المؤلفون: Venema, Esmee, Roozenbeek, Bob, Mulder, Maxim JHL, Brown, Scott, Majoie, Charles BLM, Steyerberg, Ewout W, Demchuk, Andrew M, Muir, Keith W, Dávalos, Antoni, Mitchell, Peter J, Bracard, Serge, Berkhemer, Olvert A, Lycklama à Nijeholt, Geert J, van Oostenbrugge, Robert J, Roos, Yvo BWEM, van Zwam, Wim H, van der Lugt, Aad, Hill, Michael D, White, Philip, Campbell, Bruce CV, Guillemin, Francis, Saver, Jeffrey L, Jovin, Tudor G, Goyal, Mayank, Dippel, Diederik WJ, Lingsma, Hester F, der Lugt, Aad van, Boiten, Jelis, Vos, Jan Albert, Jansen, Ivo GH, Goldhoorn, Robert-Jan B, Compagne, Kars CJ, Kappelhof, Manon, Brouwer, Josje, den Hartog, Sanne J, Hinsenveld, Wouter H, van Es, Adriaan CGM, Emmer, Bart J, Coutinho, Jonathan M, Schonewille, Wouter J, Wermer, Marieke JH, van Walderveen, Marianne AA, Staals, Julie, Hofmeijer, Jeannette, Martens, Jasper M, de Bruijn, Sebastiaan F, van Dijk, Lukas C, van der Worp, H Bart, Lo, Rob H, van Dijk, Ewoud J, Boogaarts, Hieronymus D, Vries, J de, de Kort, Paul LM, van Tuijl, Julia, Peluso, Jo P, Fransen, Puck, van den Berg, Jan SP, van Hasselt, Boudewijn AAM, Aerden, Leo AM, Dallinga, René J, Uyttenboogaart, Maarten, Eschgi, Omid, Bokkers, Reinoud PH, Schreuder, Tobien HCML, Heijboer, Roel JJ, Keizer, Koos, Yo, Lonneke SF, den Hertog, Heleen M, Bulut, Tomas, Brouwers, Paul JAM, Sprengers, Marieke ES, Jenniskens, Sjoerd FM, van den Berg, René, Yoo, Albert J, Beenen, Ludo FM, Postma, Alida A, Roosendaal, Stefan D, van der Kallen, Bas FW, van den Wijngaard, Ido R, Bot, Joost, van Doormaal, Pieter-Jan, Meijer, Anton, Ghariq, Elyas, van Proosdij, Marc P, Krietemeijer, G Menno, Lo, Rob, Gerrits, Dick, Dinkelaar, Wouter, Appelman, Auke PA

المصدر: Stroke. 52(9)

مصطلحات موضوعية: Clinical Trials and Supportive Activities, Clinical Research, Stroke, Brain Disorders, Neurosciences, Aged, Aged, 80 and over, Brain Ischemia, Endovascular Procedures, Humans, Ischemic Stroke, Male, Middle Aged, Registries, Thrombectomy, Treatment Outcome, ischemic stroke, registry, reperfusion, thrombectomy, uncertainty, HERMES collaborators and MR CLEAN Registry Investigators*, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Neurology & Neurosurgery

الوصف: Background and purposeBenefit of early endovascular treatment (EVT) for ischemic stroke varies considerably among patients. The MR PREDICTS decision tool, derived from MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), predicts outcome and treatment benefit based on baseline characteristics. Our aim was to externally validate and update MR PREDICTS with data from international trials and daily clinical practice.MethodsWe used individual patient data from 6 randomized controlled trials within the HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) collaboration to validate the original model. Then, we updated the model and performed a second validation with data from the observational MR CLEAN Registry. Primary outcome was functional independence (defined as modified Rankin Scale score 0–2) 3 months after stroke. Treatment benefit was defined as the difference between the probability of functional independence with and without EVT. Discriminative performance was evaluated using a concordance (C) statistic.ResultsWe included 1242 patients from HERMES (633 assigned to EVT, 609 assigned to control) and 3156 patients from the MR CLEAN Registry (all of whom underwent EVT within 6.5 hours). The C-statistic for functional independence was 0.74 (95% CI, 0.72–0.77) in HERMES and, after model updating, 0.80 (0.78–0.82) in the Registry. Median predicted treatment benefit of routinely treated patients (Registry) was 10.3% (interquartile range, 5.8%–14.4%). Patients with low (

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/44s4r133Test

المؤلفون: Hund, Hajo M., Boodt, Nikki, Hansen, Daniel, Haffmans, Willem A., Lycklama à Nijeholt, Geert J., Hofmeijer, Jeannette, Dippel, Diederik W. J., van der Lugt, Aad, van Es, Adriaan C. G. M., van Beusekom, Heleen M. M., Majoie, Charles B. L. M., Roos, Yvo B. W. E. M., van Oostenbrugge, Robert J., van Zwam, Wim H., Boiten, Jelis, Vos, Jan Albert, Jansen, Ivo G. H., Mulder, Maxim J. H. L., Goldhoorn, Robert- Jan B., Compagne, Kars C. J., Kappelhof, Manon, Brouwer, Josje, den Hartog, Sanne J., Hinsenveld, Wouter H., Roozenbeek, Bob, Emmer, Bart J., Coutinho, Jonathan M., Schonewille, Wouter J., Wermer, Marieke J. H., van Walderveen, Marianne A. A., Staals, Julie, Martens, Jasper M., de Bruijn, Sebastiaan F., van Dijk, Lukas C., van der Worp, H. Bart, Lo, Rob H., van Dijk, Ewoud J., Boogaarts, Hieronymus D., de Vries, J., de Kort, Paul L. M., van Tuijl, Julia, Peluso, Jo P., Fransen, Puck, van den Berg, Jan S. P., van Hasselt, Boudewijn A. A. M., Aerden, Leo A. M., Dallinga, René J., Uyttenboogaart, Maarten, Eschgi, Omid, Bokkers, Reinoud P. H.

المصدر: Neuroradiology ; volume 65, issue 5, page 933-943 ; ISSN 0028-3940 1432-1920

مصطلحات موضوعية: Cardiology and Cardiovascular Medicine, Neurology (clinical), Radiology, Nuclear Medicine and imaging

الوصف: Purpose The composition of thrombi retrieved during endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) due to large vessel occlusion (LVO) may differ depending on their origin. In this study, we investigated the association between thrombus composition and stroke etiology in a large population of patients from the Dutch MR CLEAN Registry treated with EVT in daily clinical practice. Methods The thrombi of 332 patients with AIS were histologically analyzed for red blood cells (RBC), fibrin/platelets (F/P), and white blood cells (leukocytes) using a machine learning algorithm. Stroke etiology was assessed using the Trial of Org 10,172 in acute stroke treatment (TOAST) classification. Results The thrombi of cardioembolic origin contained less RBC and more F/P than those of non-cardioembolic origin (25.8% vs 41.2% RBC [ p = 0.003] and 67.1% vs 54.5% F/P [ p = 0.004]). The likelihood of a non-cardioembolic source of stroke increased with increasing thrombus RBC content ( OR 1.02; [95% CI 1.00–1.06] for each percent increase) and decreased with a higher F/P content ( OR 1.02; [95% CI 1.00–1.06]). Thrombus composition in patients with a cardioembolic origin and undetermined origin was similar. Conclusion Thrombus composition is significantly associated with stroke etiology, with an increase in RBC and a decrease in F/P raising the odds for a non-cardioembolic cause. No difference between composition of cardioembolic thrombi and of undetermined origin was seen. This emphasizes the need for more extensive monitoring for arrhythmias and/or extended cardiac analysis in case of an undetermined origin.

الإتاحة: https://doi.org/10.1007/s00234-023-03115-yTest

المؤلفون: van der Ende, Nadinda A.M., Roozenbeek, Bob, Berkhemer, Olvert A., Koudstaal, Peter J., Boiten, Jelis, van Dijk, Ewoud J., Roos, Yvo B.W.E.M., van Oostenbrugge, Robert J., Majoie, Charles B.L.M., van Zwam, Wim, Lingsma, Hester F., van der Lugt, Aad, Dippel, Diederik W.J., Fransen, Puck S.S., Beumer, Debbie, van den Berg, Lucie A., Yoo, Albert J., Schonewille, Wouter J., Vos, Jan Albert, Nederkoorn, Paul J., Wermer, Marieke J.H., van Walderveen, Marianne A.A., Staals, Julie, Hofmeijer, Jeannette, van Oostayen, Jacques A., Lycklama a Nijeholt, Geert J., Brouwer, Patrick A., Emmer, Bart J., de Bruijn, Sebastiaan F., van Dijk, Lukas C., Kappelle, L. Jaap, Lo, Rob H., de Vries, Joost, de Kort, Paul L.M., van Rooij, Willem Jan J., van den Berg, Jan S.P., van Hasselt, Boudewijn A.A.M., Aerden, Leo A.M., Dallinga, Rene J., Visser, Marieke C., Bot, Joseph C.J., Vroomen, Patrick C., Eshghi, Omid, Schreuder, Tobien H.C.M.L., Heijboer, Roel J.J., Keizer, Koos, Tielbeek, Alexander V., den Hertog, Heleen M., Gerrits, Dick G., van den Berg-Vos, Renske M.

المصدر: Stroke ; volume 53, issue 1, page 61-69 ; ISSN 0039-2499 1524-4628

الوصف: Background and Purpose: Blinded outcome assessment in trials with prospective randomized open blinded end point design is challenging. Unblinding can result in misclassified outcomes and biased treatment effect estimates. An outcome adjudication committee assures blinded outcome assessment, but the added value for trials with prospective randomized open blinded end point design and subjective outcomes is unknown. We aimed to assess the degree of misclassification of modified Rankin Scale (mRS) scores by a central assessor and its impact on treatment effect estimates in a stroke trial with prospective randomized open blinded end point design. Methods: We used data from the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands). The primary outcome was the mRS at 90 days. Standardized, algorithm-based telephone interviews to assess the mRS were conducted from a central location by an experienced research nurse, unaware but not formally blinded to treatment allocation (central assessor). Masked reports of these interviews were adjudicated by a blinded outcome committee. Misclassification was defined as an incorrect classification of the mRS by the central assessor. The effect of endovascular treatment on the mRS was assessed with multivariable ordinal logistic regression. Results: In MR CLEAN, 53/500 (10.6%) of the mRS scores were misclassified. The degree and direction of misclassification did not differ between treatment arms ( P =0.59). Benefit of endovascular treatment was shown on the mRS when scored by the central assessor (adjusted common odds ratio, 1.60 [95% CI, 1.16–2.21]) and the outcome adjudication committee (adjusted common odds ratio, 1.67 [95% CI, 1.21–2.20]). Conclusions: Misclassification by the central assessor was small, randomly distributed over treatment arms, and did not affect treatment effect estimates. This study suggests that the added value of a blinded outcome adjudication committee is limited in a stroke trial with ...

الإتاحة: https://doi.org/10.1161/strokeaha.121.035301Test

المؤلفون: van der Steen, Wouter, van der Ende, Nadinda A.M., van Kranendonk, Katinka R., Chalos, Vicky, van Oostenbrugge, Robert J., van Zwam, Wim H., Roos, Yvo B.W.E.M., van Doormaal, Pieter J., van Es, Adriaan C.G.M., Lingsma, Hester F., Majoie, Charles B.L.M., van der Lugt, Aad, Dippel, Diederik W.J., Roozenbeek, Bob, Boiten, Jelis, Albert Vos, Jan, Jansen, Ivo G.H., Mulder, Maxim J.H.L., Goldhoorn, Robert- Jan B., Compagne, Kars C.J., Kappelhof, Manon, Brouwer, Josje, den Hartog, Sanne J., Emmer, Bart J., Coutinho, Jonathan M., Schonewille, Wouter J., Wermer, Marieke J.H., van Walderveen, Marianne A.A., Staals, Julie, Hofmeijer, Jeannette, Martens, Jasper M., Lycklama à Nijeholt, Geert J., de Bruijn, Sebastiaan F., van Dijk, Lukas C., van der Worp, H. Bart, Lo, Rob H., van Dijk, Ewoud J., Boogaarts, Hieronymus D., de Vries, J., de Kort, Paul L.M., van Tuijl, Julia, Peluso, Jo P., Fransen, Puck, van den Berg, Jan S.P., van Hasselt, Boudewijn A.A.M., Aerden, Leo A.M., Dallinga, René J., Uyttenboogaart, Maarten

المصدر: Stroke ; volume 53, issue 9, page 2818-2827 ; ISSN 0039-2499 1524-4628

الوصف: Background: Symptomatic intracranial hemorrhage (sICH) is a serious complication after endovascular treatment for ischemic stroke. We aimed to identify determinants of its occurrence and location. Methods: We retrospectively analyzed data from the Dutch MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) and MR CLEAN registry. We included adult patients with a large vessel occlusion in the anterior circulation who underwent endovascular treatment within 6.5 hours of stroke onset. We used univariable and multivariable logistic regression analyses to identify determinants of overall sICH occurrence, sICH within infarcted brain tissue, and sICH outside infarcted brain tissue. Results: SICH occurred in 203 (6%) of 3313 included patients and was located within infarcted brain tissue in 50 (25%), outside infarcted brain tissue in 23 (11%), and both within and outside infarcted brain tissue in 116 (57%) patients. In 14 patients (7%), data on location were missing. Prior antiplatelet use, baseline systolic blood pressure, baseline plasma glucose levels, post-endovascular treatment modified treatment in cerebral ischemia score, and duration of procedure were associated with all outcome parameters. In addition, determinants of sICH within infarcted brain tissue included history of myocardial infarction (adjusted odds ratio, 1.65 [95% CI, 1.06–2.56]) and poor collateral score (adjusted odds ratio, 1.42 [95% CI, 1.02–1.95]), whereas determinants of sICH outside infarcted brain tissue included level of occlusion on computed tomography angiography (internal carotid artery or internal carotid artery terminus compared with M1: adjusted odds ratio, 1.79 [95% CI, 1.16–2.78]). Conclusions: Several factors, some potentially modifiable, are associated with sICH occurrence. Further studies should investigate whether modification of baseline systolic blood pressure or plasma glucose level could reduce the risk of sICH. In addition, determinants differ per ...

الإتاحة: https://doi.org/10.1161/strokeaha.121.036195Test

المؤلفون: Almekhlafi, Mohammed, A, Goyal, Mayank, Dippel, Diederik, W J, Majoie, Charles, B L M, Campbell, Bruce, C V, Muir, Keith, W, Demchuk, Andrew, M, Bracard, Serge, Guillemin, Francis, Jovin, Tudor, G, Mitchell, Peter, J, White, Philip, Hill, Michael, D, Brown, Scott, Saver, Jeffrey, L, Berkhemer, Olvert, A, Fransen, Puck, S S, Beumer, Debbie, van den Berg, Lucie, A, Lingsma, Hester, F, Yoo, Albert, J, Schonewille, Wouter, J, Vos, Jan, Albert, Nederkoorn, Paul, J, Wermer, Marieke, J H, van Walderveen, Marianne, a A, Staals, Julie, Hofmeijer, Jeannette, van Oostayen, Jacques, A, Lycklama À Nijeholt, Geert, J, Boiten, Jelis, Brouwer, Patrick, A, Emmer, Bart, J, de Bruijn, Sebastiaan, F, van Dijk, Lukas, C, Kappelle, L, Jaap, Lo, Rob, H, van Dijk, Ewoud, J, de Vries, Joost, de Kort, Paul, L M, van Rooij, Willem, Jan J, van den Berg, Jan, S P, van Hasselt, Boudewijn, a a M, Aerden, Leo, a M, Dallinga, René, J, Visser, Marieke, C, Bot, Joseph, C J, Vroomen, Patrick, C, Eshghi, Omid, Schreuder, Tobien, H C M L, Heijboer, Roel, J J, Keizer, Koos, Tielbeek, Alexander, V, den Hertog, Heleen, M, Gerrits, Dick, G, van den Berg-Vos, Renske, M, Karas, Giorgos, B, Steyerberg, Ewout, W, Flach, H, Zwenneke, Marquering, Henk, A, Sprengers, Marieke, E S, Jenniskens, Sjoerd, F M, Beenen, Ludo, F M, van den Berg, René, Koudstaal, Peter, J, van Zwam, Wim, H, Roos, Yvo, B W E M, van Der Lugt, Aad, van Oostenbrugge, Robert, J, Menon, Bijoy, K, Eesa, Muneer, Rempel, Jeremy, L, Thornton, John, Roy, Daniel, Willinsky, Robert, A, Sapkota, Biggya, L, Dowlatshahi, Dar, Frei, Donald, F, Kamal, Noreen, R, Montanera, Walter, J, Poppe, Alexandre, y, Ryckborst, Karla, J, Silver, Frank, L, Shuaib, Ashfaq, Tampieri, Donatella, Williams, David, Bang, Oh, Young, Baxter, Blaise, W, Burns, Paul, A, Choe, Hana, Heo, Ji-Hoe, Holmstedt, Christine, A, Jankowitz, Brian, Kelly, Michael, Linares, Guillermo, Mandzia, Jennifer, L, Shankar, Jai, Sohn, Sung-Il, Swartz, Richard, H, Coutts, Shelagh, B, Smith, Eric, E, Morrish, William, F, Weill, Alain, Subramaniam, Suresh, Mitha, Alim, P, Wong, John, H, Lowerison, Mark, W, Sajobi, Tolulope, T, Bonafe, Alain, Diener, Hans, C, Levy, Elad, I, Pereira, Vitor, M, Albers, Gregory, W, Cognard, Christophe, Cohen, David, J, Hacke, Werner, Jansen, Olav, Mattle, Heinrich, P, Nogueira, Raul, G, Siddiqui, Adnan, H, Yavagal, Dileep, R, Devlin, Thomas, G, Lopes, Demetrius, K, Reddy, Vivek, K, Du Mesnil de Rochemont, Richard, Singer, Oliver, C, Jahan, Reza, Kleinig, Timothy, J, Dewey, Helen, M, Churilov, Leonid, Yassi, Nawaf, Yan, Bernard, Dowling, Richard, J, Parsons, Mark, W, Oxley, Thomas, J, Wu, Teddy, y, Brooks, Mark, Simpson, Marion, A, Miteff, Ferdinand, Levi, Christopher, R, Krause, Martin, Harrington, Timothy, J, Faulder, Kenneth, C, Steinfort, Brendan, S, Priglinger, Miriam, Ang, Timothy, Scroop, Rebecca, Barber, Philip, A, Mcguinness, Ben, Wijeratne, Tissa, Phan, Thanh, G, Chong, Winston, Chandra, Ronil, V, Bladin, Christopher, F, Badve, Monica, Rice, Henry, de Villiers, Laetitia, Ma, Henry, Desmond, Patricia, M, Donnan, Geoffrey, A, Davis, Stephen, M, Chamorro, Angel, Cobo, Erik, de Miquel, María, A, Molina, Carlos, A, Rovira, Alex, San Román, Luis, Serena, Joaquín, Abilleira, Sonia, Ribó, Marc, Millán, Mònica, Urra, Xabier, Cardona, Pere, López-Cancio, Elena, Tomasello, Alejandro, Castaño, Carlos, Blasco, Jordi, Aja, Lucía, Dorado, Laura, Quesada, Helena, Rubiera, Marta, Hernandez-Pérez, María, von Kummer, Rüdiger, Gallofré, Miquel, Dávalos, Antoni, Ford, Gary, A, Messow, Claudia-Martina, Ford, Ian, Murray, Alicia, Clifton, Andrew, Brown, Martin, M, Madigan, Jeremy, Lenthall, Rob, Robertson, Fergus, Dixit, Anand, Cloud, Geoffrey, C, Wardlaw, Joanna, Freeman, Janet, Ducrocq, Xavier, Mas, Jean, Louis, Soudant, Marc, Oppenheim, Catherine, Moulin, Thierry

المساهمون: University of Calgary, Erasmus University Medical Center Rotterdam (Erasmus MC), Department of Radiology and Nuclear Medicine Amsterdam, VU University Medical Center Amsterdam, University of Melbourne, University of Glasgow, Imagerie Adaptative Diagnostique et Interventionnelle (IADI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Département de neuroradiologie diagnostique et thérapeutique CHRU Nancy, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre d'investigation clinique Nancy (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), The Royal Melbourne Hospital, Newcastle University Newcastle, Altair Development, David Geffen School of Medicine Los Angeles, University of California Los Angeles (UCLA), University of California (UC)-University of California (UC)

المصدر: ISSN: 2168-6149.

مصطلحات موضوعية: [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology

الوصف: International audience ; The benefits of endovascular thrombectomy (EVT) are time dependent. Prior studies may have underestimated the time-benefit association because time of onset is imprecisely known. OBJECTIVE To assess the lifetime outcomes associated with speed of endovascular thrombectomy in patients with acute ischemic stroke due to large-vessel occlusion (LVO). DATA SOURCES PubMed was searched for randomized clinical trials of stent retriever thrombectomy devices vs medical therapy in patients with anterior circulation LVO within 12 hours of last known well time, and for which a peer-reviewed, complete primary results article was published by August 1, 2020.

العلاقة: info:eu-repo/semantics/altIdentifier/pmid/33938914; hal-03220460; https://hal.univ-lorraine.fr/hal-03220460Test; https://hal.univ-lorraine.fr/hal-03220460/documentTest; https://hal.univ-lorraine.fr/hal-03220460/file/jamaneurology_almekhlafi_2021_oi_210020_1619662792.50218.pdfTest; PUBMED: 33938914; PUBMEDCENTRAL: PMC8094030

الإتاحة: https://doi.org/10.1001/jamaneurol.2021.1055Test
https://hal.univ-lorraine.fr/hal-03220460Test
https://hal.univ-lorraine.fr/hal-03220460/documentTest
https://hal.univ-lorraine.fr/hal-03220460/file/jamaneurology_almekhlafi_2021_oi_210020_1619662792.50218.pdfTest

المؤلفون: den Hartog, Sanne J., Zaidat, Osama, Roozenbeek, Bob, van Es, Adriaan C. G. M., Bruggeman, Agnetha A. E., Emmer, Bart J., Majoie, Charles B. L. M., van Zwam, Wim H., van den Wijngaard, Ido R., van Doormaal, Pieter Jan, Lingsma, Hester F., Burke, James F., Dippel, Diederik W. J., van der Lugt, Aad, Roos, Yvo B. W. E. M., van Oostenbrugge, Robert J., Boiten, Jelis, Vos, Jan Albert, Jansen, Ivo G. H., Mulder, Maxim J. H. L., Goldhoorn, Robert‐Jan B., Compagne, Kars C. J., Kappelhof, Manon, Brouwer, Josje, Hinsenveld, Wouter H., Coutinho, Jonathan M., Schonewille, Wouter J., Wermer, Marieke J. H., van Walderveen, Marianne A. A., Staals, Julie, Hofmeijer, Jeannette, Martens, Jasper M., Lycklama à Nijeholt, Geert J., de Bruijn, Sebastiaan F., van Dijk, Lukas C., van der Worp, H. Bart, Lo, Rob H., van Dijk, Ewoud J., Boogaarts, Hieronymus D., de Vries, J., de Kort, Paul L. M., van Tuijl, Julia, Peluso, Jo P., Fransen, Puck, van den Berg, Jan S. P., van Hasselt, Boudewijn A. A. M., Aerden, Leo A. M., Dallinga, René J., Uyttenboogaart, Maarten, Eschgi, Omid

المصدر: Journal of the American Heart Association ; volume 10, issue 7 ; ISSN 2047-9980

الوصف: Background First‐pass reperfusion (FPR) is associated with favorable outcome after endovascular treatment. It is unknown whether this effect is independent of patient characteristics and whether FPR has better outcomes compared with excellent reperfusion (Expanded Thrombolysis in Cerebral Infarction [eTICI] 2C‐3) after multiple‐passes reperfusion. We aimed to evaluate the association between FPR and outcome with adjustment for patient, imaging, and treatment characteristics to single out the contribution of FPR. Methods and Results FPR was defined as eTICI 2C‐3 after 1 pass. Multivariable regression models were used to investigate characteristics associated with FPR and to investigate the effect of FPR on outcomes. We included 2686 patients of the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry. Factors associated with FPR were as follows: history of hyperlipidemia (adjusted odds ratio [OR], 1.05; 95% CI, 1.01–1.10), middle cerebral artery versus intracranial carotid artery occlusion (adjusted OR, 1.11; 95% CI, 1.06–1.16), and aspiration versus stent thrombectomy (adjusted OR, 1.07; 95% CI, 1.03–1.11). Interventionist experience increased the likelihood of FPR (adjusted OR, 1.03 per 50 patients previously treated; 95% CI, 1.01–1.06). Adjusted for patient, imaging, and treatment characteristics, FPR remained associated with a better 24‐hour National Institutes of Health Stroke Scale (NIHSS) score (−37%; 95% CI, −43% to −31%) and a better modified Rankin Scale (mRS) score at 3 months (adjusted common OR, 2.16; 95% CI, 1.83–2.54) compared with no FPR (multiple‐passes reperfusion+no excellent reperfusion), and compared with multiple‐passes reperfusion alone (24‐hour NIHSS score, (−23%; 95% CI, −31% to −14%), and mRS score (adjusted common OR, 1.45; 95% CI, 1.19–1.78)). Conclusions FPR compared with multiple‐passes reperfusion is associated with favorable outcome, independently of patient, imaging, and treatment characteristics. Factors ...

الإتاحة: https://doi.org/10.1161/jaha.120.019988Test

المؤلفون: Chalos, Vicky, van der Ende, Nadinda A. M., Lingsma, Hester F., Mulder, Maxim J. H. L., Venema, Esmee, Dijkland, Simone A., Berkhemer, Olvert A., Yoo, Albert J., Broderick, Joseph P., Palesch, Yuko Y., Yeatts, Sharon D., Roos, Yvo B. W. E. M., van Oostenbrugge, Robert J., van Zwam, Wim H., Majoie, Charles B. L. M., van der Lugt, Aad, Roozenbeek, Bob, Dippel, Diederik W. J., Fransen, Puck S. S., Beumer, Debbie, van den Berg, Lucie A., Schonewille, Wouter J., Vos, Jan Albert, Nederkoorn, Paul J., Wermer, Marieke J. H., van Walderveen, Marianne A. A., Staals, Julie, Hofmeijer, Jeannette, van Oostayen, Jacques A., Nijeholt, Geert J. Lycklama A., Boiten, Jelis, Brouwer, Patrick A., Emmer, Bart J., de Bruijn, Sebastiaan F., van Dijk, Lukas C., Kappelle, L. Jaap, Lo, Rob H., van Dijk, Ewoud J., de Vries, Joost, de Kort, Paul L. M., van Rooij, Willem Jan J., van den Berg, Jan S. P., van Hasselt, Boudewijn A. A. M., Aerden, Leo A. M., Dallinga, Rene J., Visser, Marieke C., Bot, Joseph C. J.

المصدر: Chalos , V , van der Ende , N A M , Lingsma , H F , Mulder , M J H L , Venema , E , Dijkland , S A , Berkhemer , O A , Yoo , A J , Broderick , J P , Palesch , Y Y , Yeatts , S D , Roos , Y B W E M , van Oostenbrugge , R J , van Zwam , W H , Majoie , C B L M , van der Lugt , A , Roozenbeek , B , Dippel , D W ....

مصطلحات موضوعية: endovascular treatment, informed consent, NIHSS, outcome, stroke, thrombectomy, SURROGATE END-POINTS, CLINICAL-TRIALS, PLASMINOGEN-ACTIVATOR, ENDOVASCULAR THERAPY, RANDOMIZED-TRIAL, ALTEPLASE, SEVERITY

الوصف: Background and Purpose- The modified Rankin Scale (mRS) at 3 months is the most commonly used primary outcome measure in stroke treatment trials, but it lacks specificity and requires long-term follow-up interviews, which consume time and resources. An alternative may be the National Institutes of Health Stroke Scale (NIHSS), early after stroke. Our aim was to evaluate whether the NIHSS assessed within 1 week after treatment could serve as a primary outcome measure for trials of acute treatment for ischemic stroke. Methods- We used data from 2 randomized controlled trials of endovascular treatment for ischemic stroke: the positive MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands; N=500) and the neutral IMS (Interventional Management of Stroke) III trial (N=656). We used a causal mediation model, with linear and ordinal logistic regression adjusted for confounders, to evaluate the NIHSS 24 hours and 5 to 7 days after endovascular treatment as primary outcome measures (instead of the mRS at 3 months) in both trials. Patients who had died before the NIHSS was assessed received the maximum score of 42. NIHSS+1 was then log10-transformed. Results- In both trials, there was a significant correlation between the NIHSS at 24 hours and 5 to 7 days and the mRS. In MR CLEAN, we found a significant effect of endovascular treatment on the mRS and on the NIHSS at 24 hours and 5 to 7 days. After adjustment for NIHSS at 24 hours and 5 to 7 days, the effect of endovascular treatment on the mRS decreased from common odds ratio 1.68 (95% CI, 1.22-2.32) to respectively 1.36 (95% CI, 0.97-1.91) and 1.24 (95% CI, 0.87-1.79), indicating that treatment effect on the mRS is in large part mediated by the NIHSS. In the IMS III trial there was no treatment effect on the NIHSS at 24 hours and 5 to 7 days, corresponding with the absence of a treatment effect on the mRS. Conclusions- The NIHSS within 1 week satisfies the requirements for a surrogate end point and may be ...

العلاقة: https://cris.maastrichtuniversity.nl/en/publications/1684c0ea-c367-4808-926f-61026fb6d55cTest

الإتاحة: https://doi.org/10.1161/STROKEAHA.119.026791Test
https://cris.maastrichtuniversity.nl/en/publications/1684c0ea-c367-4808-926f-61026fb6d55cTest

المؤلفون: Wiegers, Eveline J.A., Mulder, Maxim J.H.L., Jansen, Ivo G.H., Venema, Esmee, Compagne, Kars C.J., Berkhemer, Olvert A., Emmer, Bart J., Marquering, Henk A., van Es, Adriaan C.G.M., Sprengers, Marieke E., van Zwam, Wim H., van Oostenbrugge, Robert J., Roos, Yvo B.W.E.M., Majoie, Charles B.L.M., Roozenbeek, Bob, Lingsma, Hester F., Dippel, Diederik W.J., van der Lugt, Aad, Boiten, Jelis, Vos, Jan Albert, Brouwer, Josje, den Hartog, Sanne J., Hinsenveld, Wouter H., Kappelhof, Manon, Goldhoorn, Robert-Jan B., Coutinho, Jonathan M., Schonewille, Wouter J., Wermer, Marieke J.H., van Walderveen, Marianne A.A., Staals, Julie, Hofmeijer, Jeannette, Martens, Jasper M., Lycklama à Nijeholt, Geert J., de Bruijn, Sebastiaan F., van Dijk, Lukas C., van der Worp, H. Bart, Lo, Rob H., van Dijk, Ewoud J., Boogaarts, Hieronymus D., de Vries, J., de Kort, Paul L.M., van Tuijl, Julia, Peluso, Jo Jo P., Fransen, Puck, van den Berg, Jan S.P., van Hasselt, Boudewijn A.A.M., Aerden, Leo A.M., Dallinga, René J., Uyttenboogaart, Maarten

المصدر: Stroke ; volume 51, issue 5, page 1493-1502 ; ISSN 0039-2499 1524-4628

الوصف: Background and Purpose— Collateral circulation status at baseline is associated with functional outcome after ischemic stroke and effect of endovascular treatment. We aimed to identify clinical and imaging determinants that are associated with collateral grade on baseline computed tomography angiography in patients with acute ischemic stroke due to an anterior circulation large vessel occlusion. Methods— Patients included in the MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands; n=500) and MR CLEAN Registry (n=1488) were studied. Collateral status on baseline computed tomography angiography was scored from 0 (absent) to 3 (good). Multivariable ordinal logistic regression analyses were used to test the association of selected determinants with collateral status. Results— In total, 1988 patients were analyzed. Distribution of the collateral status was as follows: absent (7%, n=123), poor (32%, n=596), moderate (39%, n=735), and good (23%, n=422). Associations for a poor collateral status in a multivariable model existed for age (adjusted common odds ratio, 0.92 per 10 years [95% CI, 0.886–0.98]), male (adjusted common odds ratio, 0.64 [95% CI, 0.53–0.76]), blood glucose level (adjusted common odds ratio, 0.97 [95% CI, 0.95–1.00]), and occlusion of the intracranial segment of the internal carotid artery with occlusion of the terminus (adjusted common odds ratio 0.50 [95% CI, 0.41–0.61]). In contrast to previous studies, we did not find an association between cardiovascular risk factors and collateral status. Conclusions— Older age, male sex, high glucose levels, and intracranial internal carotid artery with occlusion of the terminus occlusions are associated with poor computed tomography angiography collateral grades in patients with acute ischemic stroke eligible for endovascular treatment.

الإتاحة: https://doi.org/10.1161/strokeaha.119.027483Test

المؤلفون: Ospel, Johanna, Kappelhof, Manon, Groot, Adrien E., LeCouffe, Natalie E., Coutinho, Jonathan M., Yoo, Albert J., Yo, Lonneke S.F., Beenen, Ludo F.M., van Zwam, Wim H., van der Lugt, Aad, Postma, Alida A., Roos, Yvo B.W.E.M., Goyal, Mayank, Majoie, Charles B.L.M., Dippel, Diederik W.J., van Oostenbrugge, Robert J., Boiten, Jelis, Albert Vos, Jan, Jansen, Ivo G.H., Mulder, Maxim J.H.L., Goldhoorn, Robert- Jan B., Compagne, Kars C.J., Brouwer, Josje, den Hartog, Sanne J., Hinsenveld, Wouter H., Roozenbeek, Bob, van Es, Adriaan C.G.M., Emmer, Bart J., Schonewille, Wouter J., Wermer, Marieke J.H., van Walderveen, Marianne A.A., Staals, Julie, Hofmeijer, Jeannette, Martens, Jasper M., Lycklama à Nijeholt, Geert J., de Bruijn, Sebastiaan F., van Dijk, Lukas C., van der Worp, H. Bart, Lo, Rob H., van Dijk, Ewoud J., Boogaarts, Hieronymus D., de Vries, J., de Kort, Paul L.M., van Tuijl, Julia, Peluso, Jo P., Fransen, Puck, van den Berg, Jan S.P., van Hasselt, Boudewijn A.A.M., Aerden, Leo A.M., Dallinga, René J.

المصدر: Stroke ; volume 51, issue 12, page 3742-3745 ; ISSN 0039-2499 1524-4628

الوصف: Background and Purpose: Ischemic brain tissue damage in patients with acute ischemic stroke, as measured by the Alberta Stroke Program Early CT Score (ASPECTS) may be more impactful in older than in younger patients, although this has not been studied. We aimed to investigate a possible interaction effect between age and ASPECTS on functional outcome in acute ischemic stroke patients undergoing endovascular treatment, and compared reperfusion benefit across age and ASPECTS subgroups. Methods: Patients with ischemic stroke from the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands; March 2014–November 2017) were included. Multivariable ordinal logistic regression was performed to obtain effect size estimates (adjusted common odds ratio) on functional outcome (modified Rankin Scale score) for continuous age and granular ASPECTS, with a 2-way multiplicative interaction term (age×ASPECTS). Outcomes in four patient subgroups based on age (< versus ≥ median age [71.8 years]) and baseline ASPECTS (6–10 versus 0–5) were assessed. Results: We included 3279 patients. There was no interaction between age and ASPECTS on modified Rankin Scale ( P =0.925). The highest proportion of modified Rankin Scale 5 to 6 was observed in patients >71.8 years with baseline ASPECTS 0 to 5 (68/107, 63.6%). There was benefit of reperfusion in all age-ASPECTS subgroups. Although the adjusted common odds ratio was lower in patients >71.8 years with ASPECTS 0 to 5 (adjusted common odds ratio, 1.60 [95% CI, 0.66–3.88], n=110), there was no significant difference from the main effect ( P =0.299). Conclusions: Although the proportion of poor outcomes following endovascular treatment was highest in older patients with low baseline ASPECTS, outcomes did not significantly differ from the main effect. These results do not support withholding endovascular treatment based n a combination of high age and low ASPECTS.

الإتاحة: https://doi.org/10.1161/strokeaha.120.031773Test

المؤلفون: Wiegers, Eveline J.A., Compagne, Kars C.J., Janssen, Paula M., Venema, Esmee, Deckers, Jaap W., Schonewille, Wouter J., Albert Vos, Jan, Lycklama à Nijeholt, Geert J., Roozenbeek, Bob, Martens, Jasper M., Hofmeijer, Jeannette, van Oostenbrugge, Robert-Jan, van Zwam, Wim H., Majoie, Charles B.L.M., van der Lugt, Aad, Lingsma, H.F., Roos, Yvo B.W.E.M., Dippel, Diederik W.J., Boiten, Jelis, Brouwer, Josje, den Hartog, Sanne J., Hinsenveld, Wouter H., Kappelhof, Manon, Goldhoorn, Robert-Jan B., Mulder, Maxim J.H.L., Jansen, Ivo G.H., van Es, Adriaan C.G.M., Emmer, Bart J., Coutinho, Jonathan M., Wermer, Marieke J.H., van Walderveen, Marianne A.A., Staals, Julie, de Bruijn, Sebastiaan F., van Dijk, Lukas C., van der Worp, H. Bart, Lo, Rob H., van Dijk, Ewoud J., Boogaarts, Hieronymus D., Vries, J. de, de Kort, Paul L.M., van Tuijl, Julia, Peluso, Jo Jo P., Fransen, Puck, van den Berg, Jan S.P., van Hasselt, Boudewijn A.A.M., Aerden, Leo A.M., Dallinga, René J., Uyttenboogaart, Maarten, Eschgi, Omid

المصدر: Stroke ; volume 51, issue 7, page 1941-1950 ; ISSN 0039-2499 1524-4628

الوصف: 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 ...

الإتاحة: https://doi.org/10.1161/strokeaha.119.026731Test