Author: "Dick Gerrits" - Searchworks@Jio Institute Digital Library Search Results

Your search keyword '"Dick Gerrits"' showing total 20 results

Start Over Author "Dick Gerrits"

20 results on '"Dick Gerrits"'

1. Association of Ischemic Core Imaging Biomarkers With Post-Thrombectomy Clinical Outcomes in the MR CLEAN Registry

Author: Miou S. Koopman, Jan W. Hoving, Manon Kappelhof, Olvert A. Berkhemer, Ludo F. M. Beenen, Wim H. van Zwam, Hugo W. A. M. de Jong, Jan Willem Dankbaar, Diederik W. J. Dippel, Jonathan M. Coutinho, Henk A. Marquering, Bart J. Emmer, Charles B. L. M. Majoie, for the MR CLEAN Registry Investigators, Aad van der Lugt, Yvo B. W. E. M. Roos, Robert J. van Oostenbrugge, Jelis Boiten, Jan Albert Vos, Ivo G. H. Jansen, Maxim J. H. L. Mulder, Robert-Jan B. Goldhoorn, Kars C. J. Compagne, Josje Brouwer, Sanne J. den Hartog, Wouter H. Hinsenveld, Bob Roozenbeek, Adriaan C. G. M. van Es, Wouter J. Schonewille, Marieke J. H. Wermer, Marianne A. A. van Walderveen, Julie Staals, 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, 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, Reinoud P. H. Bokkers, 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, 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, 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, Lieve M. Schupp, Eva J. H. F. Voogd, Sabine Collette, Adrien E. D. Groot, Natalie E. LeCouffe, Praneeta R. Konduri, Haryadi Prasetya, Nerea Arrarte- Terreros, and Lucas A. Ramos
Subjects: CT perfusion (CTP), ischemic core, thrombectomy, stroke, alberta stroke program early CT score (ASPECTS), collaterals, Neurology. Diseases of the nervous system, RC346-429
Abstract: Background: A considerable proportion of acute ischemic stroke patients treated with endovascular thrombectomy (EVT) are dead or severely disabled at 3 months despite successful reperfusion. Ischemic core imaging biomarkers may help to identify patients who are more likely to have a poor outcome after endovascular thrombectomy (EVT) despite successful reperfusion. We studied the association of CT perfusion-(CTP), CT angiography-(CTA), and non-contrast CT-(NCCT) based imaging markers with poor outcome in patients who underwent EVT in daily clinical practice.Methods: We included EVT-treated patients (July 2016–November 2017) with an anterior circulation occlusion from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry with available baseline CTP, CTA, and NCCT. We used multivariable binary and ordinal logistic regression to analyze the association of CTP ischemic core volume, CTA-Collateral Score (CTA-CS), and Alberta Stroke Program Early CT Score (ASPECTS) with poor outcome (modified Rankin Scale score (mRS) 5-6) and likelihood of having a lower score on the mRS at 90 days.Results: In 201 patients, median core volume was 13 (IQR 5-41) mL. Median ASPECTS was 9 (IQR 8-10). Most patients had grade 2 (83/201; 42%) or grade 3 (28/201; 14%) collaterals. CTP ischemic core volume was associated with poor outcome [aOR per 10 mL 1.02 (95%CI 1.01–1.04)] and lower likelihood of having a lower score on the mRS at 90 days [aOR per 10 mL 0.85 (95% CI 0.78–0.93)]. In multivariable analysis, neither CTA-CS nor ASPECTS were significantly associated with poor outcome or the likelihood of having a lower mRS.Conclusion: In our population of patients treated with EVT in daily clinical practice, CTP ischemic core volume is associated with poor outcome and lower likelihood of shift toward better outcome in contrast to either CTA-CS or ASPECTS.
Published: 2022
Full Text: View/download PDF

2. 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, and Adrien E D Groot
Subjects: Neurology. Diseases of the nervous system, RC346-429
Abstract: Background Randomised 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.Methods The 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.Results Of 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, p
Full Text: View/download PDF

3. Prehospital transdermal glyceryl trinitrate in patients with presumed acute stroke (MR ASAP)

Author: Sophie A van den Berg, Simone M Uniken Venema, Hendrik Reinink, Jeannette Hofmeijer, Wouter J Schonewille, Irene Miedema, Puck S S Fransen, D Martijn O Pruissen, Theodora W M Raaijmakers, Gert W van Dijk, Frank-Erik de Leeuw, Jorine A van Vliet, Vincent I H Kwa, Henk Kerkhoff, Alex van 't Net, Rene Boomars, Arjen Siegers, Tycho Lok, Klaartje Caminada, Laura M Esteve Cuevas, Marieke C Visser, Casper P Zwetsloot, Jooske M F Boomsma, Mirjam H Schipper, Roeland P J van Eijkelenburg, Olvert A Berkhemer, Daan Nieboer, Hester F Lingsma, Bart J Emmer, Robert J van Oostenbrugge, Aad van der Lugt, Yvo B W E M Roos, Charles B L M Majoie, Diederik W J Dippel, Paul J Nederkoorn, H Bart van der Worp, Ayla van Ahee, Frank Visseren, Patricia Halkes, Ruben van Eijk, Michelle Simons, Wilma Pellikaan, Wilma Van Wijngaarden, Eva Ponjee, Petra Geijtenbeek, Ton Arts, Elles Zock, Wilma Oudshoorn, Frans Steenwinkel, Hamdia Samim, Mark van Zandwijk, Lisette Vrielink, Peter Jan Mulder, Aico Gerritsen, Jim Ijzermans, Marjan Kooijman, Oscar Francissen, Rick van Nuland, Wim van Zwam, Linda Jacobi, Rene van den Berg, Ludo Beenen, Adriaan van Es, Pieter-Jan van Doormaal, Geert Lycklama a Nijeholt, Ido van den Wijngaard, Albert Yoo, Lonneke Yo, Jasper Martens, Bas Hammer, Stefan Roosendaal, Anton Meijer, Menno Krietemeijer, Reinoud Bokkers, Anouk van der Hoorn, Dick Gerrits, Jonathan Coutinho, Ben Jansen, Sanne Manschot, Peter Koudstaal, Koos Keizer, Vicky Chalos, Adriaan Versteeg, Lennard Wolff, Henk van Voorst, Matthijs van der Sluijs, Arnolt-Jan Hoving, Kilian Treurniet, Natalie LeCouffe, Rob van de Graaf, Robert-Jan Goldhoorn, Wouter Hinseveld, Anne Pirson, Lotte Sondag, Manon Kappelhof, Manon Tolhuisen, Josje Brouwer, Wouter van der Steen, Leon Rinkel, Agnetha Bruggeman, Rita Sprengers, Martin Sterrenberg, Sabrina Verheesen, Leontien Heiligers, Yvonne Martens, Naziha El Ghannouti, Miranda Slotboom, MUMC+: MA Neurologie (3), MUMC+: Hersen en Zenuw Centrum (3), Klinische Neurowetenschappen, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, RS: Carim - B05 Cerebral small vessel disease, Graduate School, ACS - Atherosclerosis & ischemic syndromes, ANS - Neurovascular Disorders, Neurology, Radiology and Nuclear Medicine, ANS - Cellular & Molecular Mechanisms, ACS - Microcirculation, ACS - Pulmonary hypertension & thrombosis, Biomedical Engineering and Physics, ANS - Brain Imaging, ANS - Compulsivity, Impulsivity & Attention, Radiology & Nuclear Medicine, Public Health, Radiology and nuclear medicine, Pediatrics, Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Damage and Repair in Cancer Development and Cancer Treatment (DARE), TechMed Centre, and Clinical Neurophysiology
Subjects: Adult, Adolescent, Ischemic Attack, Transient, Nitroglycerin/therapeutic use, Ambulances, Brain Ischemia/drug therapy, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], Brain Ischemia, Stroke, Nitroglycerin, Treatment Outcome, Ischemic Attack, Transient, 2023 OA procedure, Humans, Neurology (clinical), Stroke/drug therapy, Cerebral Hemorrhage/drug therapy, Cerebral Hemorrhage, Ischemic Stroke
Abstract: Contains fulltext : 287508.pdf (Publisher’s version ) (Closed access) BACKGROUND: Pooled analyses of previous randomised studies have suggested that very early treatment with glyceryl trinitrate (also known as nitroglycerin) improves functional outcome in patients with acute ischaemic stroke or intracerebral haemorrhage, but this finding was not confirmed in a more recent trial (RIGHT-2). We aimed to assess whether patients with presumed acute stroke benefit from glyceryl tr initrate started within 3 h after symptom onset. METHODS: MR ASAP was a phase 3, randomised, open-label, blinded endpoint trial done at six ambulance services serving 18 hospitals in the Netherlands. Eligible participants (aged ≥18 years) had a probable diagnosis of acute stroke (as assessed by a paramedic), a face-arm-speech-time test score of 2 or 3, systolic blood pressure of at least 140 mm Hg, and could start treatment within 3 h of symptom onset. Participants were randomly assigned (1:1) by ambulance personnel, using a secure web-based electronic application with random block sizes stratified by ambulance service, to receive either transdermal glyceryl trinitrate 5 mg/day for 24 h plus standard care (glyceryl trinitrate group) or to standard care alone (control group) in the prehospital setting. Informed consent was deferred until after arrival at the hospital. The primary outcome was functional outcome assessed with the modified Rankin Scale (mRS) at 90 days. Safety outcomes included death within 7 days, death within 90 days, and serious adverse events. Analyses were based on modified intention to treat, and treatment effects were expressed as odds ratios (ORs) or common ORs, with adjustment for baseline prognostic factors. We separately analysed the total population and the target population (ie, patients with intracerebral haemorrhage, ischaemic stroke, or transient ischaemic attack). The target sample size was 1400 patients. The trial is registered as ISRCTN99503308. FINDINGS: On June 24, 2021, the MR ASAP trial was prematurely terminated on the advice of the data and safety monitoring board, with recruitment stopped because of safety concerns in patients with intracerebral haemorrhage. Between April 4, 2018, and Feb 12, 2021, 380 patients were randomly allocated to a study group. 325 provided informed consent or died before consent could be obtained, of whom 170 were assigned to the glyceryl trinitrate group and 155 to the control group. These patients were included in the total population. 201 patients (62%) had ischaemic stroke, 34 (10%) transient ischaemic attack, 56 (17%) intracerebral haemorrhage, and 34 (10%) a stroke-mimicking condition. In the total population (n=325), the median mRS score at 90 days was 2 (IQR 1-4) in both the glyceryl trinitrate and control groups (adjusted common OR 0·97 [95% CI 0·65-1·47]). In the target population (n=291), the 90-day mRS score was 2 (2-4) in the glyceryl trinitrate group and 3 (1-4) in the control group (0·92 [0·59-1·43]). In the total population, there were no differences between the two study groups with respect to death within 90 days (adjusted OR 1·07 [0·53-2·14]) or serious adverse events (unadjusted OR 1·23 [0·76-1·99]). In patients with intracerebral haemorrhage, 12 (34%) of 35 patients allocated to glyceryl trinitrate versus two (10%) of 21 allocated to the control group died within 7 days (adjusted OR 5·91 [0·78-44·81]); death within 90 days occurred in 16 (46%) of 35 in the glyceryl trinitrate group and 11 (55%) of 20 in the control group (adjusted OR 0·87 [0·18-4·17]). INTERPRETATION: We found no sign of benefit of transdermal glyceryl trinitrate started within 3 h of symptom onset in the prehospital setting in patients with presumed acute stroke. The signal of potential early harm of glyceryl trinitrate in patients with intracerebral haemorrhage suggests that glyceryl trinitrate should be avoided in this setting. FUNDING: The Collaboration for New Treatments of Acute Stroke consortium, the Brain Foundation Netherlands, the Ministry of Economic Affairs, Stryker, Medtronic, Cerenovus, and the Dutch Heart Foundation.
Published: 2022
Full Text: View/download PDF

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

Author: Leon A. Rinkel, Kilian M. Treurniet, Daan Nieboer, Manon Kappelhof, Natalie E. LeCouffe, Agnetha A.E. Bruggeman, Wim H. van Zwam, Geert J. Lycklama à Nijeholt, Elyas Ghariq, Maarten Uyttenboogaart, Diederik W.J. Dippel, Yvo B.W.E.M. Roos, Jonathan M. Coutinho, Charles B.L.M. Majoie, Bart J. Emmer, Bob Roozenbeek, Adriaan van Es, Inger de Ridder, Bart van der Worp, Rob Lo, Koos Keizer, Rob Gons, Lonneke Yo, Jelis Boiten, Ido van den Wijngaard, Jeanette Hofmeijer, Jasper Martens, Wouter Schonewille, Jan Albert Vos, Anil Tuladhar, Floris Schreuder, Jeroen Boogaarts, Sjoerd Jenniskens, Karlijn de Laat, Lukas van Dijk, Heleen den Hertog, Boudewijn van Hasselt, Paul Brouwers, Emiel Sturm, Tomas Bulut, Michel Remmers, Anouk van Norden, Thijs de Jong, Anouk Rozeman, Otto Elgersma, Reinoud Bokkers, Julia van Tuijl, Issam Boukrab, Hans Kortman, Vincent Costalat, Caroline Arquizan, Robin Lemmens, Jelle Demeestere, Philippe Desfontaines, Denis Brisbois, Frédéric Clarençon, Yves Samson, Martin Brown, Phil White, John Gregson, Rick van Nuland, Aad van der Lugt, Linda Jacobi, René van den Berg, Ludo Beenen, Pieter-Jan van Doormaal, Albert Yoo, Bas Hammer, Stefan Roosendaal, Anton Meijer, Menno Krietemeijer, Anouk van der Hoorn, Dick Gerrits, Robert van Oostenbrugge, Ben Jansen, Sanne Manschot, Henk Kerkhof, Peter Koudstaal, Hester Lingsma, Vicky Chalos, Olvert Berkhemer, Adriaan Versteeg, Lennard Wolff, Jiahang Su, Manon Tolhuisen, Henk van Voorst, Hugo ten Cate, Moniek de Maat, Samantha Donse-Donkel, Heleen van Beusekom, Aladdin Taha, Sophie van den Berg, Rob van de Graaf, Robert-Jan Goldhoorn, Wouter Hinsenveld, Anne Pirson, Lotte Sondag, Rik Reinink, Josje Brouwer, Sabine Collette, Wouter van der Steen, Rita Sprengers, Martin Sterrenberg, Naziha El Ghannouti, Sabrina Verheesen, Wilma Pellikaan, Kitty Blauwendraat, Yvonne Drabbe, Joke de Meris, Michelle Simons, Hester Bongenaar, Anja van Loon, Eva Ponjee, Rieke Eilander, Suze Kooij, Marieke de Jong, Esther Santegoets, Suze Roodenburg, Ayla van Ahee, Marinette Moynier, Annemie Devroye, Evelyn Marcis, Ingrid Iezzi, Annie David, Atika Talbi, Leontien Heiligers, Yvonne Martens, 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), Graduate School, Neurology, Radiology and Nuclear Medicine, ACS - Microcirculation, ANS - Cellular & Molecular Mechanisms, ANS - Compulsivity, Impulsivity & Attention, ANS - Neurovascular Disorders, Biomedical Engineering and Physics, ANS - Brain Imaging, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: Carim - B05 Cerebral small vessel disease, RS: Carim - B06 Imaging, Public Health, Hematology, Radiology & Nuclear Medicine, and Cardiology
Subjects: Advanced and Specialized Nursing, Endovascular Procedures, patients, reperfusion, Brain Ischemia, Stroke, Treatment Outcome, Tissue Plasminogen Activator, Humans, stent, Stents, Neurology (clinical), Cardiology and Cardiovascular Medicine, Ischemic Stroke, Thrombectomy
Abstract: Background: We aimed to assess whether the effect of intravenous alteplase treatment (IVT) before endovascular treatment (EVT) on outcome is modified by first-line technique during EVT in IVT eligible patients. Methods: This was a post hoc analysis from MR CLEAN-NO IV (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands - Intravenous Treatment Followed by Intra-Arterial Treatment Versus Direct Intra-Arterial Treatment for Acute Ischemic Stroke Caused by a Proximal Intracranial Occlusion), a randomized trial of IVT followed by EVT versus EVT alone in patients presenting directly to EVT-capable centers. We included data from all patients who underwent EVT with a thrombectomy attempt. We compared patients treated with stent retriever (with or without aspiration) to aspiration alone as first-line EVT technique and assessed the interaction of first-line EVT technique with IVT treatment. Primary outcome was the 90-day modified Rankin Scale score, analyzed with mixed model ordinal regression for a shift towards better outcome. Secondary outcomes included successful reperfusion (extended Thrombolysis in Cerebral Infarction score 2b–3). Results: Of 473 included patients, 102 (21.6%) were treated with aspiration alone as first-line technique. In the full population, functional outcome was similar for patients treated with stent retriever versus aspiration only (adjusted common odds ratio [acOR]‚ 1.07 [95% CI, 0.69–1.66]). We observed a significant interaction between IVT and first-line EVT technique ( P =0.03). In the aspiration-only group, patients treated with EVT alone had worse functional outcome compared to those treated with IVT and EVT (acOR, 0.44 [95% CI, 0.21–0.90]). In the stent retriever group, functional outcome did not differ between patients treated with or without IVT (acOR, 1.08 [95% CI, 0.74–1.57]). There was no statistically significant interaction for successful reperfusion. Conclusions: In MR CLEAN-NO IV, the treatment effect of IVT was modified by first-line EVT technique. Patients treated with aspiration only as first-line technique had worse clinical outcomes if they did not receive IVT. No such difference was observed in patients treated with stent retrievers. Confirmation by pooling with results from other trials is needed to confirm these findings.
Published: 2022
Full Text: View/download PDF

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

Author: Henk van Voorst, Agnetha A.E. Bruggeman, Jurr Andriessen, Jan W. Hoving, Praneeta R. Konduri, Wenjin Yang, Manon Kappelhof, Nerea Arrarte Terreros, Yvo B.W.E.M. Roos, Wim H. van Zwam, Aad van der Lugt, Anouk van der Hoorn, Jelis Boiten, Stefan Roosendaal, Sjoerd Jenniskens, Matthan W.A. Caan, Henk A. Marquering, Bart J. Emmer, Charles B.L.M. Majoie, Diederik W.J. Dippel, Robert J. van Oostenbrugge, Jan Albert Vos, Ivo G.H. Jansen, Maxim J.H.L. Mulder, Robert- Jan B. Goldhoorn, Kars C.J. Compagne, Josje Brouwer, Sanne J. den Hartog, Wouter H. Hinsenveld, Bob Roozenbeek, Adriaan C.G.M. van Es, Jonathan M. Coutinho, Wouter J. Schonewille, Marieke J.H. Wermer, Marianne A.A. van Walderveen, Julie Staals, 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, René van den Berg, Albert J. Yoo, Ludo F.M. Beenen, Alida A. Postma, 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, Saman Vinke, 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 Collette, Adrien E.D. Groot, Natalie E. LeCouffe, Haryadi Prasetya, Lucas A. Ramos, Radiology and Nuclear Medicine, Biomedical Engineering and Physics, ANS - Brain Imaging, APH - Methodology, APH - Aging & Later Life, ACS - Atherosclerosis & ischemic syndromes, ANS - Neurovascular Disorders, ACS - Microcirculation, Pediatrics, Radiology and nuclear medicine, Damage and Repair in Cancer Development and Cancer Treatment (DARE), and Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE)
Subjects: IMPACT, RECANALIZATION, GUIDELINES, functional status, All institutes and research themes of the Radboud University Medical Center, Brain Ischemia/diagnostic imaging, LENGTH, ischemic stroke, Humans, Ischemic Stroke/complications, thrombosis, Retrospective Studies, Advanced and Specialized Nursing, Other Research Radboud Institute for Health Sciences [Radboudumc 0], THROMBECTOMY, Endovascular Procedures/methods, Treatment Outcome, Thrombosis/diagnostic imaging, Thrombectomy/methods, stents, HEART, Neurology (clinical), prognosis, Cardiology and Cardiovascular Medicine, STROKE, Stroke/diagnostic imaging
Abstract: Background: A larger thrombus in patients with acute ischemic stroke might result in more complex endovascular treatment procedures, resulting in poorer patient outcomes. Current evidence on thrombus volume and length related to procedural and functional outcomes remains contradicting. This study aimed to assess the prognostic value of thrombus volume and thrombus length and whether this relationship differs between first-line stent retrievers and aspiration devices for endovascular treatment. Methods: In this multicenter retrospective cohort study, 670 of 3279 patients from the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) for endovascularly treated large vessel occlusions were included. Thrombus volume (0.1 mL) and length (0.1 mm) based on manual segmentations and measurements were related to reperfusion grade (expanded Treatment in Cerebral Infarction score) after endovascular treatment, the number of retrieval attempts, symptomatic intracranial hemorrhage, and a shift for functional outcome at 90 days measured with the reverted ordinal modified Rankin Scale (odds ratio >1 implies a favorable outcome). Univariable and multivariable linear and logistic regression were used to report common odds ratios (cORs)/adjusted cOR and regression coefficients (B/aB) with 95% CIs. Furthermore, a multiplicative interaction term was used to analyze the relationship between first-line device choice, stent retrievers versus aspiration device, thrombus volume, and outcomes. Results: Thrombus volume was associated with functional outcome (adjusted cOR, 0.83 [95% CI, 0.71–0.97]) and number of retrieval attempts (aB, 0.16 [95% CI, 0.16–0.28]) but not with the other outcome measures. Thrombus length was only associated with functional independence (adjusted cOR, 0.45 [95% CI, 0.24–0.85]). Patients with more voluminous thrombi had worse functional outcomes if endovascular treatment was based on first-line stent retrievers (interaction cOR, 0.67 [95% CI, 0.50–0.89]; P =0.005; adjusted cOR, 0.74 [95% CI, 0.55–1.0]; P =0.04). Conclusions: In this study, patients with a more voluminous thrombus required more endovascular thrombus retrieval attempts and had a worse functional outcome. Patients with a lengthier thrombus were less likely to achieve functional independence at 90 days. For more voluminous thrombi, first-line stent retrieval compared with first-line aspiration might be associated with worse functional outcome.
Published: 2023
Full Text: View/download PDF

6. 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
Full Text: View/download PDF

7. 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
Full Text: View/download PDF

8. Etiology of Large Vessel Occlusion Posterior Circulation Stroke: Results of the MR CLEAN Registry

Author: F.A.V. (Anne) Pirson, Nikki Boodt, Josje Brouwer, Agnetha A.E. Bruggeman, Wouter H. Hinsenveld, Julie Staals, Wim H. van Zwam, Christiaan van der Leij, Rutger J.B. Brans, Charles B.L.M. Majoie, Diederik W.J. Dippel, Aad van der Lugt, Wouter J. Schonewille, Robert J. van Oostenbrugge, Yvo B.W.E.M. Roos, Jelis Boiten, Jan Albert Vos, Ivo G.H. Jansen, Maxim J.H.L. Mulder, Robert- Jan B. Goldhoorn, Kars C.J. Compagne, Manon Kappelhof, Sanne J. den Hartog, Bob Roozenbeek, Bart J. Emmer, Jonathan M. Coutinho, 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, Rutger Brans, 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, Anne F.A.V. Pirson, Graduate School, Biomedical Engineering and Physics, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, ANS - Brain Imaging, ANS - Neurovascular Disorders, Neurology, Radiology & Nuclear Medicine, Public Health, Klinische Neurowetenschappen, RS: Carim - B05 Cerebral small vessel disease, MUMC+: MA Niet Med Staf 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), MUMC+: Hersen en Zenuw Centrum (3), 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: DIAGNOSIS, EMBOLIC STROKES, UNDETERMINED SOURCE, embolic stroke, ischemic stroke, Humans, Prospective Studies, Registries, Advanced and Specialized Nursing, OUTCOMES, BASILAR ARTERY-OCCLUSION, CLINICAL-FEATURES, Endovascular Procedures, Other Research Radboud Institute for Health Sciences [Radboudumc 0], reperfusion, Stroke, Treatment Outcome, ISCHEMIC-STROKE, thrombectomy, ENDOVASCULAR TREATMENT, RISK-FACTORS, Neurology (clinical), atherosclerosis, Cardiology and Cardiovascular Medicine, SUBTYPE, Rare cancers Radboud Institute for Health Sciences [Radboudumc 9]
Abstract: Background: In patients with large vessel occlusion stroke of the anterior circulation, underlying cause is a determinant of outcome. Whether this is the case for posterior circulation large vessel occlusion stroke has yet to be determined. We aimed to report on cause in patients with posterior circulation stroke treated with endovascular thrombectomy and to analyze the association with functional outcome. Methods: We used data of patients with posterior circulation stroke included in the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) registry, a prospective multicenter observational study, between 2014 and 2018. Stroke cause was categorized into large artery atherosclerosis (LAA), cardioembolism, arterial dissection, embolic stroke of undetermined source (ESUS), other determined cause, or undetermined cause. For primary analysis on the association between cause and outcome, we used multivariable ordinal logistic regression analysis to estimate the adjusted common odds ratio for a shift towards a better functional outcome on the modified Rankin Scale at 90 days with LAA as a reference group. Secondary outcomes included favorable functional outcome (modified Rankin Scale score 0–3), National Institutes of Health Stroke Scale score at 24 to 48 hours, reperfusion on digital subtraction angiography, and stroke progression. Results: Of 264 patients with posterior circulation stroke, 84 (32%) had LAA, 48 (18%) cardioembolism, 31 (12%) dissection, and 14 (5%) ESUS. Patients with a dissection were younger (48 [interquartile range, 43–60] years) and had a lower National Institutes of Health Stroke Scale at baseline (12 [interquartile range, 6–31]) than patients with other cause. Functional outcome was better for patients with cardioembolism and ESUS compared to LAA (modified Rankin Scale adjusted common odds ratio, 2.4 [95% CI, 1.1–5.2], respectively adjusted common odds ratio, 3.1 [95% CI, 1.0–9.3]). Patients with a dissection had a lower chance of successful reperfusion compared with LAA (adjusted odds ratio, 0.20 [95% CI, 0.06–0.70]). Conclusions: Unlike the anterior circulation, most frequent cause in our posterior large vessel occlusion stroke cohort is LAA followed by cardioembolism, dissection, and ESUS. Patients with cardioembolism and ESUS have a better prognosis for functional outcome after endovascular thrombectomy than patients with LAA.
Published: 2022
Full Text: View/download PDF

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

Author: Sanne J. den Hartog, Hester F. Lingsma, Pieter‐Jan van Doormaal, Jeannette Hofmeijer, Lonneke S. F. Yo, Charles B. L. M. Majoie, Diederik W. J. Dippel, Aad van der Lugt, Bob Roozenbeek, Yvo B. W. E. M. Roos, Robert J. van Oostenbrugge, Wim H. van Zwam, 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, 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, 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, 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, Anton Meijer, Elyas Ghariq, Marc P. van Proosdij, G. Menno Krietemeijer, 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, ANS - Neurovascular Disorders, ACS - Microcirculation, ACS - Atherosclerosis & ischemic syndromes, Radiology & Nuclear Medicine, Neurology, Public Health, Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), and Damage and Repair in Cancer Development and Cancer Treatment (DARE)
Subjects: Other Research Radboud Institute for Health Sciences [Radboudumc 0], Endovascular Procedures, Hospitals, Stroke, Brain ischemia, Treatment Outcome, surgical procedures, operative, RC666-701, Reperfusion, Humans, Diseases of the circulatory (Cardiovascular) system, cardiovascular diseases, Quality improvement, Cardiology and Cardiovascular Medicine, Ischemic Stroke, Thrombectomy
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 providing endovascular treatment for ischemic stroke. Quality of stroke care improvements should not only be guided by between‐hospital comparisons, but also aim to reduce variation between patients within a hospital, and should specifically focus on CTA‐to‐groin time and groin‐to‐reperfusion time.
Published: 2022

10. 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

11. 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

12. 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

13. 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

14. 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
Full Text: View/download PDF

15. 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
Full Text: View/download PDF

16. 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
Full Text: View/download PDF

17. 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

18. 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

19. 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
Full Text: View/download PDF

20. A versatile alginate droplet generator applicable for microencapsulation of pancreatic islets

Author: Wilbert M. Fritschy, Reinout van Schilfgaarde, Dick Gerrits, and Gerrit H. J. Wolters
Subjects: endocrine system, Materials science, Biocompatibility, Alginates, Diffusion, Drug Compounding, Airflow, Nozzle, INSULIN RELEASE, Islets of Langerhans Transplantation, Biocompatible Materials, Capsules, Bead, MICROCAPSULES, RATS, Air flow rate, Materials Testing, medicine, Humans, INVITRO, TRANSPLANTATION, Pancreatic islets, General Engineering, General Medicine, Transplantation, medicine.anatomical_structure, Chemical engineering, visual_art, visual_art.visual_art_medium, Biomedical engineering
Abstract: Alginate beads for immunoisolation of pancreatic islets by microencapsulation should be small, smooth, and spherical in order to ensure that around the islets a strong alginate-polylysine-alginate capsule will be formed with optimal biocompatibility and diffusion of nutrients and hormones. However, the preparation of small capsules around islets is difficult. Our newly designed air jet droplet generator allows for variations in the length and diameter of the alginate nozzle and the air jacket and is in this way adaptable to a required bead size. Alginate droplets are converted into rigid beads in a 100 mM CaCl2 solution. Their size depends upon the diameter of the jacket, the air flow rate, and the outer diameter of the nozzle, whereas the production rate depends upon the pressure on the alginate, and on the diameter and the length of the nozzle. When the air flow or the alginate flow surpasses a certain rate, the droplets are fragmented. Thus study describes the mutual relationship of these variables and defines their optimal range for reproducible production of smooth and spherical beads for microencapsulation of islets at an acceptable production rate. © 1992 John Wiley & Sons, Inc.
Published: 1992

Catalog

Books, media, physical & digital resources

See catalog results

Searchworks

Select search scope, currently: Articles

Catalog

books, media & more in Jio Institute collections

Articles

journal articles & other e-resources

Refine your results

20 results on '"Dick Gerrits"'

1. Association of Ischemic Core Imaging Biomarkers With Post-Thrombectomy Clinical Outcomes in the MR CLEAN Registry

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

3. Prehospital transdermal glyceryl trinitrate in patients with presumed acute stroke (MR ASAP)

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

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

6. 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

7. Prediction of Outcome and Endovascular Treatment Benefit Validation and Update of the MR PREDICTS Decision Tool

8. Etiology of Large Vessel Occlusion Posterior Circulation Stroke: Results of the MR CLEAN Registry

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

10. White matter lesions and outcomes after endovascular treatment for acute ischemic stroke MR CLEAN registry results

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

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

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

14. 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

15. Clinical significance of mesenteric arterial collateral circulation in patients with celiac artery compression syndrome

16. Endovascular Treatment of Chronic Splanchnic Syndrome

17. Retrograde open mesenteric stenting for acute mesenteric ischemia

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

19. 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

20. A versatile alginate droplet generator applicable for microencapsulation of pancreatic islets

Catalog

Searchworks

Select search scope, currently: Articles Catalog books, media & more in Jio Institute collections Articles journal articles & other e-resources

Search

Search Constraints

Refine your results

Search Limiters

Topic

Publication Year Range

Language

Publication Type

Journal

Database

Publisher

20 results on '"Dick Gerrits"'

Search Results

Catalog

Select search scope, currently: Articles

Catalog

books, media & more in Jio Institute collections

Articles

journal articles & other e-resources