRAL-ARTERY, medicine, Humans, Endovascular treatment, Stent retriever, Aged, Advanced and Specialized Nursing, middle cerebral artery, business.industry, MECHANICAL THROMBECTOMY, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Stent, medicine.disease, RANDOMIZED-TRIAL, Surgery, ENDOVASCULAR TREATMENT, stent, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

Background and Purpose: Thrombectomy with stent retriever and direct aspiration are equally effective in the endovascular treatment of anterior circulation acute ischemic stroke. We report efficacy and safety of initial treatment technique per occlusion segment. Methods: For this study, we analyzed data from the MR CLEAN Registry, a prospective, observational study in all centers that perform endovascular therapy in the Netherlands. We used ordinal logistic regression analysis to compare clinical and technical results of first line direct aspiration treatment with that of stent retriever thrombectomy stratified for occlusion segment. Primary outcome measure was functional outcome at 3 months. Secondary outcome measures included reperfusion grade expressed as the extended Thrombolysis in Cerebral Infarction score, periprocedural complication risk, time to reperfusion, and mortality. Results: Of the 2282 included patients, 1658 (73%) were initially treated with stent retriever and 624 (27%) with aspiration. Four hundred sixty-two patients had an occlusion of the intracranial part of the carotid artery, 1349 of the proximal middle cerebral artery, and 471 of the distal parts of the middle cerebral artery. There was no difference in functional outcome between aspiration and stent retriever thrombectomy (odds ratio, 1.0 [95% CI, 0.9–1.2]) in any of the occlusion segments ( P value for interaction=0.2). Reperfusion rate was higher in the aspiration group (odds ratio, 1.4 [95% CI, 1.1–1.6]) and did not differ between occlusion segments ( P value for interaction=0.6). Procedure times were shorter in the aspiration group (minutes 50 versus 65 minutes; P Conclusions: In unselected patients with anterior circulation infarcts, we observed equal functional outcome of aspiration and stent retriever thrombectomy in all occlusion segments. When aspiration was the first line treatment modality, reperfusion rates were higher and procedure times shorter in all occlusion segments.

Published
2021

6. Path from clinical research to implementation endovascular treatment of ischemic stroke in the Netherlands

Author

Eveline J.A. Wiegers, Kars C.J. Compagne, Paula M. Janssen, Esmee Venema, Jaap W. Deckers, Wouter J. Schonewille, Jan Albert Vos, Geert J. Lycklama à Nijeholt, Bob Roozenbeek, Jasper M. Martens, Jeannette Hofmeijer, Robert-Jan van Oostenbrugge, Wim H. van Zwam, Charles B.L.M. Majoie, Aad van der Lugt, H.F. Lingsma, Yvo B.W.E.M. Roos, Diederik W.J. Dippel, Jelis Boiten, Josje Brouwer, Sanne J. den Hartog, Wouter H. Hinsenveld, Manon Kappelhof, Robert-Jan B. Goldhoorn, Maxim J.H.L. Mulder, Ivo G.H. Jansen, Adriaan C.G.M. van Es, Bart J. Emmer, Jonathan M. Coutinho, Marieke J.H. Wermer, Marianne A.A. van Walderveen, Julie Staals, Sebastiaan F. de Bruijn, Lukas C. van Dijk, H. Bart van der Worp, Rob H. Lo, Ewoud J. van Dijk, Hieronymus D. Boogaarts, J. de Vries, Paul L.M. de Kort, Julia van Tuijl, Jo Jo P. Peluso, Puck Fransen, Jan S.P. van den Berg, Boudewijn A.A.M. van Hasselt, Leo A.M. Aerden, René J. Dallinga, Maarten Uyttenboogaart, Omid Eschgi, Reinoud P.H. Bokkers, Tobien H.C.M.L. Schreuder, Roel J.J. Heijboer, Koos Keizer, Lonneke S.F. Yo, Heleen M. den Hertog, Emiel J.C. Sturm, Paul Brouwers, Marieke E.S. Sprengers, Sjoerd F.M. Jenniskens, René van den Berg, Albert J. Yoo, Ludo F.M. Beenen, Alida A. Postma, Stefan D. Roosendaal, Bas F.W. van der Kallen, Ido R. van den Wijngaard, Joost Bot, Pieter-Jan van Doormaal, Anton Meijer, Elyas Ghariq, Marc P. van Proosdij, G. Menno Krietemeijer, Jo P. Peluso, Rob Lo, Dick Gerrits, Wouter Dinkelaar, Auke P.A. Appelman, Bas Hammer, Sjoert Pegge, Anouk van der Hoorn, Saman Vinke, H. Zwenneke Flach, Naziha el Ghannouti, Martin Sterrenberg, Corina Puppels, Wilma Pellikaan, Rita Sprengers, Marjan Elfrink, Michelle Simons, Marjolein Vossers, Joke de Meris, Tamara Vermeulen, Annet Geerlings, Gina van Vemde, Tiny Simons, Cathelijn van Rijswijk, Gert Messchendorp, Nynke Nicolaij, Hester Bongenaar, Karin Bodde, Sandra Kleijn, Jasmijn Lodico, Hanneke Droste, Maureen Wollaert, Sabrina Verheesen, D. Jeurrissen, Erna Bos, Yvonne Drabbe, Michelle Sandiman, Nicoline Aaldering, Berber Zweedijk, Mostafa Khalilzada, Jocova Vervoort, Eva Ponjee, Sharon Romviel, Karin Kanselaar, Denn Barning, Vicky Chalos, Ralph R. Geuskens, Tim van Straaten, Saliha Ergezen, Roger R.M. Harmsma, Daan Muijres, Anouk de Jong, Olvert A. Berkhemer, Anna M.M. Boers, J. Huguet, P.F.C. Groot, Marieke A. Mens, Katinka R. van Kranendonk, Kilian M. Treurniet, Manon L. Tolhuisen, Heitor Alves, Annick J. Weterings, Eleonora L.F. Kirkels, Eva J.H.F. Voogd, Lieve M. Schupp, Sabine Collette, Adrien E.D. Groot, Natalie E. LeCouffe, Praneeta R. Konduri, Haryadi Prasetya, Nerea Arrarte-Terreros, Lucas A. Ramos, Damage and Repair in Cancer Development and Cancer Treatment (DARE), ​Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Clinical Neurophysiology, Radiology and Nuclear Medicine, ACS - Microcirculation, Amsterdam Neuroscience - Neurovascular Disorders, Neurology, ACS - Atherosclerosis & ischemic syndromes, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, MUMC+: Hersen en Zenuw Centrum (3), RS: Carim - B05 Cerebral small vessel disease, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: Carim - B06 Imaging, Public Health, Radiology & Nuclear Medicine, and Cardiology

Subjects
Male, SELECTION, medicine.medical_specialty, MEDLINE, ischemia, Rate ratio, THERAPY, symbols.namesake, NUMBER, medicine, Humans, Registries, Poisson regression, Endovascular treatment, Stroke, Aged, Netherlands, Aged, 80 and over, Advanced and Specialized Nursing, implementation science, business.industry, Patient Selection, Standard treatment, MECHANICAL THROMBECTOMY, Endovascular Procedures, Other Research Radboud Institute for Health Sciences [Radboudumc 0], 22/2 OA procedure, Middle Aged, medicine.disease, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], stroke, brain ischemia, Clinical trial, Treatment Outcome, Clinical research, INTRAVENOUS T-PA, thrombectomy, Emergency medicine, ONSET, symbols, Female, TRIAL, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Rare cancers Radboud Institute for Health Sciences [Radboudumc 9]
Abstract

Contains fulltext : 220823.pdf (Publisher’s version ) (Closed access) Before 2015, endovascular treatment (EVT) for acute ischemic stroke was considered a promising treatment option. Based on limited evidence, it was performed in several dedicated stroke centers worldwide on selected patients. Since 2015, EVT for patients with intracranial large vessel occlusion has quickly been implemented as standard treatment in many countries worldwide, supported by the revised international guidelines based on solid evidence from multiple clinical trials. We describe the development in use of EVT in the Netherlands before, during, and after the pivotal EVT trials. We used data from all patients who were treated with EVT in the Netherlands from January 2002 until December 2018. We undertook a time-series analysis to examine trends in the use of EVT using Poisson regression analysis. Incidence rate ratios per year with 95% CIs were obtained to demonstrate the impact and implementation after the publication of the EVT trial results. We made regional observation plots, adjusted for stroke incidence, to assess the availability and use of the treatment in the country. In the buildup to the MR CLEAN (Multicenter Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands), a slow increase of EVT patients was observed, with 0.2% of all ischemic stroke patients receiving EVT. Before the trial results were formally announced, a statistically significant increase in EVT-treated patients per year was observed (incidence rate ratio, 1.72 [95% CI, 1.46-2.04]), and after the trial publication, an immediate steep increase was seen, followed by a more gradual increase (incidence rate ratio, 2.14 [95% CI, 1.77-2.59]). In 2018, the percentage of ischemic stroke patients receiving EVT increased to 5.8%. A well-developed infrastructure, a pragmatic approach toward the use of EVT in clinical practice, in combination with a strict adherence by the regulatory authorities to national evidence-based guidelines has led to successful implementation of EVT in the Netherlands. Ongoing efforts are directed at further increasing the proportion of stroke patients with EVT in all regions of the country.

Published
2020

7. Abstract TMP2: Reduction of Time to Endovascular Treatment and Improved Outcomes After Ischemic Stroke in Routine Clinical Practice: Comparison of the MR CLEAN Registry First and Second Cohorts

Author

Boudewijn A.A.M. van Hasselt, Kars C.J. Compagne, Marianne A. A. van Walderveen, Maarten Uyttenboogaart, Diederik W.J. Dippel, Wouter J. Schonewille, Emiel J Sturm, Heleen M. den Hertog, Jelis Boiten, Reinoud P H Bokkers, Hieronymus D. Boogaarts, Manon Kappelhof, Jeannette Hofmeijer, Rob T.H. Lo, Robert J. van Oostenbrugge, Aad van der Lugt, Paul L.M. de Kort, Sebastiaan F.T.M. de Bruijn, Geert J. Lycklama à Nijeholt, Jasper M. Martens, Lukas C. van Dijk, Charles B. L. M. Majoie, Marieke J.H. Wermer, Robert-Jan B. Goldhoorn, Julia H. van Tuijl, Bart van der Worp, P. J. A. M. Brouwers, J.P. Peluso, Ewoud J. van Dijk, Jan Albert Vos, Wim H. van Zwam, Yvo B.W.E.M. Roos, Dick Gerrits, and Puck S.S. Fransen

Subjects
Advanced and Specialized Nursing, medicine.medical_specialty, business.industry, medicine.medical_treatment, Time to treatment, Infarction, medicine.disease, Emergency medicine, Ischemic stroke, medicine, Routine clinical practice, Neurology (clinical), Endovascular treatment, Cardiology and Cardiovascular Medicine, business, Stroke, Acute ischemic stroke, Reduction (orthopedic surgery)
Abstract

Introduction: Outcomes after endovascular treatment (EVT) for acute ischemic stroke are highly time dependent, but whether active reduction of time to treatment leads to better outcome has not been demonstrated. We compared data of the two subsequent MR CLEAN Registry cohorts, comprising all patients in the Netherlands who had EVT for acute ischemic stroke from 2014-2017, for a trend in time to treatment and its association with outcome. Methods: We compared workflow, successful reperfusion (eTICI 2B-3), NIHSS at 24h, functional outcome (mRS) at 90 days, occurrence of symptomatic intracranial hemorrhage (sICH) and mortality in patients with ischemic stroke and a proximal intracranial occlusion in the anterior circulation included in the second cohort of the Registry (June 2016-November 2017; n = 1779) to those in patients included in the first cohort (March 2014-June 2016; n = 1526) using logistic regression. Results: Baseline NIHSS was 16 in both cohorts. Times from onset-to-groin and onset-to-reperfusion were shorter in the second cohort than in the first (185 versus 210 minutes; p Discussion: Our data show that outcomes after EVT in routine clinical practice are improving, likely attributable to improved workflow and experience.

Published
2020
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8. Clinical significance of mesenteric arterial collateral circulation in patients with celiac artery compression syndrome

Author

Marco J. Bruno, Adriaan Moelker, Clark J. Zeebregts, Juliette T.M. Blauw, A.S. van Petersen, André S. van Petersen, J.J. Kolkman, L.J.D. van Dijk, Hence J.M. Verhagen, Dick Gerrits, Robert H. Geelkerken, Job van der Palen, Olaf J. Bakker, Maikel P. Peppelenbosch, Jeroen J. Kolkman, Man, Biomaterials and Microbes (MBM), Vascular Ageing Programme (VAP), Rehabilitation medicine, Gastroenterology & Hepatology, Radiology & Nuclear Medicine, and Surgery

Subjects
Male, Abdominal pain, Time Factors, OCCLUSION, Databases, Factual, medicine.medical_treatment, Constriction, Pathologic, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, 0302 clinical medicine, Median Arcuate Ligament Syndrome, Celiac Artery, Celiac artery, CRITERIA, Splanchnic Circulation, Netherlands, Ultrasonography, Doppler, Duplex, GASTRIC EXERCISE TONOMETRY, medicine.diagnostic_test, Middle Aged, Collateral circulation, Mesenteric Arteries, ISCHEMIA, Treatment Outcome, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Cardiology, Female, Radiology, medicine.symptom, Cardiology and Cardiovascular Medicine, Median arcuate ligament syndrome, Artery, Adult, medicine.medical_specialty, Adolescent, Collateral Circulation, STENOSIS, Young Adult, 03 medical and health sciences, Angioplasty, medicine.artery, Internal medicine, MANAGEMENT, medicine, Humans, Aged, Retrospective Studies, business.industry, Angiography, Digital Subtraction, medicine.disease, n/a OA procedure, Abdominal Pain, Mesenteric ischemia, Angiography, ADAPTATIONS, RAT, Surgery, business, Angioplasty, Balloon
Abstract

Objective: Although extensive collateral arterial circulation will prevent ischemia in most patients with stenosis of a single mesenteric artery, mesenteric ischemia may occur in these patients, for example, in patients with celiac artery compression syndrome (CACS). Variation in the extent of collateral circulation may explain the difference in clinical symptoms and variability in response to therapy; however, evidence is lacking. The objective of the study was to classify the presence of mesenteric arterial collateral circulation in patients with CACS and to evaluate the relation with clinical improvement after treatment.Methods: Collateral mesenteric circulation was classified on the basis of angiographic findings. Collaterals were categorized in three groups: no visible collaterals (grade 0), collaterals seen on selective angiography only (grade 1), and collaterals visible on nonselective angiography (grade 2). Surgical release of the celiac artery in patients with suspected CACS was performed by arcuate ligament release. Clinical success after surgical revascularization was defined as an improvement in abdominal pain.Results: Between 2002 and 2013, there were 135 consecutive patients with suspected CACS who were operated on. In 129 patients, preoperative angiograms allowed classification of collateral circulation. Primary assisted anatomic success was 93% (120/129). In patients with grade 0 collaterals, clinical success was 81% (39 of 48 patients); with grade 1 collaterals, 89% (25 of 28 patients); and with grade 2 collaterals, 52% (23 of 44 patients; P Conclusions: Patients with CACS and with extensive collateral mesenteric arterial circulation are less likely to benefit from arcuate ligament release than are patients without this type of collateral circulation. The classification of the extent of mesenteric collateral circulation may predict and guide shared decision-making in patients with CACS.

Published
2017
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9. Endovascular Treatment of Chronic Splanchnic Syndrome

Author

Peter Mensink, J.L van Wanroij, Robert H. Geelkerken, Ad B. Huisman, Jeroen J. Kolkman, Dick Gerrits, and A.S. van Petersen

Subjects
Male, medicine.medical_specialty, Percutaneous, medicine.medical_treatment, Arterial Occlusive Diseases, Revascularization, Celiac Artery, Mesenteric Artery, Superior, medicine.artery, Medicine, Humans, Medical history, Endovascular treatment, Superior mesenteric artery, Splanchnic Circulation, Gastric tonometry, Aged, Retrospective Studies, Aged, 80 and over, Medicine(all), medicine.diagnostic_test, business.industry, Balloon expandable stent, Syndrome, medicine.disease, Atherosclerosis, Chronic splanchnic syndrome, Surgery, Mesenteric ischemia, surgical procedures, operative, Angiography, Chronic Disease, Female, Stents, Radiology, business, Splanchnic, Cardiology and Cardiovascular Medicine, Angioplasty, Balloon
Abstract

Objective. The technical and clinical outcome of endovascular revascularization was analyzed in patients with suspicion of chronic splanchnic syndrome (CSS). Methods. Medical history, duplex, angiography and exercise gastric tonometry suggested CSS in 97 patients. Twenty-seven of them were treated endovascular (one patient had 3-vessel, 12 patients had 2-vessels, 14 patients had 1-vessel CSS). Five patients received previous splanchnic revascularization. Twenty-three patients (85%) had severe co-morbidity: cardiac, pulmonary or cachexia. Endovascular treatment consisted of percutaneous transluminal angiography (PTA) of the coeliac artery (CA) or superior mesenteric artery (SMA) in three and primary balloon expandable stenting in 24 patients (13 CA and 10 SMA solitary, two CA and SMA both, 31 splanchnic arteries in total). Results. Three patients showed procedure related complications (11%). Mean follow-up was 19, range 2–76 months. Two patients died during follow up, both not procedure or CSS related. Five patients had no improvement of symptoms, without evidence of re- or residual stenosis. The primary clinical success was 67%, secondary clinical success was 81%. The primary patency was 81% and secondary patency was 100%. Conclusion. Endovascular treatment of CSS has a reasonable outcome. It is an alternative to operative treatment, especially in patients with high co-morbidity or limited life expectancy.

Published
2004
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10. Retrograde open mesenteric stenting for acute mesenteric ischemia

Author

Marjolein Brusse-Keizer, Jeroen J. Kolkman, Dick Gerrits, Robert H. Geelkerken, R. Meerwaldt, and Juliette T.M. Blauw

Subjects
Male, Reoperation, medicine.medical_specialty, Percutaneous, Time Factors, medicine.medical_treatment, Ischemia, Constriction, Pathologic, Revascularization, Severity of Illness Index, Postoperative Complications, Mesenteric Artery, Superior, medicine.artery, Internal medicine, Mesenteric Vascular Occlusion, medicine, Vascular Patency, Humans, Superior mesenteric artery, Registries, Vascular Diseases, Mesenteric arteries, Aged, Netherlands, Retrospective Studies, business.industry, Endovascular Procedures, Bowel resection, Middle Aged, medicine.disease, Surgery, Radiography, medicine.anatomical_structure, Treatment Outcome, Mesenteric ischemia, Mesenteric Ischemia, Cardiology, Female, Stents, Emergencies, business, Cardiology and Cardiovascular Medicine
Abstract

Objective Acute mesenteric ischemia (AMI) encompasses the sequels of end-stage untreated chronic mesenteric ischemia and acute mesenteric artery thrombosis. Percutaneous mesenteric artery stenting (PMAS) is the preferred treatment of patients with AMI but is not always feasible. Retrograde open mesenteric stenting (ROMS) is a hybrid technique that combines the advantages of open surgical and endovascular approaches. The literature on the results of this new technique is scarce. The aim of this study was to evaluate the results of ROMS in a consecutive series of patients with AMI. Methods All patients with emergent mesenteric revascularization for AMI between January 2007 and September 2011 were entered in our prospective registry. Technical success, mortality, patency, clinical success, and complication rate at 30 days and 6 and 12 months were assessed. Results Sixty-eight patients presented with AMI and 54 underwent PMAS, of which four were unsuccessful and followed by ROMS. Eleven patients were directly treated with ROMS, making a total of 15 patients (10 women and five men; median age, 66 years [interquartile range, 54-73 years]). In all patients, only the superior mesenteric artery was revascularized. In nine of the 15 patients, all three mesenteric arteries were severely stenotic or occluded. Technical success was achieved in 14 patients. At ROMS in two patients, the small bowel was severely ischemic. One of these patients needed a partial bowel resection because of irreversible transmural ischemia. At 30 days, the mortality rate was 20% and the primary patency was 92%. Ten patients underwent unplanned relaparotomy, of whom one needed resection of a large part of the small bowel. At 12 months, the mortality rate was still 20%. The primary patency was 83%. Primary assisted patency was 91%, and secondary patency was 100%. Clinical success at 30 days, 6 months, and 12 months, respectively, was 73%, 67%, and 67%. Conclusions AMI is still a devastating event. If PMAS is not feasible, ROMS is a reliable alternative and is associated with a relatively low mortality and morbidity rate.

Published
2013

11. Superior Two-year Results of Externally Unsupported Polyester Compared to Supported Grafts in Above-knee Bypass Grafting: A Multicenter Randomised Trial

Author

van der Jacobus Palen, Robert H. Geelkerken, R.J. van Det, Dick Gerrits, Clark J. Zeebregts, Bianca H.R. Vriens, R. Meerwaldt, Faculty of Behavioural, Management and Social Sciences, Man, Biomaterials and Microbes (MBM), and Vascular Ageing Programme (VAP)

Subjects
DACRON, Adult, Male, Duplex ultrasonography, medicine.medical_specialty, Bypass grafting, Polyesters, Externally supported prothesis, Physical examination, Bypass grafts, Blood Vessel Prosthesis Implantation, Peripheral arterial occlusive disease, Risk Factors, Thin wall, FEMOROPOPLITEAL BYPASS, POLYTETRAFLUOROETHYLENE, Medicine, Humans, Knee, Popliteal Artery, cardiovascular diseases, Prospective Studies, Aged, Medicine(all), Aged, 80 and over, medicine.diagnostic_test, business.industry, Mortality rate, VEIN, Middle Aged, Femoro-popliteal bypass, Fluoropolymer coated polyester, Surgery, Blood Vessel Prosthesis, Clinical trial, Femoral Artery, Treatment Outcome, EXS, Peripheral bypass, Female, medicine.symptom, Externally supported prosthesis, PTFE, business, Claudication, Cardiology and Cardiovascular Medicine, Follow-Up Studies
Abstract

Objectives: The aim of this study was to compare externally supported thin wall knitted polyester (P-EXS) and externally unsupported thin wall knitted polyester (P-non-EXS) for above-knee (AK) femoro-popliteal bypass grafting.Design: A prospective multicenter randomised clinical trial.Material and methods: Between 1999 and 2008, 265 AK femoro-popliteal bypass grafts (6 mm in diameter) were performed, including 136 P-EXS and 129 P-non-EXS. The selection of patients was based on the presence of disabling claudication or critical ischaemia. Follow-up took place at 3, 6, 12, 18, and 24 months and included clinical examination and duplex ultrasonography. The main end points of this study were primary patency rates at one and two years. Secondary end points were mortality, and primary assisted and secondary patency rates. Cumulative patency rates were calculated with life-table analysis and log-rank testing.Results: The 1-year primary, primary assisted and secondary patency rates were 65%, 70% and 84%, respectively, for P-EXS and 76% (p = 0.05), 82% (p = 0.03) and 88% (p = 0.35), respectively, for P-non-EXS. Two-year primary, primary assisted and secondary patency rates were 45%, 57% and 70%, respectively, for P-EXS and 62% (p = 0.003), 75% (p = 0.005) and 84% (p = 0.02), respectively, for P-non-EXS. The overall mortality rate after two years was 11.3%.Conclusion: In above-knee femoro-popliteal bypass grafting patency rates of externally supported knitted polyester grafts were inferior to their unsupported counterpart. ISRCTN: At the time this study started this number was not the standard. (C) 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Published
2013

12. Sa1948 Right-Sided Ischemic Colitis Has a Different Clinical Presentation and Outcome Compared to Left-Sided Ischemic Colitis; a Single Center Study Over a 10 Year Period

Author

A. Bijlsma, Jeroen J. Kolkman, Robert H. Geelkerken, Dick Gerrits, and Lotte B. ten Heggeler

Subjects
medicine.medical_specialty, Hepatology, business.industry, Gastroenterology, medicine, Presentation (obstetrics), Right-Sided, medicine.disease, Single Center, business, Left sided, Ischemic colitis, Surgery
Published
2012
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