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1. Collateral Circulation and Outcome in Atherosclerotic Versus Cardioembolic Cerebral Large Vessel Occlusion

Author

Guglielmi, V., LeCouffe, N.E., Zinkstok, S.M., Compagne, K.C.J., Eker, R., Treurniet, K.M., Tolhuisen, M.L., Worp, H.B. van der, Jansen, I.G.H., Oostenbrugge, R.J. van, Marquering, H.A., Dippel, D.W.J., Emmer, B.J., Majoie, C.B.L.M., Roos, Y.B.W.E.M., Coutinho, J.M., Lugt, A. van der, Zwam, W.H. van, Boiten, J., Vos, J.A., Mulder, M.J.H.L., Goldhoorn, R.J.B., Kappelhof, M., Schonewille, W.J., Wermer, M.J.H., Walderveen, M.A.A. van, Staals, J., Hofmeijer, J., Martens, J.M., Nijeholt, G.J.L.A., Roozenbeek, B., Bruijn, S.F. de, Dijk, L.C. van, R.H. lo, Dijk, E.J. van, Boogaarts, H.D., Kort, P.L.M. de, Peluso, J.P., Berg, J.S.P. van den, Hasselt, B.A.A.M. van, Aerden, L.A.M., Dallinga, R.J., Uyttenboogaart, M., Eshghi, O., Schreuder, T.H.C.M.L., Heijboer, R.J.J., Keizer, K., Yo, L.S.F., Hertog, H.M. den, Sturm, E.J.C., Sprengers, M.E.S., Jenniskens, S.F.M., Berg, R. van den, Yoo, A.J., Beenen, L.F.M., Postma, A.A., Roosendaal, S.D., Kallen, B.F.W. van der, Wijngaard, I.R. van den, Es, A.C.G.M. van, Bot, J., Doormaal, P.J. van, Flach, H.Z., Lingsma, H.F., Ghannouti, N. el, Sterrenberg, M., Puppels, C., Pellikaan, W., Sprengers, R., Elfrink, M., Meris, J. de, Vermeulen, T., Geerlings, A., Vemde, G. van, Simons, T., Rijswijk, C. van, Messchendorp, G., Bongenaar, H., Bodde, K., Kleijn, S., Lodico, J., Droste, H., Wollaert, M., Jeurrissen, D., Bos, E., Drabbe, Y., Aaldering, N., Zweedijk, B., Khalilzada, M., Venema, E., Chalos, V., Geuskens, R.R., Straaten, T. van, Ergezen, S., Harmsma, R.R.M., Muijres, D., Jong, A. de, Hinsenveld, W., Berkhemer, O.A., Boers, A.M.M., Huguet, J., Groot, P.F.C., Mens, M.A., Kranendonk, K.R. van, Tolhuijsen, M.L., Alves, H., MR-CLEAN Registry Investigators, Neurology, Radiology and nuclear medicine, VU University medical center, Pediatric surgery, ACS - Atherosclerosis & ischemic syndromes, Radiology & Nuclear Medicine, ​Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Graduate School, ACS - Microcirculation, ACS - Pulmonary hypertension & thrombosis, ANS - Neurovascular Disorders, Radiology and Nuclear Medicine, AGEM - Re-generation and cancer of the digestive system, AGEM - Digestive immunity, CCA - Imaging and biomarkers, ARD - Amsterdam Reproduction and Development, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, RS: Carim - B05 Cerebral small vessel disease, RS: CARIM - R3.03 - Cerebral small vessel disease, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: Carim - B06 Imaging, RS: CARIM - R3.11 - Imaging, Promovendi CD, MUMC+: MA AIOS Neurologie (9), MUMC+: MA Med Staf Spec Neurologie (9), MUMC+: DA BV AIOS Nucleaire Geneeskunde (9), MUMC+: DA BV AIOS Radiologie (9), and MUMC+: MA Niet Med Staf Neurologie (9)

Subjects
Carotid Artery Diseases, Male, endovascular treatment, Original Contributions, FEATURES, EMBOLIC STROKES, Brain Ischemia, Modified Rankin Scale, Occlusion, Medicine, Advanced and Specialised Nursing, Registries, collateral circulation, ACUTE ISCHEMIC-STROKE, Stroke, HYPOPERFUSION, Aged, 80 and over, education.field_of_study, Brain, Atrial fibrillation, Middle Aged, THROMBECTOMY, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], Collateral circulation, ETIOLOGY, Intracranial Embolism, Cardiology, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, Female, Internal carotid artery, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, atherothrombotic stroke, Population, Clinical Sciences, Clinical Neurology, UNDETERMINED SOURCE, CLASSIFICATION, All institutes and research themes of the Radboud University Medical Center, medicine.artery, Internal medicine, ischemic stroke, Humans, cardiovascular diseases, education, cardiac emboli, Aged, Advanced and Specialized Nursing, business.industry, Other Research Radboud Institute for Health Sciences [Radboudumc 0], medicine.disease, CT ANGIOGRAPHY, Stenosis, ATRIAL-FIBRILLATION, Neurology (clinical), business
Abstract

Supplemental Digital Content is available in the text., Background and Purpose— Due to chronic hypoperfusion, cervical atherosclerosis may promote cerebral collateral circulation. We hypothesized that patients with ischemic stroke due to cervical carotid atherosclerosis have a more extensive collateral circulation and better outcomes than patients with cardioembolism. We tested this hypothesis in a population of patients who underwent endovascular treatment for large vessel occlusion. Methods— From the MR-CLEAN Registry (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), we selected consecutive adult endovascular treatment patients (March 2014 to June 2016) with acute ischemic stroke due to anterior circulation large vessel occlusion and compared patients with cervical carotid artery stenosis >50% to those with cardioembolic etiology. The primary outcome was collateral score, graded on a 4-point scale. Secondary outcomes included the modified Rankin Scale (mRS) score and mortality at 90 days. We performed multivariable regression analyses and adjusted for potential confounders. Results— Of 1627 patients in the Registry, 190 patients with cervical carotid atherosclerosis and 476 with cardioembolism were included. Patients with cervical carotid atherosclerosis were younger (median 69 versus 76 years, P

Published
2019
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2. Workflow Intervals of Endovascular Acute Stroke Therapy During On- Versus Off-Hours The MR CLEAN Registry

Author

Hinsenveld, W.H., Ridder, I.R. de, Oostenbrugge, R.J. van, Vos, J.A., Groot, A.E., Coutinho, J.M., Nijeholt, G.J.L.A., Boiten, J., Schonewille, W.J., Dippel, D.W.J., Lugt, A. van der, Majoie, C.B.L.M., Roos, Y.B.W.E.M., Zwam, W.H. van, Jansen, I.G.H., Mulder, M.J.H.L., Goldhoorn, R.J.B., Compagne, K.C.J., Kappelhof, M., Wermer, M.J.H., Walderveen, M.A.A. van, Staals, J., Hofmeijer, J., Martens, J.M., Roozenbeek, B., Emmer, B.J., Bruijn, S.F. de, Dijk, L.C. van, Worp, H.B. van der, R.H. lo, Dijk, E.J. van, Boogaarts, H.D., Kort, P.L.M. de, Peluso, J.J.P., Berg, J.S.P. van den, Hasselt, B.A.A.M. van, Aerden, L.A.M., Dallinga, R.J., Uyttenboogaart, M., Eshghi, O., Schreuder, T.H.C.M.L., Heijboer, R.J.J., Keizer, K., Yo, L.S.F., Hertog, H.M. den, Sturm, E.J.C., Sprengers, M.E.S., Jenniskens, S.F.M., Berg, R. van den, Yoo, A.J., Beenen, L.F.M., Postma, A.A., Roosendaal, S.D., Kallen, B.F.W. van der, Wijngaard, I.R. van den, Es, A.C.G.M. van, Bot, J., Doormaal, P.J. van, Flach, H.Z., Lingsma, H.F., Ghannouti, N. el, Sterrenberg, M., Puppels, C., Pellikaan, W., Sprengers, R., Elfrink, M., Meris, J. de, Vermeulen, T., Geerlings, A., Vemde, G. van, Simons, T., Rijswijk, C. van, Messchendorp, G., Bongenaar, H., Bodde, K., Kleijn, S., Lodico, J., Droste, H., Wollaert, M., Jeurrissen, D., Bos, E., Drabbe, Y., Aaldering, N., Zweedijk, B., Khalilzada, M., Venema, E., Chalos, V., Geuskens, R.R., Straaten, T. van, Ergezen, S., Harmsma, R.R.M., Muijres, D., Jong, A. de, Hinsenveld, W., Berkhemer, O.A., Boersc, A.M.M., Huguet, J., Groot, P.F.C., Mens, M.A., Kranendonk, K.R. van, Treurniet, K.M., Tolhuijsen, M.L., Alves, H., MR CLEAN Registry Investigators, RS: Carim - B05 Cerebral small vessel disease, RS: CARIM - R3.03 - Cerebral small vessel disease, MUMC+: MA Niet Med Staf Neurologie (9), Promovendi CD, MUMC+: MA Med Staf Spec Neurologie (9), MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, RS: Carim - B06 Imaging, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: CARIM - R3.11 - Imaging, MUMC+: MA AIOS Neurologie (9), MUMC+: DA BV AIOS Nucleaire Geneeskunde (9), MUMC+: DA BV AIOS Radiologie (9), Psychiatrie & Neuropsychologie, Radiology and nuclear medicine, VU University medical center, Pediatric surgery, ACS - Atherosclerosis & ischemic syndromes, ​Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Graduate School, Neurology, ANS - Neurovascular Disorders, Radiology and Nuclear Medicine, ACS - Microcirculation, ACS - Pulmonary hypertension & thrombosis, AGEM - Digestive immunity, AGEM - Re-generation and cancer of the digestive system, ARD - Amsterdam Reproduction and Development, Radiology & Nuclear Medicine, and Public Health

Subjects
Male, medicine.medical_specialty, Time Factors, workflow, medicine.medical_treatment, DOOR, endovascular procedures, DELAYS, Time-to-Treatment, All institutes and research themes of the Radboud University Medical Center, Modified Rankin Scale, medicine, Clinical endpoint, Humans, QUALITY, Registries, Lead (electronics), Stroke, Aged, Retrospective Studies, Aged, 80 and over, Advanced and Specialized Nursing, OUTCOMES, Groin, business.industry, delivery of health care, holidays, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Odds ratio, Middle Aged, THROMBECTOMY, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], medicine.disease, ADMISSION, stroke, Surgery, TIME, Observational Studies as Topic, medicine.anatomical_structure, ISCHEMIC-STROKE, Intravenous therapy, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, Complication, business
Abstract

Background and Purpose— Endovascular treatment (EVT) of patients with acute ischemic stroke because of large vessel occlusion involves complicated logistics, which may cause a delay in treatment initiation during off-hours. This might lead to a worse functional outcome. We compared workflow intervals between endovascular treatment–treated patients presenting during off- and on-hours. Methods— We retrospectively analyzed data from the MR CLEAN Registry, a prospective, multicenter, observational study in the Netherlands and included patients with an anterior circulation large vessel occlusion who presented between March 2014 and June 2016. Off-hours were defined as presentation on Monday to Friday between 17:00 and 08:00 hours, weekends (Friday 17:00 to Monday 8:00) and national holidays. Primary end point was first door to groin time. Secondary end points were functional outcome at 90 days (modified Rankin Scale) and workflow time intervals. We stratified for transfer status, adjusted for prognostic factors, and used linear and ordinal regression models. Results— We included 1488 patients of which 936 (62.9%) presented during off-hours. Median first door to groin time was 140 minutes (95% CI, 110–182) during off-hours and 121 minutes (95% CI, 85–157) during on-hours. Adjusted first door to groin time was 14.6 minutes (95% CI, 9.3–20.0) longer during off-hours. Door to needle times for intravenous therapy were slightly longer (3.5 minutes, 95% CI, 0.7–6.3) during off-hours. Groin puncture to reperfusion times did not differ between groups. For transferred patients, the delay within the intervention center was 5.0 minutes (95% CI, 0.5–9.6) longer. There was no significant difference in functional outcome between patients presenting during off- and on-hours (adjusted odds ratio, 0.92; 95% CI, 0.74–1.14). Reperfusion rates and complication rates were similar. Conclusions— Presentation during off-hours is associated with a slight delay in start of endovascular treatment in patients with acute ischemic stroke. This treatment delay did not translate into worse functional outcome or increased complication rates.

Published
2019
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3. Impact of single phase CT angiography collateral status on functional outcome over time: results from the MR CLEAN Registry

Author

Jansen, I.G.H., Mulder, M.J.H.L., Goldhoorn, R.J.B., Boers, A.M.M., Es, A.C.G.M. van, Yo, L.S.F., Hofmeijer, J., Martens, J.M., Walderveen, M.A.A. van, Kallen, B.F.W. van der, Jenniskens, S.F.M., Treurniet, K.M., Marqueriny, H.A., Sprengers, M.E.S., Schonewille, W.J., Bot, J.C.J., Nijeholt, G.J.L.A., Lingsma, H.F., Liebeskind, D.S., Boiten, J., Vos, J.A., Roos, Y.B.W.E.M., Oostenbrugge, R.J. van, Lugt, A. van der, Zwam, W.H. van, Dippel, D.W.J., Wijngaard, I.R. van den, Majoie, C.B.L.M., Coutinho, J.M., Wermern, M.J.H., Staals, J., Roozenbeek, B., Emmer, B.J., Bruijn, S.F. de, Dijk, L.C. van, Worp, H.B. van der, R.H. lo, Dijk, E.J. van, Boogaarts, H.D., Kort, P.L.M. de, Peluso, J.J.P., Berg, J.S.P. van den, Hasselt, B.A.A.M. van, Aerden, L.A.M., Dallinga, R.J., Uyttenboogaart, M., Eshghi, O., Schreuder, T.H.C.M.L., Heijboer, R.J.J., Keizer, K., Hertog, H.M. den, Sturm, E.J.C., Berg, R. van den, Yoo, A.J., Beenen, L.F.M., Roosendaal, S.D., Es, A. van, Emmer, B., Bot, J., Doormaal, P.J. van, Flach, H.Z., Ghannouti, N. el, Sterrenberg, M., Puppels, C., Pellikaan, W., Sprengers, R., Elfrink, M., Meris, J. de, Vermeulen, T., Geerlings, A., Vemde, G. van, Simons, T., Rijswijk, C. van, Messchendorp, G., Bongenaar, H., Bodde, K., Kleijn, S., Lodico, J., Droste, H., Wollaert, M., Jeurrissen, D., Bos, E., Drabbe, Y., Zweedijk, B., Khalilzada, M., Venema, E., Chalos, V., Compagne, K.J., Geuskens, R.R., Straaten, T. van, Ergezen, S., Harmsma, R.R.M., Muijres, D., Jong, A. de, Hinseveld, W., Berkhemer, O.A., Huguet, J., Groot, P.F.C., Mens, M.A., Kranendonk, K.R. van, Kappelhof, M., Tolhuijsen, M.L., Alves, H., MR CLEAN Registry Investigators, ​Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Clinical Neurophysiology, Neurology, Radiology & Nuclear Medicine, Public Health, MUMC+: MA AIOS Neurologie (9), Klinische Neurowetenschappen, RS: Carim - B05 Cerebral small vessel disease, RS: CARIM - R3.03 - Cerebral small vessel disease, Promovendi CD, MUMC+: MA Neurologie (3), RS: Carim - B06 Imaging, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: CARIM - R3.11 - Imaging, MUMC+: MA Med Staf Spec Neurologie (9), Radiology and nuclear medicine, Amsterdam Neuroscience - Neurovascular Disorders, ACS - Atherosclerosis & ischemic syndromes, ANS - Neurovascular Disorders, ACS - Microcirculation, Graduate School, and Radiology and Nuclear Medicine

Subjects
Male, PREDICTOR, Computed Tomography Angiography, THERAPY, 030218 nuclear medicine & medical imaging, law.invention, Brain Ischemia, 0302 clinical medicine, Randomized controlled trial, Modified Rankin Scale, Time windows, law, ct angiography, REPERFUSION, Prospective Studies, Registries, Single phase, Stroke, intervention, Netherlands, Aged, 80 and over, medicine.diagnostic_test, Endovascular Procedures, General Medicine, Middle Aged, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], Treatment Outcome, Cardiology, Female, LEPTOMENINGEAL COLLATERALS, STROKE, Adult, medicine.medical_specialty, Adolescent, Time to treatment, Collateral Circulation, 03 medical and health sciences, Young Adult, Internal medicine, SCORE, medicine, MANAGEMENT, Humans, Endovascular treatment, Aged, business.industry, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Recovery of Function, medicine.disease, n/a OA procedure, ENDOVASCULAR TREATMENT, Angiography, Surgery, Neurology (clinical), business, COMPUTED TOMOGRAPHIC ANGIOGRAPHY, 030217 neurology & neurosurgery
Abstract

BackgroundCollateral status modified the effect of endovascular treatment (EVT) for stroke in several randomized trials. We assessed the association between collaterals and functional outcome in EVT treated patients and investigated if this association is time dependent.MethodsWe included consecutive patients from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands (MR CLEAN) Registry (March 2014–June 2016) with an anterior circulation large vessel occlusion undergoing EVT. Functional outcome was measured on the modified Rankin Scale (mRS) at 90 days. We investigated the association between collaterals and mRS in the MR CLEAN Registry with ordinal logistic regression and if this association was time dependent with an interaction term. Additionally, we determined modification of EVT effect by collaterals compared with MR CLEAN controls, and also investigated if this was time dependent with multiplicative interaction terms.Results1412 patients were analyzed. Functional independence (mRS score of 0–2) was achieved in 13% of patients with grade 0 collaterals, in 27% with grade 1, in 46% with grade 2, and in 53% with grade 3. Collaterals were significantly associated with mRS (adjusted common OR 1.5 (95% CI 1.4 to 1.7)) and significantly modified EVT benefit (P=0.04). None of the effects were time dependent. Better collaterals corresponded to lower mortality (PConclusionIn routine clinical practice, better collateral status is associated with better functional outcome and greater treatment benefit in EVT treated acute ischemic stroke patients, independent of time to treatment. Within the 6 hour time window, a substantial proportion of patients with absent and poor collaterals can still achieve functional independence.

Published
2019
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4. Endovascular Treatment With or Without Prior Intravenous Alteplase for Acute Ischemic Stroke

Author

Chalos, V., LeCouffe, N.E., Uyttenboogaart, M., Lingsma, H.F., Mulder, M.J.H.L., Venema, E., Treurniet, K.M., Eshghi, O., Worp, H.B. van der, Lugt, A. van der, Roos, Y.B.W.E.M., Majoie, C.B.L.M., Dippel, D.W.J., Roozenbeek, B., Coutinho, J.M., Oostenbrugge, R.J. van, Zwam, W.H. van, Boiten, J., Vos, J.A., Jansen, I.G.H., Goldhoorn, R.J.B., Schonewille, W.J., Wermer, M.J.H., Walderveen, M.A.A. van, Staals, J., Hofmeijer, J., Martens, J.M., Nijeholt, G.J.L.A., Emmer, B.J., Bruijn, S.F. de, Dijk, L.C. van, R.H. lo, Dijk, E.J. van, Boogaarts, H.D., Kort, P.L.M. de, Peluso, J.J.P., Berg, J.S.P. van den, Hasselt, B.A.A.M. van, Aerden, L.A.M., Dallinga, R.J., Schreuder, T.H.C.M.L., Heijboer, R.J.J., Keizer, K., Yo, L.S.F., Hertog, H.M. den, Sturm, E.J.C., Sprengers, M.E.S., Jenniskens, S.F.M., Berg, R. van den, Yoo, A.J., Beenen, L.F.M., Roosendaal, S.D., Kallen, B.F.W. van der, Wijngaard, I.R. van den, Es, A.C.G.M. van, Bot, J.C.J., Doormaal, P.J. van, Flach, H.Z., Ghannouti, N. el, Sterrenberg, M., Puppels, C., Pellikaan, W., Sprengers, R., Elfrink, M., Meris, J. de, Vermeulen, T., Geerlings, A., Vemde, G. van, Simons, T., Rijswijk, C. van, Messchendorp, G., Bongenaar, H., Bodde, K., Kleijn, S., Lodico, J., Droste, H., Wollaert, M., Jeurrissen, D., Bos, E., Drabbe, Y., Zweedijk, B., Khalilzada, M., Compagne, K.C.J., Geuskens, R.R., Straaten, T. van, Ergezen, S., Harmsma, R.R.M., Jong, A. de, Hinsenveld, W., Berkhemer, O.A., Boers, A.M.M., Groot, P.F.C., Mens, M.A., Kranendonk, K.R. van, Kappelhof, M., Tolhuijsen, M.L., Alves, H., MR CLEAN Registry Investigators, Neurology, Public Health, Radiology & Nuclear Medicine, ​Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Radiology and nuclear medicine, ACS - Atherosclerosis & ischemic syndromes, Graduate School, ACS - Microcirculation, ANS - Neurovascular Disorders, Radiology and Nuclear Medicine, MUMC+: MA Neurologie (3), Klinische Neurowetenschappen, RS: Carim - B05 Cerebral small vessel disease, RS: CARIM - R3.03 - Cerebral small vessel disease, RS: Carim - B06 Imaging, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: CARIM - R3.11 - Imaging, MUMC+: MA Niet Med Staf Neurologie (9), Promovendi CD, MUMC+: MA Med Staf Spec Neurologie (9), and Clinical Neurophysiology

Subjects
Male, endovascular treatment, Time Factors, medicine.medical_treatment, RECANALIZATION, ANTERIOR CIRCULATION STROKE, THERAPY, law.invention, Brain Ischemia, Workflow, Disability Evaluation, Randomized controlled trial, Modified Rankin Scale, law, Risk Factors, REPERFUSION, Thrombolytic Therapy, Prospective Studies, Registries, Stroke, DIRECT MECHANICAL THROMBECTOMY, Netherlands, Original Research, Aged, 80 and over, OUTCOMES, Confounding, Endovascular Procedures, Atrial fibrillation, Thrombolysis, Middle Aged, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], Combined Modality Therapy, stroke, Treatment Outcome, thrombectomy, Tissue Plasminogen Activator, Cardiology, Female, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, thrombolysis, Cerebrovascular Procedures, All institutes and research themes of the Radboud University Medical Center, Fibrinolytic Agents, Internal medicine, large vessel occlusion, medicine, Humans, Aged, Ischemic Stroke, business.industry, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Odds ratio, Recovery of Function, medicine.disease, Cerebrovascular Disease/Stroke, Observational study, business
Abstract

Background It is unclear whether intravenous thrombolysis ( IVT ) with alteplase before endovascular treatment ( EVT ) is beneficial for patients with acute ischemic stroke caused by a large vessel occlusion. We compared clinical and procedural outcomes, safety, and workflow between patients treated with both IVT and EVT and those treated with EVT alone in routine clinical practice. Methods and Results Using multivariable regression, we evaluated the association of IVT + EVT with 90‐day functional outcome (modified Rankin Scale), mortality, reperfusion, first‐pass effect, and symptomatic intracranial hemorrhage in the MR CLEAN (Multicenter Randomised Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands) Registry. Of 1485 patients, 1161 (78%) were treated with IVT + EVT , and 324 (22%) with EVT alone. Patients treated with IVT + EVT had atrial fibrillation less often (16% versus 44%) and had better pre‐stroke modified Rankin Scale scores (pre‐stroke modified Rankin Scale 0: 73% versus 52%) than those treated with EVT alone. Procedure time was shorter in the IVT + EVT group (median 62 versus 68 minutes). Nontransferred IVT + EVT patients had longer door‐to‐groin‐puncture times (median 105 versus 94 minutes). IVT + EVT was associated with better functional outcome (adjusted common odds ratio 1.47; 95% CI : 1.10–1.96) and lower mortality (adjusted odds ratio 0.58; 95% CI : 0.40–0.82). Successful reperfusion, first‐pass effect, and symptomatic intracranial hemorrhage did not differ between groups. Conclusions In this observational study, patients treated with IVT + EVT had better clinical outcomes than patients who received EVT alone. This finding may demonstrate a true benefit of IVT before EVT , but its interpretation is hampered by the possibility of residual confounding and selection bias. Randomized trials are required to properly assess the effect of IVT before EVT .

Published
2019
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5. Safety and Outcome of Endovascular Treatment for Minor Ischemic Stroke: Results From the Multicenter Clinical Registry of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands

Author

Goldhoorn, R.B., Mulder, M.J.H.L., Jansen, I.G.H., Zwam, W.H. van, Staals, J., Lugt, A. van der, Dippel, D.W.J., Lingsma, H.F., Vos, J.A., Boiten, J., Wijngaard, I.R. van den, Majoie, C.B.L.M., Roos, Y.B.W.E.M., Oostenbrugge, R.J. van, Goldhoorn, R.J.B., Schonewille, W.J., Coutinho, J.M., Wermer, M.J.H., Walderveen, M.A.A. van, Hofmeijer, J., Martens, J.M., Nijeholt, G.J.L.A., Roozenbeek, B., Emmer, B.J., Bruijn, S.F. de, Dijk, L.C. van, Worp, H.B. van der, R.H. lo, Dijk, E.J. van, Boogaarts, H.D., Kort, P.L.M. de, Peluso, J.J.P., Berg, J.S.P. van den, Hasselt, B.A.A.M. van, Aerden, L.A.M., Dallinga, R.J., Uyttenboogaart, M., Eshghi, O., Schreuder, T.H.C.M.L., Heijboer, R.J.J., Keizer, K., Yo, L.S.F., Hertog, H.M. den, Sturm, E.J.C., Sprengers, M.E.S., Jenniskens, S.F.M., Berg, R. van den, Yoo, A.J., Beenen, L.F.M., Roosendaal, S.D., Kallen, B.F.W. van der, Es, A. van, Emmer, B., Bot, J., Doormaal, P.J. van, Postma, A., Flach, H.Z., Ghannouti, N. el, Sterrenberg, M., Puppels, C., Pellikaan, W., Sprengers, R., Elfrink, M., Meris, J. de, Vermeulen, T., Geerlings, A., Vemde, G. van, Simons, T., Rijswijk, C. van, Messchendorp, G., Bongenaar, H., Bodde, K., Kleijn, S., Lodico, J., Droste, H., Wollaert, M., Jeurrissen, D., Bos, E., Drabbe, Y., Zweedijk, B., Khalilzada, M., Venema, E., Chalos, V., Compagne, K.J., Geuskens, R.R., Straaten, T. van, Ergezen, S., Harmsma, R.R.M., Muijres, D., Jong, A. de, Hinsenveld, W., Berkhemer, O.A., Boers, A.M.M., Huguet, J., Groot, P.F.C., Mens, M.A., Kranendonk, K.R. van, Treurniet, K.M., Kappelhof, M., Tolhuijsen, M.L., Alves, H., MR CLEAN Registry Investigators, Neurology, Radiology & Nuclear Medicine, Public Health, Klinische Neurowetenschappen, RS: Carim - B05 Cerebral small vessel disease, RS: CARIM - R3.03 - Cerebral small vessel disease, MUMC+: MA Niet Med Staf Neurologie (9), Promovendi CD, RS: Carim - B06 Imaging, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: CARIM - R3.11 - Imaging, MUMC+: MA Med Staf Spec Neurologie (9), MUMC+: MA Neurologie (3), MUMC+: DA BV AIOS Nucleaire Geneeskunde (9), RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, MUMC+: DA BV AIOS Radiologie (9), Amsterdam Neuroscience - Neurovascular Disorders, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, Radiology and Nuclear Medicine, ​Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), and Radiology and nuclear medicine

Subjects
Male, endovascular treatment, Time Factors, Severity of Illness Index, THERAPY, ANGIOGRAPHY, law.invention, Brain Ischemia, Disability Evaluation, 0302 clinical medicine, Randomized controlled trial, Modified Rankin Scale, law, Risk Factors, Occlusion, Prospective Studies, Registries, Stroke, Netherlands, Ischemic stroke, medicine.diagnostic_test, LARGE VESSEL OCCLUSION, Rehabilitation, Endovascular Procedures, minor symptoms, Middle Aged, THROMBECTOMY, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], Treatment Outcome, Cerebrovascular Circulation, Cardiology, ANTERIOR CIRCULATION, Female, TRIAL, SCALE SCORE, Cardiology and Cardiovascular Medicine, Intracranial Hemorrhages, medicine.medical_specialty, Clinical Decision-Making, 03 medical and health sciences, large vessel oclusion, All institutes and research themes of the Radboud University Medical Center, Internal medicine, medicine, Humans, Artery occlusion, cardiovascular diseases, Aged, business.industry, Patient Selection, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Recovery of Function, MILD, medicine.disease, Arterial occlusion, Angiography, Surgery, Observational study, Neurology (clinical), business, 030217 neurology & neurosurgery, INTRAARTERIAL TREATMENT
Abstract

Goal: Insufficient data is available about safety and efficacy of endovascular treatment (EVT) in patients with minor stroke symptoms because these patients were excluded from most randomized trials. We aimed to compare characteristics, functional outcome, and complications in patients with minor ischemic stroke National Institutes of Health Stroke Scale score ≤5 (NIHSS score ≤5) and moderate to severe ischemic stroke (NIHSS score ≥6) due to intracranial proximal artery occlusion of the anterior circulation who underwent EVT. Materials and Methods: We report patients with an anterior circulation occlusion who were included between March 2014 and June 2016 in the multicenter randomized clinical trial of EVT of acute ischemic stroke in the Netherlands Registry, a prospective, multicenter, observational study for stroke centers that perform EVT in the Netherlands. Minor ischemic stroke was defined as baseline NIHSS score of 5 or less. Primary outcome is the modified Rankin Scale (mRS) score at 90 days. Secondary outcomes include symptomatic intracranial hemorrhage (sICH) and mortality. Findings: Seventy-one (5.5%) patients had a NIHSS score of 5 or less. Functional independence (mRS 0-2 at 90 days) was reached in 75% of these patients, compared to 40% of patients with NIHSS score of 6 or more. sICH occurred in 4% of patients, of which 1% occurred peri-interventionally. Death occurred in 6% of patients. Conclusions: Patients with minor ischemic stroke with an intracranial proximal arterial occlusion of the anterior circulation who underwent EVT have a high chance of favorable outcome and appear to have low occurrence of treatment-related sICH. Therefore, our results encourage the use of EVT for minor ischemic stroke in the absence of effect estimates from controlled studies.

Published
2019
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6. Acute endovascular treatment of patients with ischemic stroke from intracranial large vessel occlusion and extracranial carotid dissection

Author

Compagne, K.C.J., Goldhoorn, R.B., Uyttenboogaart, M., Oostenbrugge, R.J. van, Zwam, W.H. van, Doormaal, P.J. van, Dippel, D.W.J., Lugt, A. van der, Emmer, B.J., Es, A.C.G.M. van, Majoie, C.B.L.M., Roos, Y.B.W.E.M., Boiten, J., Vos, J.A., Jansen, I.G.H., Mulder, M.J.H.L., Kappelhof, M., Schonewille, W.J., Coutinho, J.M., Wermer, M.J.H., Walderveen, M.A.A. van, Staals, J., Hofmeijer, J., Martens, J.M., Nijeholt, G.J.L., Roozenbeek, B., Bruijn, S.F. de, Dijk, L.C. van, Worp, H.B. van der, R.H. lo, Dijk, E.J. van, Boogaarts, H.D., Kort, P.L.M. de, Peluso, J.J.P., Berg, J.S.P. van den, Hasselt, B.A.A.M. van, Aerden, L.A.M., Dallinga, R.J., Eshghi, O., Schreuder, T.H.C.M.L., Heijboer, R.J.J., Keizer, K., Yo, L.S.F., Hertog, H.M. den, Sturm, E.J.C., Sprengers, M.E.S., Jenniskens, S.F.M., Berg, R. van den, Yoo, A.J., Beenen, L.F.M., Postma, A.A., Roosendaal, S.D., Kallen, B.F.W. van der, Wijngaard, I.R. van den, Bot, J., Boiten, G.J., Flach, H.Z., Lingsma, H.F., Ghannouti, N. el, Sterrenberg, M., Puppels, C., Pellikaan, W., Sprengers, R., Elfrink, M., Meris, J. de, Vermeulen, T., Geerlings, A., Vemde, G. van, Simons, T., Rijswijk, C. van, Messchendorp, G., Bongenaar, H., Bodde, K., Kleijn, S., Lodico, J., Droste, H., Wollaert, M., Jeurrissen, D., Bos, E., Drabbe, Y., Aaldering, N., Zweedijk, B., Khalilzada, M., Venema, E., Chalos, V., Geuskens, R.R., Straaten, T. van, Ergezen, S., Harmsma, R.R.M., Muijres, D., Jong, A. de, Hinseveld, W., Berkhemer, O.A., Boers, A.M.M., Huguet, J., Groot, P.F.C., Mens, M.A., Kranendonk, K.R. van, Treurniet, K.M., Tolhuijsen, M.L., Alves, H., MR CLEAN Investigators, ​Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Radiology and Nuclear Medicine, ANS - Neurovascular Disorders, Radiology and nuclear medicine, VU University medical center, Pediatric surgery, ACS - Atherosclerosis & ischemic syndromes, Klinische Neurowetenschappen, RS: Carim - B05 Cerebral small vessel disease, RS: CARIM - R3.03 - Cerebral small vessel disease, MUMC+: MA Niet Med Staf Neurologie (9), Promovendi CD, MUMC+: MA Neurologie (3), RS: Carim - B06 Imaging, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: CARIM - R3.11 - Imaging, MUMC+: MA Med Staf Spec Neurologie (9), MUMC+: DA BV AIOS Nucleaire Geneeskunde (9), RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, MUMC+: DA BV AIOS Radiologie (9), Radiology & Nuclear Medicine, Neurology, and Public Health

Subjects
endovascular treatment, medicine.medical_specialty, carotid dissection, CAD, 030204 cardiovascular system & hematology, lcsh:RC346-429, Carotid artery dissection, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Occlusion, SCORE, medicine, ischemic stroke, MANAGEMENT, REPERFUSION, ACUTE ISCHEMIC-STROKE, cardiovascular diseases, Endovascular treatment, Contraindication, lcsh:Neurology. Diseases of the nervous system, Original Research, tandem lesion, business.industry, MECHANICAL THROMBECTOMY, ARTERY DISSECTION, medicine.disease, Neurology, thrombectomy, Carotid artery occlusion, Cardiology, Neurology (clinical), Carotid dissection, business, 030217 neurology & neurosurgery, Large vessel occlusion, INTRAARTERIAL TREATMENT
Abstract

Introduction: Carotid artery dissection (CAD) and atherosclerotic carotid artery occlusion (ACAO) are major causes of a tandem occlusion in patients with intracranial large vessel occlusion (LVO). Presence of tandem occlusions may hamper intracranial access and potentially increases the risk of procedural complications of endovascular treatment (EVT). Our aim was to assess neurological, functional and technical outcome and complications of EVT for intracranial LVO in patients with CAD in comparison to patients with ACAO and to patients without CAD or ACAO.Methods: We analyzed data of the MR CLEAN trial intervention arm and MR CLEAN Registry, acquired in 16 Dutch EVT-centers. Primary outcome was the change in stroke severity by comparing the National Institute of Health Stroke Scale (NIHSS) score at 24-48 h after treatment vs. baseline. Secondary outcomes included reperfusion rate and symptomatic intracranial hemorrhage (sICH). We compared outcomes and complications between patients with CAD vs. patients with ACAO and patients without CAD or ACAO.Results: In total, we identified 74 (4.7%) patients with CAD, 92 (5.9%) patients with ACAO and 1398 (89.4%) patients without CAD or ACAO. Neurological improvement at short-term after EVT in patients with CAD was significantly better compared to ACAO (raw mean -5 vs. mean -1 NIHSS point; p = 0.03) and did not differ compared to patients without CAD or ACAO (-4 NIHSS points; p = 0.62). Rates of successful reperfusion in patients with CAD (47%) was comparable to patients with ACAO (47%; p = 1.00), but was less often achieved compared to patients without CAD or ACAO (58%; p = 0.08). Occurrence of sICH did not differ significantly between CAD patients (5%) and ACAO (11%; p = 0.33) or without CAD/ACAO (6%; p = 1.00).Conclusion: EVT in patients with intracranial LVO due to CAD results in neurological improvement comparable to patients without tandem occlusions. Therefore, carotid artery dissection by itself should not be a contraindication for endovascular treatment in stroke patients with intracranial large vessel occlusion. Although more challenging endovascular procedures are to be suspected in both patients with CAD or ACAO, accurate distinction between CAD and ACAO might influence clinical decision making as better clinical outcome can be expected in patients with CAD.

Published
2019
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7. Acute Endovascular Treatment of Patients With lschemic Stroke From Intracranial Large Vessel Occlusion and Extracranial Carotid Dissection

Author

Compagne, K.C.J. (Kars), Goldhoorn, R.B., Uyttenboogaart, M., Oostenbrugge, R.J. (Robert Jan) van, Zwam, W.H., van Doormaal, P.J., Dippel, D.W.J. (Diederik), Lugt, A. (Aad) van der, van Es, A.C.G.M., Mulder, M.J.H.L., Roozenbeek, B. (Bob), Lingsma, H.F. (Hester), el Ghannouti, N., Sterrenberg, M., Khalilzada, M. (Mostafa), Venema, E., Chalos, V., Ergezen, S., Harmsma, R.R.M., Muijres, D., de Jong, A.C., Berkhemer, O.A., Tolhuijsen, M.L., Alves, H., Compagne, K.C.J. (Kars), Goldhoorn, R.B., Uyttenboogaart, M., Oostenbrugge, R.J. (Robert Jan) van, Zwam, W.H., van Doormaal, P.J., Dippel, D.W.J. (Diederik), Lugt, A. (Aad) van der, van Es, A.C.G.M., Mulder, M.J.H.L., Roozenbeek, B. (Bob), Lingsma, H.F. (Hester), el Ghannouti, N., Sterrenberg, M., Khalilzada, M. (Mostafa), Venema, E., Chalos, V., Ergezen, S., Harmsma, R.R.M., Muijres, D., de Jong, A.C., Berkhemer, O.A., Tolhuijsen, M.L., and Alves, H.

Abstract

Introduction: Carotid artery dissection (CAD) and atherosclerotic carotid artery occlusion (ACAO) are major causes of a tandem occlusion in patients with intracranial large vessel occlusion (LVO). Presence of tandem occlusions may hamper intracranial access and potentially increases the risk of procedural complications of endovascular treatment (EVT). Our aim was to assess neurological, functional and technical outcome and complications of EVT for intracranial LVO in patients with CAD in comparison to patients with ACAO and to patients without CAD or ACAO. Methods: We analyzed data of the MR CLEAN trial intervention arm and MR CLEAN Registry, acquired in 16 Dutch EVT-centers. Primary outcome was the change in stroke severity by comparing the National Institute of Health Stroke Scale (NIHSS) score at 24–48 h after treatment vs. baseline. Secondary outcomes included reperfusion rate and symptomatic intracranial hemorrhage (sICH). We compared outcomes and complications between patients with CAD vs. patients with ACAO and patients without CAD or ACAO. Results: In total, we identified 74 (4.7%) patients with CAD, 92 (5.9%) patients with ACAO and 1398 (89.4%) patients without CAD or ACAO. Neurological improvement at short-term after EVT in patients with CAD was significantly better compared to ACAO (resp. mean −5 vs. mean −1 NIHSS point; p = 0.03) and did not differ compared to patients without CAD or ACAO (−4 NIHSS points; p = 0.62). Rates of successful reperfusion in patients with CAD (47%) was comparable to patients with ACAO (47%; p = 1.00), but was less often achieved compared to patients without CAD or ACAO (58%; p = 0.08). Occurrence of sICH did not differ significantly between CAD patients (5%) and ACAO (11%; p = 0.33) or without CAD/ACAO (6%; p = 1.00). Conclusion: EVT in patients with intracranial LVO due to CAD results in neurological improvement comparabl

Published
2019
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