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Your search keyword '"Nijeholt, GJL"' showing total 4 results
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4 results on '"Nijeholt, GJL"'

1. Comparison of eight prehospital stroke scales to detect intracranial large-vessel occlusion in suspected stroke (PRESTO): a prospective observational study

Author

Duvekot, Martijne, Venema, Esmee, Rozeman, AD, Moudrous, W, Vermeij, FH, Biekart, M, Lingsma, Hester, Maasland, L, Wijnhoud, AD, Mulder, LJM, Alblas, KCL, van Eijkelenburg, RPJ, Buijck, Bianca, Bakker, J, Plaisier, AS, Hensen, JHJ, Nijeholt, GJL, van Doormaal, Pieter Jan, van Es, AC, van der Lugt, Aad, Kerkhoff, H, Dippel, Diederik, Roozenbeek, Bob, Duvekot, Martijne, Venema, Esmee, Rozeman, AD, Moudrous, W, Vermeij, FH, Biekart, M, Lingsma, Hester, Maasland, L, Wijnhoud, AD, Mulder, LJM, Alblas, KCL, van Eijkelenburg, RPJ, Buijck, Bianca, Bakker, J, Plaisier, AS, Hensen, JHJ, Nijeholt, GJL, van Doormaal, Pieter Jan, van Es, AC, van der Lugt, Aad, Kerkhoff, H, Dippel, Diederik, and Roozenbeek, Bob

Abstract

Background: Due to the time-sensitive effect of endovascular treatment, rapid prehospital identification of large-vessel occlusion in individuals with suspected stroke is essential to optimise outcome. Interhospital transfers are an important cause of delay of endovascular treatment. Prehospital stroke scales have been proposed to select patients with large-vessel occlusion for direct transport to an endovascular-capable intervention centre. We aimed to prospectively validate eight prehospital stroke scales in the field. Methods: We did a multicentre, prospective, observational cohort study of adults with suspected stroke (aged ≥18 years) who were transported by ambulance to one of eight hospitals in southwest Netherlands. Suspected stroke was defined by a positive Face-Arm-Speech-Time (FAST) test. We included individuals with blood glucose of at least 2·5 mmol/L. People who presented more than 6 h after symptom onset were excluded from the analysis. After structured training, paramedics used a mobile app to assess items from eight prehospital stroke scales: Rapid Arterial oCclusion Evaluation (RACE), Los Angeles Motor Scale (LAMS), Cincinnati Stroke Triage Assessment Tool (C-STAT), Gaze-Face-Arm-Speech-Time (G-FAST), Prehospital Acute Stroke Severity (PASS), Cincinnati Prehospital Stroke Scale (CPSS), Conveniently-Grasped Field Assessment Stroke Triage (CG-FAST), and the FAST-PLUS (Face-Arm-Speech-Time plus severe arm or leg motor deficit) test. The primary outcome was the clinical diagnosis of ischaemic stroke with a proximal intracranial large-vessel occlusion in the anterior circulation (aLVO) on CT angiography. Baseline neuroimaging was centrally assessed by neuroradiologists to validate the true occlusion status. Prehospital stroke scale performance was expressed as the area under the receiver operating characteristic curve (AUC) and was compared with National Institutes of Health Stroke Scale (NIHSS) scores assessed by clinicians at the emergency departmen

Published
2021

2. The effect of anesthetic management during intra-arterial therapy for acute stroke in MR CLEAN

Author

Berkhemer, Olvert, van den Berg, LA, Fransen, Puck, Beumer, D, Yoo, AJ, Lingsma, Hester, Schonewille, WJ, van den Berg, R, Wermer, MJH, Boiten, J, Nijeholt, GJL, Nederkoorn, PJ, Hollmann, MW, Zwam, WH, van der Lugt, Aad, van Oostenbrugge, RJ, Majoie, CBLM, Dippel, Diederik, Roos, YBWEM, Neurology, Public Health, and Radiology & Nuclear Medicine

Abstract

Background: The aim of the current study was to assess the influence of anesthetic management on the effect of treatment in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN). Methods: MR CLEAN was amulticenter, randomized, open-label trial of intra-arterial therapy (IAT) vs no IAT. The intended anesthetic management at the start of the procedure was used for this post hoc analysis. The primary effect parameter was the adjusted common odds ratio (acOR) for a shift in direction of a better outcome on the modified Rankin Scale (mRS) at 90 days, estimated with multivariable ordinal logistic regression analysis, which included a term for general anesthesia (GA). Results: GA was associated with significant (p=0.011) effect modification, resulting in estimated decrease of 51%(95% confidence interval [CI] 31%-86%) in treatment effect compared to non-GA. We found a shift in the distribution on the mRS in favor of non-GA compared to control group (acOR 2.18 [95% CI 1.49-3.20]). The shift in distribution between GA and control group was in a similar direction (acOR 1.12 [95% CI 0.71-1.78]) with loss of statistical significance. Conclusions: In this post hoc analysis, we found that the type of anesthetic management influences outcome following IAT. Only treatment without general anesthesia was associated with a significant treatment benefit in MR CLEAN. Classification of evidence: This study provides Class II evidence that for patients with acute ischemic stroke undergoing IAT, mRS scores at 90 days improve only in patients treated without GA.

Published
2016

4. Value of CT Perfusion for Collateral Status Assessment in Patients with Acute Ischemic Stroke.

Author

Prasetya H, Tolhuisen ML, Koopman MS, Kappelhof M, Meijer FJA, Yo LSF, Á Nijeholt GJL, van Zwam WH, van der Lugt A, Roos YBWEM, Majoie CBLM, van Bavel ET, Marquering HA, and On Behalf Of The Mr Clean Registry Investigators

Abstract

Good collateral status in acute ischemic stroke patients is an important indicator for good outcomes. Perfusion imaging potentially allows for the simultaneous assessment of local perfusion and collateral status. We combined multiple CTP parameters to evaluate a CTP-based collateral score. We included 85 patients with a baseline CTP and single-phase CTA images from the MR CLEAN Registry. We evaluated patients' CTP parameters, including relative CBVs and tissue volumes with several time-to-maximum ranges, to be candidates for a CTP-based collateral score. The score candidate with the strongest association with CTA-based collateral score and a 90-day mRS was included for further analyses. We assessed the association of the CTP-based collateral score with the functional outcome (mRS 0-2) by analyzing three regression models: baseline prognostic factors (model 1), model 1 including the CTA-based collateral score (model 2), and model 1 including the CTP-based collateral score (model 3). The model performance was evaluated using C-statistic. Among the CTP-based collateral score candidates, relative CBVs with a time-to-maximum of 6-10 s showed a significant association with CTA-based collateral scores ( p = 0.02) and mRS ( p = 0.05) and was therefore selected for further analysis. Model 3 most accurately predicted favorable outcomes (C-statistic = 0.86, 95% CI: 0.77-0.94) although differences between regression models were not statistically significant. We introduced a CTP-based collateral score, which is significantly associated with functional outcome and may serve as an alternative collateral measure in settings where MR imaging is not feasible.

Published
2022
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