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Ali M, van Etten ES, Akoudad S, Schaafsma JD, Visser MC, Ali M, Cordonnier C, Sandset EC, Klijn CJM, Ruigrok YM, Wermer MJH. Haemorrhagic stroke and brain vascular malformations in women: risk factors and clinical features. Lancet Neurol 2024; 23:625-635. [PMID: 38760100 DOI: 10.1016/s1474-4422(24)00122-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/18/2024] [Accepted: 03/14/2024] [Indexed: 05/19/2024]
Abstract
Haemorrhagic stroke is a severe condition with poor prognosis. Biological sex influences the risk factors, presentations, treatment, and patient outcomes of intracerebral haemorrhage, aneurysmal subarachnoid haemorrhage, and vascular malformations. Women are usually older at onset of intracerebral haemorrhage compared with men but have an increased risk of aneurysmal subarachnoid haemorrhage as they age. Female-specific factors such as pregnancy, eclampsia or pre-eclampsia, postmenopausal status, and hormone therapy influence a woman's long-term risk of haemorrhagic stroke. The presence of intracranial aneurysms, arteriovenous malformations, or cavernous malformations poses unique clinical dilemmas during pregnancy and delivery. In the absence of evidence-based guidelines for managing the low yet uncertain risk of haemorrhagic stroke during pregnancy and delivery in women with vascular malformations, multidisciplinary teams should carefully assess the risks and benefits of delivery methods for these patients. Health-care providers should recognise and address the challenges that women might have to confront when recovering from haemorrhagic stroke.
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Affiliation(s)
- Mariam Ali
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands.
| | - Ellis S van Etten
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands
| | - Saloua Akoudad
- Department of Neurology, University Medical Centre Groningen, Groningen, Netherlands
| | - Joanna D Schaafsma
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Marieke C Visser
- Department of Neurology, Amsterdam University Medical Centre, Location AMC, Amsterdam, Netherlands
| | - Mahsoem Ali
- Department of Surgery, Amsterdam University Medical Centre, Location VUmc, Amsterdam, Netherlands
| | - Charlotte Cordonnier
- University Lille, Inserm, CHU Lille, UMR-S1172, Lille Neuroscience and Cognition, Lille, France
| | - Else Charlotte Sandset
- Department of Neurology, Stroke Unit, Oslo University Hospital, Oslo, Norway; The Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Catharina J M Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Ynte M Ruigrok
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Marieke J H Wermer
- Department of Neurology, University Medical Centre Groningen, Groningen, Netherlands
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2
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Ali M, Dekker L, Daems JD, Ali M, van Zwet EW, Steyerberg EW, Duvekot MHC, Nguyen TTM, Moudrous W, van de Wijdeven RM, Visser MC, de Laat KF, Kerkhoff H, van den Wijngaard IR, Dippel DWJ, Roozenbeek B, Kruyt ND, Wermer MJH. Sex Differences in Prehospital Identification of Large Vessel Occlusion in Patients With Suspected Stroke. Stroke 2024; 55:548-554. [PMID: 38299328 PMCID: PMC10896195 DOI: 10.1161/strokeaha.123.044898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/03/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Differences in clinical presentation of acute ischemic stroke between men and women may affect prehospital identification of anterior circulation large vessel occlusion (aLVO). We assessed sex differences in diagnostic performance of 8 prehospital scales to detect aLVO. METHODS We analyzed pooled individual patient data from 2 prospective cohort studies (LPSS [Leiden Prehospital Stroke Study] and PRESTO [Prehospital Triage of Patients With Suspected Stroke Study]) conducted in the Netherlands between 2018 and 2019, including consecutive patients ≥18 years suspected of acute stroke who presented within 6 hours after symptom onset. Ambulance paramedics assessed clinical items from 8 prehospital aLVO detection scales: Los Angeles Motor Scale, Rapid Arterial Occlusion Evaluation, Cincinnati Stroke Triage Assessment Tool, Cincinnati Prehospital Stroke Scale, Prehospital Acute Stroke Severity, gaze-face-arm-speech-time, Conveniently Grasped Field Assessment Stroke Triage, and Face-Arm-Speech-Time Plus Severe Arm or Leg Motor Deficit. We assessed the diagnostic performance of these scales for identifying aLVO at prespecified cut points for men and women. RESULTS Of 2358 patients with suspected stroke (median age, 73 years; 47% women), 231 (10%) had aLVO (100/1114 [9%] women and 131/1244 [11%] men). The area under the curve of the scales ranged from 0.70 (95% CI, 0.65-0.75) to 0.77 (95% CI, 0.73-0.82) in women versus 0.69 (95% CI, 0.64-0.73) to 0.75 (95% CI, 0.71-0.79) in men. Positive predictive values ranged from 0.23 (95% CI, 0.20-0.27) to 0.29 (95% CI, 0.26-0.31) in women versus 0.29 (95% CI, 0.24-0.33) to 0.37 (95% CI, 0.32-0.43) in men. Negative predictive values were similar (0.95 [95% CI, 0.94-0.96] to 0.98 [95% CI, 0.97-0.98] in women versus 0.94 [95% CI, 0.93-0.95] to 0.96 [95% CI, 0.94-0.97] in men). Sensitivity of the scales was slightly higher in women than in men (0.53 [95% CI, 0.43-0.63] to 0.76 [95% CI, 0.68-0.84] versus 0.49 [95% CI, 0.40-0.57] to 0.63 [95% CI, 0.55-0.73]), whereas specificity was lower (0.79 [95% CI, 0.76-0.81] to 0.87 [95% CI, 0.84-0.89] versus 0.82 [95% CI, 0.79-0.84] to 0.90 [95% CI, 0.88-0.91]). Rapid arterial occlusion evaluation showed the highest positive predictive values in both sexes (0.29 in women and 0.37 in men), reflecting the different event rates. CONCLUSIONS aLVO scales show similar diagnostic performance in both sexes. The rapid arterial occlusion evaluation scale may help optimize prehospital transport decision-making in men as well as in women with suspected stroke.
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Affiliation(s)
- Mariam Ali
- Department of Neurology (Mariam Ali, L.D., I.R.v.d.W., N.D.K., M.J.H.W., T.T.M.N.), Leiden University Medical Center, the Netherlands
| | - Luuk Dekker
- Department of Neurology (Mariam Ali, L.D., I.R.v.d.W., N.D.K., M.J.H.W., T.T.M.N.), Leiden University Medical Center, the Netherlands
| | - Jasper D Daems
- Department of Neurology (J.D.D., M.H.C.D., R.M.v.d.W., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Public Health (J.D.D.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | | | - Erik W van Zwet
- Department of Biomedical Data Sciences (E.W.v.Z., E.W.S.), Leiden University Medical Center, the Netherlands
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences (E.W.v.Z., E.W.S.), Leiden University Medical Center, the Netherlands
| | - Martijne H C Duvekot
- Department of Neurology (J.D.D., M.H.C.D., R.M.v.d.W., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (M.H.C.D., H.K.)
| | - T Truc My Nguyen
- Department of Neurology (Mariam Ali, L.D., I.R.v.d.W., N.D.K., M.J.H.W., T.T.M.N.), Leiden University Medical Center, the Netherlands
| | - Walid Moudrous
- Department of Neurology, Maasstad Hospital, Rotterdam, the Netherlands (W.M.)
| | - Ruben M van de Wijdeven
- Department of Neurology (J.D.D., M.H.C.D., R.M.v.d.W., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Marieke C Visser
- Department of Neurology (M.C.V.)
- Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands (M.C.V.)
| | - Karlijn F de Laat
- Department of Neurology, Haga Hospital, the Hague, the Netherlands (K.F.d.L.)
| | - Henk Kerkhoff
- Department of Neurology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (M.H.C.D., H.K.)
| | - Ido R van den Wijngaard
- Department of Neurology (Mariam Ali, L.D., I.R.v.d.W., N.D.K., M.J.H.W., T.T.M.N.), Leiden University Medical Center, the Netherlands
- Department of Neurology, Haaglanden Medical Center, the Hague, the Netherlands (I.R.v.d.W.)
- University Neurovascular Center Leiden-The Hague, the Netherlands (I.R.v.d.W., N.D.K.)
| | - Diederik W J Dippel
- Department of Neurology (J.D.D., M.H.C.D., R.M.v.d.W., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Bob Roozenbeek
- Department of Neurology (J.D.D., M.H.C.D., R.M.v.d.W., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Nyika D Kruyt
- Department of Neurology (Mariam Ali, L.D., I.R.v.d.W., N.D.K., M.J.H.W., T.T.M.N.), Leiden University Medical Center, the Netherlands
- University Neurovascular Center Leiden-The Hague, the Netherlands (I.R.v.d.W., N.D.K.)
| | - Marieke J H Wermer
- Department of Neurology (Mariam Ali, L.D., I.R.v.d.W., N.D.K., M.J.H.W., T.T.M.N.), Leiden University Medical Center, the Netherlands
- Department of Neurology, University Medical Centre Groningen, University of Groningen, the Netherlands (M.J.H.W.)
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Ali M, Dekker L, Ali M, Van Zwet EW, Hofmeijer J, Nederkoorn PJ, Majoie CB, van Es AC, Uyttenboogaart M, van der Meij A, van Walderveen MAA, Visser MC, Dippel DW, Schonewille WJ, van den Wijngaard IR, Kruyt ND, Wermer MJH. Sex differences in outcomes after endovascular treatment in posterior circulation stroke: results from the MR CLEAN Registry. J Neurointerv Surg 2024:jnis-2023-021086. [PMID: 38171605 DOI: 10.1136/jnis-2023-021086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Women with anterior circulation large vessel occlusion (LVO) have been reported to have worse outcomes after endovascular treatment (EVT) than men. Whether these disparities also exist in LVO of the posterior circulation is yet uncertain. We assessed sex differences in clinical, technical, and safety outcomes of EVT in posterior circulation LVO. METHODS We used data of patients with posterior circulation LVO included in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry (2014-2018). Primary outcome was the modified Rankin Scale (mRS) score at 90 days assessed with multivariable ordinal regression analysis. Secondary outcomes included favorable functional outcome (mRS ≤3), functional independence (mRS ≤2), death within 90 days, National Institutes of Health Stroke Scale (NIHSS) score 24-48 hours postintervention, complications, successful reperfusion (extended Thrombolysis in Cerebral Ischemia 2B-3), and procedure duration analyzed with multivariable logistic and linear regression analyses. RESULTS We included 264 patients (42% women). Compared with men, women were older (median age 68 vs 63 years), more often had prestroke disability (mRS ≥1: 37% vs 30%), and received intravenous thrombolytics less often (45% vs 56%). Clinical outcomes were similar between sexes (adjusted (common) OR (aOR) 0.82, 95% CI 0.51 to 1.34; favorable functional outcome 50% vs 43%, aOR 1.31, 95% CI 0.77 to 2.25; death 32% vs 29%, aOR 0.98, 95% CI 0.52 to 1.84). In addition, NIHSS score after 24-48 hours (median 7 vs 9), successful reperfusion (77% vs 73%), and complications did not differ between men and women. CONCLUSIONS Outcomes in women treated with EVT for posterior circulation LVO were similar compared with men despite less favorable baseline characteristics in women. Therefore men and women may benefit equally from EVT.
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Affiliation(s)
- Mariam Ali
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Luuk Dekker
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mahsoem Ali
- Department of Surgery, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Erik W Van Zwet
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeanette Hofmeijer
- Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
- Clinical Neurophysiology, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Charles Blm Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Adriaan Cgm van Es
- Department of Radiology and Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten Uyttenboogaart
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anne van der Meij
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | | | - Marieke C Visser
- Department of Neurology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Diederik Wj Dippel
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Ido R van den Wijngaard
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Nyika D Kruyt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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4
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van Stigt MN, Groenendijk EA, van Meenen LCC, van de Munckhof AAGA, Theunissen M, Franschman G, Smeekes MD, van Grondelle JAF, Geuzebroek G, Siegers A, Visser MC, van Schaik SM, Halkes PHA, Majoie CBLM, Roos YBWEM, Koelman JHTM, Koopman MS, Marquering HA, Potters WV, Coutinho JM. Prehospital Detection of Large Vessel Occlusion Stroke With EEG. Neurology 2023; 101:e2522-e2532. [PMID: 37848336 PMCID: PMC10791060 DOI: 10.1212/wnl.0000000000207831] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/31/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Endovascular thrombectomy (EVT) is standard treatment for anterior large vessel occlusion stroke (LVO-a stroke). Prehospital diagnosis of LVO-a stroke would reduce time to EVT by allowing direct transportation to an EVT-capable hospital. We aim to evaluate the diagnostic accuracy of dry electrode EEG for the detection of LVO-a stroke in the prehospital setting. METHODS ELECTRA-STROKE was an investigator-initiated, prospective, multicenter, diagnostic study, performed in the prehospital setting. Adult patients were eligible if they had suspected stroke (as assessed by the attending ambulance nurse) and symptom onset <24 hours. A single dry electrode EEG recording (8 electrodes) was performed by ambulance personnel. Primary endpoint was the diagnostic accuracy of the theta/alpha frequency ratio for LVO-a stroke (intracranial ICA, A1, M1, or proximal M2 occlusion) detection among patients with EEG data of sufficient quality, expressed as the area under the receiver operating characteristic curve (AUC). Secondary endpoints were diagnostic accuracies of other EEG features quantifying frequency band power and the pairwise derived Brain Symmetry Index. Neuroimaging was assessed by a neuroradiologist blinded to EEG results. RESULTS Between August 2020 and September 2022, 311 patients were included. The median EEG duration time was 151 (interquartile range [IQR] 151-152) seconds. For 212/311 (68%) patients, EEG data were of sufficient quality for analysis. The median age was 74 (IQR 66-81) years, 90/212 (42%) were women, and the median baseline NIH Stroke Scale was 1 (IQR 0-4). Six (3%) patients had an LVO-a stroke, 109/212 (51%) had a non-LVO-a ischemic stroke, 32/212 (15%) had a transient ischemic attack, 8/212 (4%) had a hemorrhagic stroke, and 57/212 (27%) had a stroke mimic. AUC of the theta/alpha ratio was 0.80 (95% CI 0.58-1.00). Of the secondary endpoints, the pairwise derived Brain Symmetry Index in the delta frequency band had the highest diagnostic accuracy (AUC 0.91 [95% CI 0.73-1.00], sensitivity 80% [95% CI 38%-96%], specificity 93% [95% CI 88%-96%], positive likelihood ratio 11.0 [95% CI 5.5-21.7]). DISCUSSION The data from this study suggest that dry electrode EEG has the potential to detect LVO-a stroke among patients with suspected stroke in the prehospital setting. Toward future implementation of EEG in prehospital stroke care, EEG data quality needs to be improved. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov identifier: NCT03699397. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that prehospital dry electrode scalp EEG accurately detects LVO-a stroke among patients with suspected acute stroke.
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Affiliation(s)
- Maritta N van Stigt
- From the Departments of Clinical Neurophysiology (M.N.v.S., E.A.G., J.H.T.M.K.), Neurology (M.N.v.S., E.A.G., L.C.C.v.M., A.A.G.A.v.d.M., M.C.V., Y.B.W.E.M.R., J.M.C.), Radiology and Nuclear Medicine (C.B.L.M.M., M.S.K., H.A.M.), and Biomedical Engineering and Physics (H.A.M.), Amsterdam UMC location University of Amsterdam; Witte Kruis Ambulancezorg (M.T., G.F.), Alkmaar; Ambulancezorg Nederland (M.D.S.), Zwolle; Ambulance Amsterdam (J.A.F.v.G., G.G., A.S.); Department of Neurology (S.M.v.S.), OLVG Hospital location West, Amsterdam; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep location Alkmaar; TrianecT (W.V.P.), Utrecht, the Netherlands
| | - Eva A Groenendijk
- From the Departments of Clinical Neurophysiology (M.N.v.S., E.A.G., J.H.T.M.K.), Neurology (M.N.v.S., E.A.G., L.C.C.v.M., A.A.G.A.v.d.M., M.C.V., Y.B.W.E.M.R., J.M.C.), Radiology and Nuclear Medicine (C.B.L.M.M., M.S.K., H.A.M.), and Biomedical Engineering and Physics (H.A.M.), Amsterdam UMC location University of Amsterdam; Witte Kruis Ambulancezorg (M.T., G.F.), Alkmaar; Ambulancezorg Nederland (M.D.S.), Zwolle; Ambulance Amsterdam (J.A.F.v.G., G.G., A.S.); Department of Neurology (S.M.v.S.), OLVG Hospital location West, Amsterdam; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep location Alkmaar; TrianecT (W.V.P.), Utrecht, the Netherlands
| | - Laura C C van Meenen
- From the Departments of Clinical Neurophysiology (M.N.v.S., E.A.G., J.H.T.M.K.), Neurology (M.N.v.S., E.A.G., L.C.C.v.M., A.A.G.A.v.d.M., M.C.V., Y.B.W.E.M.R., J.M.C.), Radiology and Nuclear Medicine (C.B.L.M.M., M.S.K., H.A.M.), and Biomedical Engineering and Physics (H.A.M.), Amsterdam UMC location University of Amsterdam; Witte Kruis Ambulancezorg (M.T., G.F.), Alkmaar; Ambulancezorg Nederland (M.D.S.), Zwolle; Ambulance Amsterdam (J.A.F.v.G., G.G., A.S.); Department of Neurology (S.M.v.S.), OLVG Hospital location West, Amsterdam; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep location Alkmaar; TrianecT (W.V.P.), Utrecht, the Netherlands
| | - Anita A G A van de Munckhof
- From the Departments of Clinical Neurophysiology (M.N.v.S., E.A.G., J.H.T.M.K.), Neurology (M.N.v.S., E.A.G., L.C.C.v.M., A.A.G.A.v.d.M., M.C.V., Y.B.W.E.M.R., J.M.C.), Radiology and Nuclear Medicine (C.B.L.M.M., M.S.K., H.A.M.), and Biomedical Engineering and Physics (H.A.M.), Amsterdam UMC location University of Amsterdam; Witte Kruis Ambulancezorg (M.T., G.F.), Alkmaar; Ambulancezorg Nederland (M.D.S.), Zwolle; Ambulance Amsterdam (J.A.F.v.G., G.G., A.S.); Department of Neurology (S.M.v.S.), OLVG Hospital location West, Amsterdam; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep location Alkmaar; TrianecT (W.V.P.), Utrecht, the Netherlands
| | - Monique Theunissen
- From the Departments of Clinical Neurophysiology (M.N.v.S., E.A.G., J.H.T.M.K.), Neurology (M.N.v.S., E.A.G., L.C.C.v.M., A.A.G.A.v.d.M., M.C.V., Y.B.W.E.M.R., J.M.C.), Radiology and Nuclear Medicine (C.B.L.M.M., M.S.K., H.A.M.), and Biomedical Engineering and Physics (H.A.M.), Amsterdam UMC location University of Amsterdam; Witte Kruis Ambulancezorg (M.T., G.F.), Alkmaar; Ambulancezorg Nederland (M.D.S.), Zwolle; Ambulance Amsterdam (J.A.F.v.G., G.G., A.S.); Department of Neurology (S.M.v.S.), OLVG Hospital location West, Amsterdam; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep location Alkmaar; TrianecT (W.V.P.), Utrecht, the Netherlands
| | - Gaby Franschman
- From the Departments of Clinical Neurophysiology (M.N.v.S., E.A.G., J.H.T.M.K.), Neurology (M.N.v.S., E.A.G., L.C.C.v.M., A.A.G.A.v.d.M., M.C.V., Y.B.W.E.M.R., J.M.C.), Radiology and Nuclear Medicine (C.B.L.M.M., M.S.K., H.A.M.), and Biomedical Engineering and Physics (H.A.M.), Amsterdam UMC location University of Amsterdam; Witte Kruis Ambulancezorg (M.T., G.F.), Alkmaar; Ambulancezorg Nederland (M.D.S.), Zwolle; Ambulance Amsterdam (J.A.F.v.G., G.G., A.S.); Department of Neurology (S.M.v.S.), OLVG Hospital location West, Amsterdam; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep location Alkmaar; TrianecT (W.V.P.), Utrecht, the Netherlands
| | - Martin D Smeekes
- From the Departments of Clinical Neurophysiology (M.N.v.S., E.A.G., J.H.T.M.K.), Neurology (M.N.v.S., E.A.G., L.C.C.v.M., A.A.G.A.v.d.M., M.C.V., Y.B.W.E.M.R., J.M.C.), Radiology and Nuclear Medicine (C.B.L.M.M., M.S.K., H.A.M.), and Biomedical Engineering and Physics (H.A.M.), Amsterdam UMC location University of Amsterdam; Witte Kruis Ambulancezorg (M.T., G.F.), Alkmaar; Ambulancezorg Nederland (M.D.S.), Zwolle; Ambulance Amsterdam (J.A.F.v.G., G.G., A.S.); Department of Neurology (S.M.v.S.), OLVG Hospital location West, Amsterdam; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep location Alkmaar; TrianecT (W.V.P.), Utrecht, the Netherlands
| | - Joffry A F van Grondelle
- From the Departments of Clinical Neurophysiology (M.N.v.S., E.A.G., J.H.T.M.K.), Neurology (M.N.v.S., E.A.G., L.C.C.v.M., A.A.G.A.v.d.M., M.C.V., Y.B.W.E.M.R., J.M.C.), Radiology and Nuclear Medicine (C.B.L.M.M., M.S.K., H.A.M.), and Biomedical Engineering and Physics (H.A.M.), Amsterdam UMC location University of Amsterdam; Witte Kruis Ambulancezorg (M.T., G.F.), Alkmaar; Ambulancezorg Nederland (M.D.S.), Zwolle; Ambulance Amsterdam (J.A.F.v.G., G.G., A.S.); Department of Neurology (S.M.v.S.), OLVG Hospital location West, Amsterdam; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep location Alkmaar; TrianecT (W.V.P.), Utrecht, the Netherlands
| | - Geertje Geuzebroek
- From the Departments of Clinical Neurophysiology (M.N.v.S., E.A.G., J.H.T.M.K.), Neurology (M.N.v.S., E.A.G., L.C.C.v.M., A.A.G.A.v.d.M., M.C.V., Y.B.W.E.M.R., J.M.C.), Radiology and Nuclear Medicine (C.B.L.M.M., M.S.K., H.A.M.), and Biomedical Engineering and Physics (H.A.M.), Amsterdam UMC location University of Amsterdam; Witte Kruis Ambulancezorg (M.T., G.F.), Alkmaar; Ambulancezorg Nederland (M.D.S.), Zwolle; Ambulance Amsterdam (J.A.F.v.G., G.G., A.S.); Department of Neurology (S.M.v.S.), OLVG Hospital location West, Amsterdam; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep location Alkmaar; TrianecT (W.V.P.), Utrecht, the Netherlands
| | - Arjen Siegers
- From the Departments of Clinical Neurophysiology (M.N.v.S., E.A.G., J.H.T.M.K.), Neurology (M.N.v.S., E.A.G., L.C.C.v.M., A.A.G.A.v.d.M., M.C.V., Y.B.W.E.M.R., J.M.C.), Radiology and Nuclear Medicine (C.B.L.M.M., M.S.K., H.A.M.), and Biomedical Engineering and Physics (H.A.M.), Amsterdam UMC location University of Amsterdam; Witte Kruis Ambulancezorg (M.T., G.F.), Alkmaar; Ambulancezorg Nederland (M.D.S.), Zwolle; Ambulance Amsterdam (J.A.F.v.G., G.G., A.S.); Department of Neurology (S.M.v.S.), OLVG Hospital location West, Amsterdam; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep location Alkmaar; TrianecT (W.V.P.), Utrecht, the Netherlands
| | - Marieke C Visser
- From the Departments of Clinical Neurophysiology (M.N.v.S., E.A.G., J.H.T.M.K.), Neurology (M.N.v.S., E.A.G., L.C.C.v.M., A.A.G.A.v.d.M., M.C.V., Y.B.W.E.M.R., J.M.C.), Radiology and Nuclear Medicine (C.B.L.M.M., M.S.K., H.A.M.), and Biomedical Engineering and Physics (H.A.M.), Amsterdam UMC location University of Amsterdam; Witte Kruis Ambulancezorg (M.T., G.F.), Alkmaar; Ambulancezorg Nederland (M.D.S.), Zwolle; Ambulance Amsterdam (J.A.F.v.G., G.G., A.S.); Department of Neurology (S.M.v.S.), OLVG Hospital location West, Amsterdam; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep location Alkmaar; TrianecT (W.V.P.), Utrecht, the Netherlands
| | - Sander M van Schaik
- From the Departments of Clinical Neurophysiology (M.N.v.S., E.A.G., J.H.T.M.K.), Neurology (M.N.v.S., E.A.G., L.C.C.v.M., A.A.G.A.v.d.M., M.C.V., Y.B.W.E.M.R., J.M.C.), Radiology and Nuclear Medicine (C.B.L.M.M., M.S.K., H.A.M.), and Biomedical Engineering and Physics (H.A.M.), Amsterdam UMC location University of Amsterdam; Witte Kruis Ambulancezorg (M.T., G.F.), Alkmaar; Ambulancezorg Nederland (M.D.S.), Zwolle; Ambulance Amsterdam (J.A.F.v.G., G.G., A.S.); Department of Neurology (S.M.v.S.), OLVG Hospital location West, Amsterdam; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep location Alkmaar; TrianecT (W.V.P.), Utrecht, the Netherlands
| | - Patricia H A Halkes
- From the Departments of Clinical Neurophysiology (M.N.v.S., E.A.G., J.H.T.M.K.), Neurology (M.N.v.S., E.A.G., L.C.C.v.M., A.A.G.A.v.d.M., M.C.V., Y.B.W.E.M.R., J.M.C.), Radiology and Nuclear Medicine (C.B.L.M.M., M.S.K., H.A.M.), and Biomedical Engineering and Physics (H.A.M.), Amsterdam UMC location University of Amsterdam; Witte Kruis Ambulancezorg (M.T., G.F.), Alkmaar; Ambulancezorg Nederland (M.D.S.), Zwolle; Ambulance Amsterdam (J.A.F.v.G., G.G., A.S.); Department of Neurology (S.M.v.S.), OLVG Hospital location West, Amsterdam; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep location Alkmaar; TrianecT (W.V.P.), Utrecht, the Netherlands
| | - Charles B L M Majoie
- From the Departments of Clinical Neurophysiology (M.N.v.S., E.A.G., J.H.T.M.K.), Neurology (M.N.v.S., E.A.G., L.C.C.v.M., A.A.G.A.v.d.M., M.C.V., Y.B.W.E.M.R., J.M.C.), Radiology and Nuclear Medicine (C.B.L.M.M., M.S.K., H.A.M.), and Biomedical Engineering and Physics (H.A.M.), Amsterdam UMC location University of Amsterdam; Witte Kruis Ambulancezorg (M.T., G.F.), Alkmaar; Ambulancezorg Nederland (M.D.S.), Zwolle; Ambulance Amsterdam (J.A.F.v.G., G.G., A.S.); Department of Neurology (S.M.v.S.), OLVG Hospital location West, Amsterdam; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep location Alkmaar; TrianecT (W.V.P.), Utrecht, the Netherlands
| | - Yvo B W E M Roos
- From the Departments of Clinical Neurophysiology (M.N.v.S., E.A.G., J.H.T.M.K.), Neurology (M.N.v.S., E.A.G., L.C.C.v.M., A.A.G.A.v.d.M., M.C.V., Y.B.W.E.M.R., J.M.C.), Radiology and Nuclear Medicine (C.B.L.M.M., M.S.K., H.A.M.), and Biomedical Engineering and Physics (H.A.M.), Amsterdam UMC location University of Amsterdam; Witte Kruis Ambulancezorg (M.T., G.F.), Alkmaar; Ambulancezorg Nederland (M.D.S.), Zwolle; Ambulance Amsterdam (J.A.F.v.G., G.G., A.S.); Department of Neurology (S.M.v.S.), OLVG Hospital location West, Amsterdam; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep location Alkmaar; TrianecT (W.V.P.), Utrecht, the Netherlands
| | - Johannes H T M Koelman
- From the Departments of Clinical Neurophysiology (M.N.v.S., E.A.G., J.H.T.M.K.), Neurology (M.N.v.S., E.A.G., L.C.C.v.M., A.A.G.A.v.d.M., M.C.V., Y.B.W.E.M.R., J.M.C.), Radiology and Nuclear Medicine (C.B.L.M.M., M.S.K., H.A.M.), and Biomedical Engineering and Physics (H.A.M.), Amsterdam UMC location University of Amsterdam; Witte Kruis Ambulancezorg (M.T., G.F.), Alkmaar; Ambulancezorg Nederland (M.D.S.), Zwolle; Ambulance Amsterdam (J.A.F.v.G., G.G., A.S.); Department of Neurology (S.M.v.S.), OLVG Hospital location West, Amsterdam; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep location Alkmaar; TrianecT (W.V.P.), Utrecht, the Netherlands
| | - Miou S Koopman
- From the Departments of Clinical Neurophysiology (M.N.v.S., E.A.G., J.H.T.M.K.), Neurology (M.N.v.S., E.A.G., L.C.C.v.M., A.A.G.A.v.d.M., M.C.V., Y.B.W.E.M.R., J.M.C.), Radiology and Nuclear Medicine (C.B.L.M.M., M.S.K., H.A.M.), and Biomedical Engineering and Physics (H.A.M.), Amsterdam UMC location University of Amsterdam; Witte Kruis Ambulancezorg (M.T., G.F.), Alkmaar; Ambulancezorg Nederland (M.D.S.), Zwolle; Ambulance Amsterdam (J.A.F.v.G., G.G., A.S.); Department of Neurology (S.M.v.S.), OLVG Hospital location West, Amsterdam; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep location Alkmaar; TrianecT (W.V.P.), Utrecht, the Netherlands
| | - Henk A Marquering
- From the Departments of Clinical Neurophysiology (M.N.v.S., E.A.G., J.H.T.M.K.), Neurology (M.N.v.S., E.A.G., L.C.C.v.M., A.A.G.A.v.d.M., M.C.V., Y.B.W.E.M.R., J.M.C.), Radiology and Nuclear Medicine (C.B.L.M.M., M.S.K., H.A.M.), and Biomedical Engineering and Physics (H.A.M.), Amsterdam UMC location University of Amsterdam; Witte Kruis Ambulancezorg (M.T., G.F.), Alkmaar; Ambulancezorg Nederland (M.D.S.), Zwolle; Ambulance Amsterdam (J.A.F.v.G., G.G., A.S.); Department of Neurology (S.M.v.S.), OLVG Hospital location West, Amsterdam; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep location Alkmaar; TrianecT (W.V.P.), Utrecht, the Netherlands
| | - Wouter V Potters
- From the Departments of Clinical Neurophysiology (M.N.v.S., E.A.G., J.H.T.M.K.), Neurology (M.N.v.S., E.A.G., L.C.C.v.M., A.A.G.A.v.d.M., M.C.V., Y.B.W.E.M.R., J.M.C.), Radiology and Nuclear Medicine (C.B.L.M.M., M.S.K., H.A.M.), and Biomedical Engineering and Physics (H.A.M.), Amsterdam UMC location University of Amsterdam; Witte Kruis Ambulancezorg (M.T., G.F.), Alkmaar; Ambulancezorg Nederland (M.D.S.), Zwolle; Ambulance Amsterdam (J.A.F.v.G., G.G., A.S.); Department of Neurology (S.M.v.S.), OLVG Hospital location West, Amsterdam; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep location Alkmaar; TrianecT (W.V.P.), Utrecht, the Netherlands
| | - Jonathan M Coutinho
- From the Departments of Clinical Neurophysiology (M.N.v.S., E.A.G., J.H.T.M.K.), Neurology (M.N.v.S., E.A.G., L.C.C.v.M., A.A.G.A.v.d.M., M.C.V., Y.B.W.E.M.R., J.M.C.), Radiology and Nuclear Medicine (C.B.L.M.M., M.S.K., H.A.M.), and Biomedical Engineering and Physics (H.A.M.), Amsterdam UMC location University of Amsterdam; Witte Kruis Ambulancezorg (M.T., G.F.), Alkmaar; Ambulancezorg Nederland (M.D.S.), Zwolle; Ambulance Amsterdam (J.A.F.v.G., G.G., A.S.); Department of Neurology (S.M.v.S.), OLVG Hospital location West, Amsterdam; Department of Neurology (P.H.A.H.), Noordwest Ziekenhuisgroep location Alkmaar; TrianecT (W.V.P.), Utrecht, the Netherlands
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5
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Beijer E, van Wonderen SF, Zuidema WP, Visser MC, Edwards MJR, Verhofstad MHJ, Tromp TN, van den Brom CE, van Lieshout EMM, Bloemers FW, Geeraedts LMG. Sex Differences in Outcome of Trauma Patients Presented with Severe Traumatic Brain Injury: A Multicenter Cohort Study. J Clin Med 2023; 12:6892. [PMID: 37959357 PMCID: PMC10649467 DOI: 10.3390/jcm12216892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/22/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
The objective of this study was to determine whether there is an association between sex and outcome in trauma patients presented with severe traumatic brain injury (TBI). A retrospective multicenter study was performed in trauma patients aged ≥ 16 years who presented with severe TBI (Head Abbreviated Injury Scale (AIS) ≥ 4) over a 4-year-period. Subgroup analyses were performed for ages 16-44 and ≥45 years. Also, patients with isolated severe TBI (other AIS ≤ 2) were assessed, likewise, with subgroup analysis for age. Sex differences in mortality, Glasgow Outcome Score (GOS), ICU admission/length of stay (LOS), hospital LOS, and mechanical ventilation (MV) were examined. A total of 1566 severe TBI patients were included (831 patients with isolated TBI). Crude analysis shows an association between female sex and lower ICU admission rates, shorter ICU/hospital LOS, and less frequent and shorter MV in severe TBI patients ≥ 45 years. After adjusting, female sex appears to be associated with shorter ICU/hospital LOS. Sex differences in mortality and GOS were not found. In conclusion, this study found sex differences in patient outcomes following severe TBI, potentially favoring (older) females, which appear to indicate shorter ICU/hospital LOS (adjusted analysis). Large prospective studies are warranted to help unravel sex differences in outcomes after severe TBI.
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Affiliation(s)
- Elise Beijer
- Department of Trauma Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Anesthesiology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Stefan F. van Wonderen
- Department of Trauma Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Wietse P. Zuidema
- Department of Trauma Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Marieke C. Visser
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Michael J. R. Edwards
- Department of Trauma Surgery, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Michael H. J. Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Tjarda N. Tromp
- Department of Trauma Surgery, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Charissa E. van den Brom
- Department of Anesthesiology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Esther M. M. van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Frank W. Bloemers
- Department of Trauma Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Leo M. G. Geeraedts
- Department of Trauma Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands
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6
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Ali M, van der Meij A, van Os HJA, Ali M, Van Zwet EW, Spaander FHM, Hofmeijer J, Nederkoorn PJ, van den Wijngaard IR, Majoie CBLM, van Es ACGM, Schonewille WJ, van Walderveen MAA, Dippel DWJ, Visser MC, Kruyt ND, Wermer MJH. Sex differences in onset to hospital arrival time, prestroke disability, and clinical symptoms in patients with a large vessel occlusion: a MR CLEAN Registry substudy. J Neurointerv Surg 2023; 15:e255-e261. [PMID: 36379704 DOI: 10.1136/jnis-2022-019670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Women have been reported to have worse outcomes after endovascular treatment (EVT), despite a similar treatment effect in non-clinical trial populations. We aimed to assess sex differences at hospital presentation with respect to workflow metrics, prestroke disability, and presenting clinical symptoms. METHODS We included consecutive patients from the Multicentre Randomised Controlled Trial of Endovascular Treatment for Acute Ischaemic Stroke in The Netherlands (MR CLEAN) Registry (2014-2018) who received EVT for anterior circulation large vessel occlusion (LVO). We assessed sex differences in workflow metrics, prestroke disability (modified Rankin Scale (mRS) score ≥1), and stroke severity and symptoms according to the National Institutes of Health Stroke Scale (NIHSS) score on hospital admission with logistic and linear regression analyses and calculated the adjusted OR (aOR). RESULTS We included 4872 patients (47.6% women). Compared with men, women were older (median age 76 vs 70 years) and less often achieved good functional outcome at 90 days (mRS ≤2: 35.2% vs 46.4%, aOR 0.70, 95% CI 0.60 to 0.82). Mean onset-to-door time was longer in women (2 hours 16 min vs 2 hours 7 min, adjusted delay 9 min, 95% CI 4 to 13). This delay contributed to longer onset-to-groin times (3 hours 26 min in women vs 3 hours 13 min in men, adjusted delay 13 min, 95% CI 9 to 17). Women more often had prestroke disability (mRS ≥1: 41.1% vs 29.1%, aOR 1.57, 95% CI 1.36 to 1.82). NIHSS on admission was essentially similar in men and women (mean 15±6 vs 15±6, NIHSS <10 vs ≥10, aOR 0.91, 95% CI 0.78 to 1.06). There were no clear sex differences in the occurrence of specific stroke symptoms. CONCLUSION Women with LVO had longer onset-to-door times and more often prestroke disability than men. Raising awareness of these differences at hospital presentation and investigating underlying causes may help to improve outcome after EVT in women.
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Affiliation(s)
- Mariam Ali
- Neurology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Anne van der Meij
- Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Mahsoem Ali
- Surgery, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
| | - Erik W Van Zwet
- Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jeanette Hofmeijer
- Neurology, Rijnstate Hospital, Arnhem, The Netherlands
- University of Twente Faculty of Science and Technology, Enschede, The Netherlands
| | | | - Ido R van den Wijngaard
- Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Neurology, HMC Westeinde, The Hague, The Netherlands
| | - Charles B L M Majoie
- Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Adriaan C G M van Es
- Radiology and Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | - Marieke C Visser
- Neurology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Nyika D Kruyt
- Neurology, Leiden University Medical Center, Leiden, The Netherlands
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Ali M, van Os HJA, van der Weerd N, Schoones JW, Heymans MW, Kruyt ND, Visser MC, Wermer MJH. Sex Differences in Presentation of Stroke: A Systematic Review and Meta-Analysis. Stroke 2021; 53:345-354. [PMID: 34903037 PMCID: PMC8785516 DOI: 10.1161/strokeaha.120.034040] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Women have worse outcomes than men after stroke. Differences in presentation may lead to misdiagnosis and, in part, explain these disparities. We investigated whether there are sex differences in clinical presentation of acute stroke or transient ischemic attack. METHODS We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Inclusion criteria were (1) cohort, cross-sectional, case-control, or randomized controlled trial design; (2) admission for (suspicion of) ischemic or hemorrhagic stroke or transient ischemic attack; and (3) comparisons possible between sexes in ≥1 nonfocal or focal acute stroke symptom(s). A random-effects model was used for our analyses. We performed sensitivity and subanalyses to help explain heterogeneity and used the Newcastle-Ottawa Scale to assess bias. RESULTS We included 60 studies (n=582 844; 50% women). In women, headache (pooled odds ratio [OR], 1.24 [95% CI, 1.11-1.39]; I2=75.2%; 30 studies) occurred more frequently than in men with any type of stroke, as well as changes in consciousness/mental status (OR, 1.38 [95% CI, 1.19-1.61]; I2=95.0%; 17 studies) and coma/stupor (OR, 1.39 [95% CI, 1.25-1.55]; I2=27.0%; 13 studies). Aspecific or other neurological symptoms (nonrotatory dizziness and non-neurological symptoms) occurred less frequently in women (OR, 0.96 [95% CI, 0.94-0.97]; I2=0.1%; 5 studies). Overall, the presence of focal symptoms was not associated with sex (pooled OR, 1.03) although dysarthria (OR, 1.14 [95% CI, 1.04-1.24]; I2=48.6%; 11 studies) and vertigo (OR, 1.23 [95% CI, 1.13-1.34]; I2=44.0%; 8 studies) occurred more frequently, whereas symptoms of paresis/hemiparesis (OR, 0.73 [95% CI, 0.54-0.97]; I2=72.6%; 7 studies) and focal visual disturbances (OR, 0.83 [95% CI, 0.70-0.99]; I2=62.8%; 16 studies) occurred less frequently in women compared with men with any type of stroke. Most studies contained possible sources of bias. CONCLUSIONS There may be substantive differences in nonfocal and focal stroke symptoms between men and women presenting with acute stroke or transient ischemic attack, but sufficiently high-quality studies are lacking. More studies are needed to address this because sex differences in presentation may lead to misdiagnosis and undertreatment.
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Affiliation(s)
- Mariam Ali
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands (M.A., M.C.V.)
| | - Hendrikus J A van Os
- Department of Neurology, Leiden University Medical Center, the Netherlands. (H.J.A.v.O., N.v.d.W., N.D.K., M.J.H.W.)
| | - Nelleke van der Weerd
- Department of Neurology, Leiden University Medical Center, the Netherlands. (H.J.A.v.O., N.v.d.W., N.D.K., M.J.H.W.)
| | - Jan W Schoones
- Walaeus Library, Leiden University Medical Center, the Netherlands. (J.W.S.)
| | - Martijn W Heymans
- Department of Clinical Epidemiology and Biostatistics, Amsterdam UMC, the Netherlands (M.W.H.)
| | - Nyika D Kruyt
- Department of Neurology, Leiden University Medical Center, the Netherlands. (H.J.A.v.O., N.v.d.W., N.D.K., M.J.H.W.)
| | - Marieke C Visser
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands (M.A., M.C.V.)
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, the Netherlands. (H.J.A.v.O., N.v.d.W., N.D.K., M.J.H.W.)
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8
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Linstra KM, van Os HJA, Ruigrok YM, Nederkoorn PJ, van Dijk EJ, Kappelle LJ, Koudstaal PJ, Visser MC, Ferrari MD, MaassenVanDenBrink A, Terwindt GM, Wermer MJH. Sex Differences in Risk Profile, Stroke Cause and Outcome in Ischemic Stroke Patients With and Without Migraine. Front Neurosci 2021; 15:740639. [PMID: 34803586 PMCID: PMC8597840 DOI: 10.3389/fnins.2021.740639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background: An increased risk of stroke in patients with migraine has been primarily found for women. The sex-dependent mechanisms underlying the migraine–stroke association, however, remain unknown. This study aims to explore these sex differences to improve our understanding of pathophysiological mechanisms behind the migraine–stroke association. Methods: We included 2,492 patients with ischemic stroke from the prospective multicenter Dutch Parelsnoer Institute Initiative study, 425 (17%) of whom had a history of migraine. Cardiovascular risk profile, stroke cause (TOAST classification), and outcome [modified Rankin scale (mRS) at 3 months] were compared with both sexes between patients with and without migraine. Results: A history of migraine was not associated with sex differences in the prevalence of conventional cardiovascular risk factors. Women with migraine had an increased risk of stroke at young age (onset < 50 years) compared with women without migraine (RR: 1.7; 95% CI: 1.3–2.3). Men with migraine tended to have more often stroke in the TOAST category other determined etiology (RR: 1.7; 95% CI: 1.0–2.7) in comparison with men without migraine, whereas this increase was not found in women with migraine. Stroke outcome was similar for women with or without migraine (mRS ≥ 3 RR 1.1; 95% CI 0.7–1.5), whereas men seemed to have a higher risk of poor outcome compared with their counterparts without migraine (mRS ≥ 3 RR: 1.5; 95% CI: 1.0–2.1). Conclusion: Our results indicate possible sex differences in the pathophysiology underlying the migraine–stroke association, which are unrelated to conventional cardiovascular risk factors. Further research in larger cohorts is needed to validate these findings.
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Affiliation(s)
- Katie M Linstra
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands.,Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus MC, Rotterdam, Netherlands
| | | | - Ynte M Ruigrok
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Ewoud J van Dijk
- Department of Neurology, Radboud University Medical Center, Nijmegen, Netherlands
| | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Peter J Koudstaal
- Department of Neurology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Marieke C Visser
- Department of Neurology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
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9
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Zonjee VJ, Slenders JPL, de Beer F, Visser MC, Ter Meulen BC, Van den Berg-Vos RM, van Schaik SM. Practice variation in the informed consent procedure for thrombolysis in acute ischemic stroke: a survey among neurologists and neurology residents. BMC Med Ethics 2021; 22:114. [PMID: 34433444 PMCID: PMC8390276 DOI: 10.1186/s12910-021-00684-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022] Open
Abstract
Background Obtaining informed consent for intravenous thrombolysis in acute ischemic stroke can be challenging, and little is known about if and how the informed consent procedure is performed by neurologists in clinical practice. This study examines the procedure of informed consent for intravenous thrombolysis in acute ischemic stroke in high-volume stroke centers in the Netherlands. Methods In four high volume stroke centers, neurology residents and attending neurologists received an online questionnaire concerning informed consent for thrombolysis with tissue-type plasminogen activator (tPA). The respondents were asked to report their usual informed consent practice for tPA treatment and their considerations on whether informed consent should be obtained. Results From the 203 invited clinicians, 50% (n = 101) completed the questionnaire. One-third of the neurology residents (n = 21) and 21% of the neurologists (n = 8) reported that they always obtain informed consent for tPA treatment. If a patient is not capable of providing informed consent, 30% of the residents (n = 19) reported that they start tPA treatment without informed consent. In these circumstances, 53% of the neurologists (n = 20) reported that the resident under their supervision would start tPA treatment without informed consent. Most neurologists (n = 21; 55%) and neurology residents (n = 45; 72%) obtained informed consent within one minute. None of the respondents used more than five minutes for informed consent. Important themes regarding obtaining informed consent for treatment were patients’ capacity, and medical, ethical and legal considerations. Conclusion The current practice of informed consent for thrombolysis in acute ischemic stroke varies among neurologists and neurology residents. If informed consent is obtained, most clinicians stated to obtain informed consent within one minute. In the future, a shortened information provision process may be applied, making a shift from informed consent to informed refusal, while still considering the patient’s capacity, stroke severity, and possible treatment delays. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-021-00684-6.
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Affiliation(s)
- Valentijn J Zonjee
- Department of Neurology, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
| | - Jos P L Slenders
- Department of Neurology, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - Frank de Beer
- Department of Neurology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Marieke C Visser
- Department of Neurology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Bastiaan C Ter Meulen
- Department of Neurology, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - Renske M Van den Berg-Vos
- Department of Neurology, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.,Department of Neurology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Sander M van Schaik
- Department of Neurology, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
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10
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Groot AE, de Bruin H, Nguyen TTM, Kappelhof M, de Beer F, Visser MC, Zwetsloot CP, Halkes PHA, de Kruijk J, van der Meulen WDM, van der Ree TC, Kwa VIH, van Schaik SM, Hani L, van den Berg R, Sprengers MES, Roosendaal SD, Emmer BJ, Nederkoorn PJ, Majoie CBLM, Roos YBWEM, Coutinho JM. Presentation outside office hours does not negatively influence treatment times for reperfusion therapy for acute ischemic stroke. J Neurol 2021; 268:133-139. [PMID: 32737653 PMCID: PMC7815598 DOI: 10.1007/s00415-020-10106-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/19/2020] [Accepted: 07/21/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Treatment outside office hours has been associated with increased workflow times for intravenous thrombolysis (IVT) in acute ischemic stroke (AIS). Limited data suggest that this "off-hours effect" also exists for endovascular treatment (EVT). We investigated this phenomenon in a well-organized acute stroke care region in the Netherlands. METHODS Retrospective, observational cohort study of consecutive patients with AIS who received reperfusion therapy in the Greater Amsterdam Area, consisting of 14 primary stroke centers and 1 comprehensive stroke center (IVT: 2009-2015, EVT: 2014-2017). Office hours were defined as presentation during weekdays between 8 AM and 5 PM, excluding National Festive days. Primary outcome was door-to-treatment time (door-to-needle [DNT] for IVT, door-to-groin [DGT] for EVT). For DGT, we used the door time of the first hospital. Other outcomes were in-hospital mortality, modified Rankin Scale (mRS) score at 90 days and symptomatic intracranial hemorrhage (sICH). We performed multivariable linear and logistic regression analyses and used multiple imputation to account for missing values. RESULTS In total, 59% (2450/4161) and 61% (239/395) of patients treated with IVT and EVT, respectively, presented outside office hours. Median DNT was minimally longer outside office hours (32 vs. 30 min, p = 0.024, adjusted difference 2.5 min, 95% CI 0.7-4.2). Presentation outside office hours was not associated with a longer DGT (median 130 min for both groups, adjusted difference 7.0 min, 95% CI - 4.2 to 18.1). Clinical outcome and sICH rate also did not differ. CONCLUSION Presentation outside office hours did not lead to clinically relevant treatment delays for reperfusion therapy in patients with AIS.
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Affiliation(s)
- A E Groot
- Neurology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - H de Bruin
- Neurology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - T T M Nguyen
- Neurology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - M Kappelhof
- Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - F de Beer
- Neurology, Spaarne Gasthuis, Boerhaavelaan 22, 2035 RC, Haarlem, The Netherlands
| | - M C Visser
- Neurology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Boelelaan 1117-1118, 1081 HV, Amsterdam, The Netherlands
| | - C P Zwetsloot
- Neurology, Dijklander, Waterlandlaan 250, 1441 RN, Purmerend, The Netherlands
| | - P H A Halkes
- Neurology, Noord-West Ziekenhuisgroep, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
| | - J de Kruijk
- Neurology, Tergooi, Van Linschotenlaan 35, 1212 DR, Hilversum, The Netherlands
| | | | - T C van der Ree
- Neurology, Dijklander, Maelsonstraat 3, 1624 NP, Hoorn, The Netherlands
| | - V I H Kwa
- Neurology, OLVG-Oost, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
| | - S M van Schaik
- Neurology, OLVG-West, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - L Hani
- Neurology, Noord-West Ziekenhuisgroep, Huisduinerweg 3, 1782 GZ, Den Helder, The Netherlands
| | - R van den Berg
- Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - M E S Sprengers
- Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - S D Roosendaal
- Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - B J Emmer
- Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - P J Nederkoorn
- Neurology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - C B L M Majoie
- Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Y B W E M Roos
- Neurology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - J M Coutinho
- Neurology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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11
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Frey I, De Boer ME, Dronkert L, Pols AJ, Visser MC, Hertogh CMPM, Depla MFIA. Between Choice, Necessity, and Comfort: Deciding on Tube Feeding in the Acute Phase After a Severe Stroke. Qual Health Res 2020; 30:1114-1124. [PMID: 32418501 PMCID: PMC7322925 DOI: 10.1177/1049732320911370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This is an ethnographic study of decision-making concerning tube feeding in the acute phase after a severe stroke. It is based on 6 months of ethnographic research in three stroke units in the Netherlands, where the decision-making on life-sustaining treatment was studied in 16 cases of severe stroke patients. Data were collected through participant observation and interviews. For this article, the analysis was narrowed down to the decision whether or not the patient should receive tube feeding. The data on tube feeding were assembled and coded according to different modes of dealing with this decision in clinical practice, which we refer to as "repertoires." We discerned three different repertoires: choice, necessity, and comfort. Each repertoire structures clinical practice differently: It implies distinctive ethical imperatives, central concerns, sources of information, and temporalities. We hope our findings can improve decision-making by uncovering its underlying logics in clinical practice.
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Affiliation(s)
- Isabel Frey
- Vrije Universiteit Amsterdam, Amsterdam,
The Netherlands
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12
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Pierik R, Algra A, van Dijk E, Erasmus ME, van Gelder IC, Koudstaal PJ, Luijckx GJR, Nederkoorn PJ, van Oostenbrugge RJ, Ruigrok YM, Scheeren TWL, Uyttenboogaart M, Visser MC, Wermer MJH, van den Bergh WM. Distribution of Cardioembolic Stroke: A Cohort Study. Cerebrovasc Dis 2020; 49:97-104. [PMID: 31962331 DOI: 10.1159/000505616] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 12/28/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A cardiac origin in ischemic stroke is more frequent than previously assumed, but it is not clear which patients benefit from cardiac work-up if obvious cardiac pathology is absent. We hypothesized that thromboembolic stroke with a cardiac source occurs more frequently in the posterior circulation compared with thromboembolic stroke of another etiology. METHODS We performed a multicenter observational study in 3,311 consecutive patients with ischemic stroke who were enrolled in an ongoing prospective stroke registry of 8 University hospitals between September 2009 and November 2014 in The Netherlands. In this initiative, the so-called Parelsnoer Institute-Cerebrovascular Accident Study Group, clinical data, imaging, and biomaterials of patients with stroke are prospectively and uniformly collected. We compared the proportions of posterior stroke location in patients with a cardiac stroke source with those with another stroke etiology and calculated risk ratios (RR) with corresponding 95% CI with Poisson regression analyses. To assess which patient or disease characteristics were most strongly associated with a cardiac etiology in patients with ischemic stroke, we performed a stepwise backward regression analysis. RESULTS For the primary aim, 1,428 patients were eligible for analyses. The proportion of patients with a posterior stroke location among patients with a cardiac origin of their stroke (28%) did not differ statistically significant to those with another origin (25%), age and sex adjusted RR 1.16; 95% CI 0.96-1.41. For the secondary aim, 1,955 patients were eligible for analyses. No recent history of smoking, no hyperlipidemia, coronary artery disease, a higher age, and a higher National Institutes of Health Stroke Scale (NIHSS) score were associated with a cardiac etiology of ischemic stroke. CONCLUSIONS We could not confirm our hypothesis that thromboembolic stroke localized in the posterior circulation is associated with a cardioembolic source of ischemic stroke, and therefore posterior stroke localization on itself does not necessitate additional cardiac examination. The lack of determinants of atherosclerosis, for example, no recent history of smoking and no hyperlipidemia, coronary artery disease, a higher age, and a higher NIHSS score are stronger risk factors for a cardiac source of ischemic stroke.
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Affiliation(s)
- Ramon Pierik
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ale Algra
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus and the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ewoud van Dijk
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michiel E Erasmus
- Department of Cardiac Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Isabella C van Gelder
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter J Koudstaal
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Gert-Jan R Luijckx
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Ynte M Ruigrok
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas W L Scheeren
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maarten Uyttenboogaart
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marieke C Visser
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Walter M van den Bergh
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,
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13
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Eekhoff EMW, Micha D, Forouzanfar T, de Vries TJ, Netelenbos JC, Klein-Nulend J, van Loon JJWA, Lubbers WD, Schwarte L, Schober P, Raijmakers PGHM, Teunissen BP, de Graaf P, Lammertsma AA, Yaqub MM, Botman E, Treurniet S, Smilde BJ, Bökenkamp A, Boonstra A, Kamp O, Nieuwenhuijzen JA, Visser MC, Baayen HJC, Dahele M, Eeckhout GAM, Goderie TPM, Smits C, Gilijamse M, Karagozoglu KH, van de Valk P, Dickhoff C, Moll AC, Verbraak FFD, Curro-Tafili KKR, Ghyczy EAE, Rustemeyer T, Saeed P, Maugeri A, Pals G, Ridwan-Pramana A, Pekel E, Schoenmaker T, Lems W, Winters HAH, Botman M, Giannakópoulos GF, Koolwijk P, Janssen JJWM, Kloen P, Bravenboer N, Smit JM, Helder MN. Collaboration Around Rare Bone Diseases Leads to the Unique Organizational Incentive of the Amsterdam Bone Center. Front Endocrinol (Lausanne) 2020; 11:481. [PMID: 32849274 PMCID: PMC7431598 DOI: 10.3389/fendo.2020.00481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/17/2020] [Indexed: 12/26/2022] Open
Abstract
In the field of rare bone diseases in particular, a broad care team of specialists embedded in multidisciplinary clinical and research environment is essential to generate new therapeutic solutions and approaches to care. Collaboration among clinical and research departments within a University Medical Center is often difficult to establish, and may be hindered by competition and non-equivalent cooperation inherent in a hierarchical structure. Here we describe the "collaborative organizational model" of the Amsterdam Bone Center (ABC), which emerged from and benefited the rare bone disease team. This team is often confronted with pathologically complex and under-investigated diseases. We describe the benefits of this model that still guarantees the autonomy of each team member, but combines and focuses our collective expertise on a clear shared goal, enabling us to capture synergistic and innovative opportunities for the patient, while avoiding self-interest and possible harmful competition.
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Affiliation(s)
- Elisabeth M. W. Eekhoff
- Amsterdam UMC, Department of Internal Medicine Section Endocrinology, Amsterdam Bone Center, Amsterdam Movement Sciences, Amsterdam, Netherlands
- *Correspondence: Elisabeth M. W. Eekhoff
| | - Dimitra Micha
- Amsterdam UMC, Department of Clinical Genetics, Amsterdam Bone Center, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Tymour Forouzanfar
- Amsterdam UMC, Department of Oral and MaxilloFacial Surgery/Oral Pathology, Amsterdam Bone Center, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Teun J. de Vries
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
| | - J. Coen Netelenbos
- Amsterdam UMC, Department of Internal Medicine Section Endocrinology, Amsterdam Bone Center, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Jenneke Klein-Nulend
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Jack J. W. A. van Loon
- Amsterdam UMC, Department of Oral and MaxilloFacial Surgery/Oral Pathology, Amsterdam Bone Center, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Wouter D. Lubbers
- Amsterdam UMC, Department of Anaesthesiology, Amsterdam, Netherlands
| | - Lothar Schwarte
- Amsterdam UMC, Department of Anaesthesiology, Amsterdam, Netherlands
| | - Patrick Schober
- Amsterdam UMC, Department of Anaesthesiology, Amsterdam, Netherlands
| | | | - Bernd P. Teunissen
- Amsterdam UMC, Department of Radiology and Nuclear Medicine, Amsterdam, Netherlands
| | - Pim de Graaf
- Amsterdam UMC, Department of Radiology and Nuclear Medicine, Amsterdam, Netherlands
| | | | - Maqsood M. Yaqub
- Amsterdam UMC, Department of Radiology and Nuclear Medicine, Amsterdam, Netherlands
| | - Esmée Botman
- Amsterdam UMC, Department of Internal Medicine Section Endocrinology, Amsterdam Bone Center, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Sanne Treurniet
- Amsterdam UMC, Department of Internal Medicine Section Endocrinology, Amsterdam Bone Center, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Bernard J. Smilde
- Amsterdam UMC, Department of Internal Medicine Section Endocrinology, Amsterdam Bone Center, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Arend Bökenkamp
- Amsterdam UMC, Emma Children's Hospital, Vrije Universiteit Amsterdam, Department of Pediatric Nephrology, Amsterdam, Netherlands
| | - Anco Boonstra
- Amsterdam UMC, Department of Pulmonology, Amsterdam, Netherlands
| | - Otto Kamp
- Amsterdam UMC, Department of Cardiology, Amsterdam, Netherlands
| | | | | | | | - Max Dahele
- Amsterdam UMC, Department of Radiation Oncology, Amsterdam, Netherlands
| | | | - Thadé P. M. Goderie
- Amsterdam UMC, Department of Otolaryngology—Head and Neck Surgery, Ear and Hearing, Amsterdam, Netherlands
| | - Cas Smits
- Amsterdam UMC, Department of Otolaryngology—Head and Neck Surgery, Ear and Hearing, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Marjolijn Gilijamse
- Amsterdam UMC, Department of Oral and MaxilloFacial Surgery/Oral Pathology, Amsterdam Bone Center, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - K. Hakki Karagozoglu
- Amsterdam UMC, Department of Oral and MaxilloFacial Surgery/Oral Pathology, Amsterdam Bone Center, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | | | - Chris Dickhoff
- Amsterdam UMC, Thoracic and Endocrine Surgery, Department of Surgery and Cardiothoracic Surgery, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - Annette C. Moll
- Amsterdam UMC, AMC, Department of Ophtalmology, Amsterdam, Netherlands
| | | | | | - Ebba A. E. Ghyczy
- Amsterdam UMC, AMC, Department of Ophtalmology, Amsterdam, Netherlands
| | | | - Peeroz Saeed
- Amsterdam UMC, Department of Ophtalmology, Amsterdam, Netherlands
| | - Alessandra Maugeri
- Amsterdam UMC, Department of Clinical Genetics, Amsterdam Bone Center, Amsterdam, Netherlands
| | - Gerard Pals
- Amsterdam UMC, Department of Clinical Genetics, Amsterdam Bone Center, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Angela Ridwan-Pramana
- Amsterdam UMC, Dentistry and Prosthodontics Department of Oral and MaxilloFacial Surgery/Oral Pathology, Special Dentistry Foundation, Amsterdam, Netherlands
| | - Esther Pekel
- Amsterdam UMC, Department of Dietetics, Amsterdam, Netherlands
| | - Ton Schoenmaker
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
| | - Willem Lems
- Amsterdam UMC, Department of Reumatology, Amsterdam, Netherlands
| | - Henri A. H. Winters
- Amsterdam UMC, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Bone Center, Amsterdam, Netherlands
| | - Matthijs Botman
- Amsterdam UMC, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Bone Center, Amsterdam, Netherlands
| | | | - Peter Koolwijk
- Amsterdam UMC, Department of Physiology, Amsterdam Cardiovascular Science, Amsterdam, Netherlands
| | | | - Peter Kloen
- Amsterdam UMC, Department of Orthopaedic Surgery, Amsterdam, Netherlands
| | - Nathalie Bravenboer
- Amsterdam UMC, Department of Clinical Chemistry, Amsterdam Bone Center, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Jan Maerten Smit
- Amsterdam UMC, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Bone Center, Amsterdam, Netherlands
| | - Marco N. Helder
- Amsterdam UMC, Department of Oral and MaxilloFacial Surgery/Oral Pathology, Amsterdam Bone Center, Amsterdam Movement Sciences, Amsterdam, Netherlands
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14
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Mulder IA, Holswilder G, van Walderveen MAA, van der Schaaf IC, Bennink E, Horsch AD, Kappelle LJ, Velthuis BK, Dankbaar JW, Terwindt GM, Schonewille WJ, Visser MC, Ferrari MD, Algra A, Wermer MJH. Stroke progression and clinical outcome in ischemic stroke patients with a history of migraine. Int J Stroke 2019; 14:946-955. [DOI: 10.1177/1747493019851288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Patients with migraine might be more susceptible of spreading depolarizations, which are known to affect vascular and neuronal function and penumbra recovery after stroke. We investigated whether these patients have more severe stroke progression and less favorable outcomes after recanalization therapy. Methods We included patients from a prospective multicenter ischemic stroke cohort. Lifetime migraine history was based on the International Classification of Headache Disorders II criteria. Patients without confirmed migraine diagnosis were excluded. Patients underwent CT angiography and CT perfusion <9 h of onset and follow-up CT after three days. On admission, presence of a perfusion deficit, infarct core and penumbra volume, and blood brain barrier permeability (BBBP) were assessed. At follow-up we assessed malignant edema, hemorrhagic transformation, and final infarct volume. Outcome at three months was evaluated with the modified Rankin Scale (mRS). We calculated adjusted relative risks (aRR) or difference of means (aB) with regression analyses. Results We included 600 patients of whom 43 had migraine. There were no differences between patients with or without migraine in presence of a perfusion deficit on admission (aRR: 0.98, 95%CI: 0.77–1.25), infarct core volume (aB: -10.8, 95%CI: -27.04–5.51), penumbra volume (aB: -11.6, 95%CI: -26.52–3.38), mean blood brain barrier permeability (aB: 0.08, 95%CI: -3.11–2.96), malignant edema (0% vs. 5%), hemorrhagic transformation (aRR: 0.26, 95%CI: 0.04–1.73), final infarct volume (aB: -14.8, 95%CI: 29.9–0.2) or outcome after recanalization therapy (mRS > 2, aRR: 0.50, 95%CI: 0.21–1.22). Conclusion Elderly patients with a history of migraine do not seem to have more severe stroke progression and have similar treatment outcomes compared with patients without migraine.
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Affiliation(s)
- Inge A Mulder
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ghislaine Holswilder
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Edwin Bennink
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Alexander D Horsch
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L Jaap Kappelle
- Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Marieke C Visser
- Department of Neurology, VU Medical Center, Amsterdam, the Netherlands
| | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ale Algra
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marieke JH Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
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15
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Hamming AM, van Walderveen MAA, Mulder IA, van der Schaaf IC, Kappelle LJ, Velthuis BK, Ferrari MD, Terwindt GM, Visser MC, Schonewille W, Algra A, Wermer MJH. Circle of Willis variations in migraine patients with ischemic stroke. Brain Behav 2019; 9:e01223. [PMID: 30772952 PMCID: PMC6422794 DOI: 10.1002/brb3.1223] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 12/18/2018] [Accepted: 12/22/2018] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Migraine is a risk factor for stroke, which might be explained by a higher prevalence in anatomical variants in the circle of Willis (CoW). Here, we compared the presence of CoW variants in patients with stroke with and without migraine. MATERIALS AND METHODS Participants were recruited from the prospective Dutch acute Stroke Study. All participants underwent CT angiography on admission. Lifetime migraine history was assessed with a screening questionnaire and confirmed by an interview based on International Classification of Headache Disorders criteria. The CoW was assessed for incompleteness/hypoplasia (any segment <1 mm), for anterior cerebral artery asymmetry (difference > 1/3), and for posterior communicating artery (Pcom) dominance (Pcom-P1 difference > 1/3). Odds ratios with adjustments for age and sex (aOR) were calculated with logistic regression. RESULTS We included 646 participants with stroke, of whom 52 had a history of migraine. Of these, 45 (87%) had an incomplete or hypoplastic CoW versus 506 (85%) of the 594 participants without migraine (aOR: 1.47; 95% CI: 0.63-3.44). There were no differences between participants with and without migraine in variations of the anterior or posterior CoW, anterior cerebral artery asymmetry (aOR: 0.86; 95% CI: 0.43-1.74), or Pcom dominance (aOR: 0.64; 95% CI: 0.32-1.30). There were no differences in CoW variations between migraine patients with or without aura. CONCLUSION We found no significant difference in the completeness of the CoW in acute stroke patients with migraine compared to those without.
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Affiliation(s)
- Arend M Hamming
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Inge A Mulder
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - L Jaap Kappelle
- Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke C Visser
- Department of Neurology, VU Medical Center, Amsterdam, The Netherlands
| | | | - Ale Algra
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.,The Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach Z, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, Zech M, Kowarik M, Seifert C, Schwaiger B, Puri A, Hou S, Wakhloo A, Moonis M, Henniger N, Goddeau R, van den Berg R, Massari F, Minaeian A, Lozano JD, Ramzan M, Stout C, Patel A, Tunguturi A, Onteddu S, Carandang R, Howk M, Koudstaal PJ, Ribó M, Sanjuan E, Rubiera M, Pagola J, Flores A, Muchada M, Meler P, Huerga E, Gelabert S, Coscojuela P, van Zwam WH, Tomasello A, Rodriguez D, Santamarina E, Maisterra O, Boned S, Seró L, Rovira A, Molina CA, Millán M, Muñoz L, Roos YB, Pérez de la Ossa N, Gomis M, Dorado L, López-Cancio E, Palomeras E, Munuera J, García Bermejo P, Remollo S, Castaño C, García-Sort R, van der Lugt A, Cuadras P, Puyalto P, Hernández-Pérez M, Jiménez M, Martínez-Piñeiro A, Lucente G, Dávalos A, Chamorro A, Urra X, Obach V, van 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R, Banaras A, Aeron-Thomas J, Hazel B, Maguire H, Veraque E, Heshmatollah A, Harrison L, Keshvara R, Cunningham J, Schipperen S, Vinken S, van Boxtel T, Koets J, Boers M, Santos E, Borst J, Jansen I, Kappelhof M, Lucas M, Geuskens R, Barros RS, Dobbe R, Csizmadia M, Hill MD, Goyal M, Demchuk AM, Menon BK, Eesa M, Ryckborst KJ, Wright MR, Kamal NR, Andersen L, Randhawa PA, Stewart T, Patil S, Minhas P, Almekhlafi M, Mishra S, Clement F, Sajobi T, Shuaib A, Montanera WJ, Roy D, Silver FL, Jovin TG, Frei DF, Sapkota B, Rempel JL, Thornton J, Williams D, Tampieri D, Poppe AY, Dowlatshahi D, Wong JH, Mitha AP, Subramaniam S, Hull G, Lowerison MW, Sajobi T, Salluzzi M, Wright MR, Maxwell M, Lacusta S, Drupals E, Armitage K, Barber PA, Smith EE, Morrish WF, Coutts SB, Derdeyn C, Demaerschalk B, Yavagal D, Martin R, Brant R, Yu Y, Willinsky RA, Montanera WJ, Weill A, Kenney C, Aram H, Stewart T, Stys PK, Watson TW, Klein G, Pearson D, Couillard P, Trivedi A, Singh D, Klourfeld E, Imoukhuede O, Nikneshan D, Blayney S, Reddy R, Choi P, Horton M, Musuka T, Dubuc V, Field TS, Desai J, Adatia S, Alseraya A, Nambiar V, van Dijk R, Wong JH, Mitha AP, Morrish WF, Eesa M, Newcommon NJ, Shuaib A, Schwindt B, Butcher KS, Jeerakathil T, Buck B, Khan K, Naik SS, Emery DJ, Owen RJ, Kotylak TB, Ashforth RA, Yeo TA, McNally D, Siddiqui M, Saqqur M, Hussain D, Kalashyan H, Manosalva A, Kate M, Gioia L, Hasan S, Mohammad A, Muratoglu M, Williams D, Thornton J, Cullen A, Brennan P, O'Hare A, Looby S, Hyland D, Duff S, McCusker M, Hallinan B, Lee S, McCormack J, Moore A, O'Connor M, Donegan C, Brewer L, Martin A, Murphy S, O'Rourke K, Smyth S, Kelly P, Lynch T, Daly T, O'Brien P, O'Driscoll A, Martin M, Daly T, Collins R, Coughlan T, McCabe D, Murphy S, O'Neill D, Mulroy M, Lynch O, Walsh T, O'Donnell M, Galvin T, Harbison J, McElwaine P, Mulpeter K, McLoughlin C, Reardon M, Harkin E, Dolan E, Watts M, Cunningham N, Fallon C, Gallagher S, Cotter P, Crowe M, Doyle R, Noone I, Lapierre M, Coté VA, Lanthier S, Odier C, Durocher A, Raymond J, Weill A, Daneault N, Deschaintre Y, Jankowitz B, Baxendell L, Massaro L, Jackson-Graves C, Decesare S, Porter P, Armbruster K, Adams A, Billigan J, Oakley J, Ducruet A, Jadhav A, Giurgiutiu DV, Aghaebrahim A, Reddy V, Hammer M, Starr M, Totoraitis V, Wechsler L, Streib S, Rangaraju S, Campbell D, Rocha M, Gulati D, Silver FL, Krings T, Kalman L, Cayley A, Williams J, Stewart T, Wiegner R, Casaubon LK, Jaigobin C, del Campo JM, Elamin E, Schaafsma JD, Willinsky RA, Agid R, Farb R, ter Brugge K, Sapkoda BL, Baxter BW, Barton K, Knox A, Porter A, Sirelkhatim A, Devlin T, Dellinger C, Pitiyanuvath N, Patterson J, Nichols J, Quarfordt S, Calvert J, Hawk H, Fanale C, Frei DF, Bitner A, Novak A, Huddle D, Bellon R, Loy D, Wagner J, Chang I, Lampe E, Spencer B, Pratt R, Bartt R, Shine S, Dooley G, Nguyen T, Whaley M, McCarthy K, Teitelbaum J, Tampieri D, Poon W, Campbell N, Cortes M, Dowlatshahi D, Lum C, Shamloul R, Robert S, Stotts G, Shamy M, Steffenhagen N, Blacquiere D, Hogan M, AlHazzaa M, Basir G, Lesiuk H, Iancu D, Santos M, Choe H, Weisman DC, Jonczak K, Blue-Schaller A, Shah Q, MacKenzie L, Klein B, Kulandaivel K, Kozak O, Gzesh DJ, Harris LJ, Khoury JS, Mandzia J, Pelz D, Crann S, Fleming L, Hesser K, Beauchamp B, Amato-Marzialli B, Boulton M, Lopez-Ojeda P, Sharma M, Lownie S, Chan R, Swartz R, Howard P, Golob D, Gladstone D, Boyle K, Boulos M, Hopyan J, Yang V, Da Costa L, Holmstedt CA, Turk AS, Navarro R, Jauch E, Ozark S, Turner R, Phillips S, Shankar J, Jarrett J, Gubitz G, Maloney W, Vandorpe R, Schmidt M, Heidenreich J, Hunter G, Kelly M, Whelan R, Peeling L, Burns PA, Hunter A, Wiggam I, Kerr E, Watt M, Fulton A, Gordon P, Rennie I, Flynn P, Smyth G, O'Leary S, Gentile N, Linares G, McNelis P, Erkmen K, Katz P, Azizi A, Weaver M, Jungreis C, Faro S, Shah P, Reimer H, Kalugdan V, Saposnik G, Bharatha A, Li Y, Kostyrko P, Santos M, Marotta T, Montanera W, Sarma D, Selchen D, Spears J, Heo JH, Jeong K, Kim DJ, Kim BM, Kim YD, Song D, Lee KJ, Yoo J, Bang OY, Rho S, Lee J, Jeon P, Kim KH, Cha J, Kim SJ, Ryoo S, Lee MJ, Sohn SI, Kim CH, Ryu HG, Hong JH, Chang HW, Lee CY, Rha J, Davis SM, Donnan GA, Campbell BCV, Mitchell PJ, Churilov L, Yan B, Dowling R, Yassi N, Oxley TJ, Wu TY, Silver G, McDonald A, McCoy R, Kleinig TJ, Scroop R, Dewey HM, Simpson M, Brooks M, Coulton B, Krause M, Harrington TJ, Steinfort B, Faulder K, Priglinger M, Day S, Phan T, Chong W, Holt M, Chandra RV, Ma H, Young D, Wong K, Wijeratne T, Tu H, Mackay E, Celestino S, Bladin CF, Loh PS, Gilligan A, Ross Z, Coote S, Frost T, Parsons MW, Miteff F, Levi CR, Ang T, Spratt N, Kaauwai L, Badve M, Rice H, de Villiers L, Barber PA, McGuinness B, Hope A, Moriarty M, Bennett P, Wong A, Coulthard A, Lee A, Jannes J, Field D, Sharma G, Salinas S, Cowley E, Snow B, Kolbe J, Stark R, King J, Macdonnell R, Attia J, D'Este C, Saver JL, Goyal M, Diener HC, Levy EI, Bonafé A, Mendes Pereira V, Jahan R, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, von Kummer R, Smith W, Turjman F, Hamilton S, Chiacchierini R, Amar A, Sanossian N, Loh Y, Devlin T, Baxter B, Hawk H, Sapkota B, Quarfordt S, Sirelkhatim A, Dellinger C, Barton K, Reddy VK, Ducruet A, Jadhav A, Horev A, Giurgiutiu DV, Totoraitis V, Hammer M, Jankowitz B, Wechsler L, Rocha M, Gulati D, Campbell D, Star M, Baxendell L, Oakley J, Siddiqui A, Hopkins LN, Snyder K, Sawyer R, Hall S, Costalat V, Riquelme C, Machi P, Omer E, Arquizan C, Mourand I, Charif M, Ayrignac X, Menjot de Champfleur N, Leboucq N, Gascou G, Moynier M, du Mesnil de Rochemont R, Singer O, Berkefeld J, Foerch C, Lorenz M, Pfeilschifer W, Hattingen E, Wagner M, You SJ, Lescher S, Braun H, Dehkharghani S, Belagaje SR, Anderson A, Lima A, Obideen M, Haussen D, Dharia R, Frankel M, Patel V, Owada K, Saad A, Amerson L, Horn C, Doppelheuer S, Schindler K, Lopes DK, Chen M, Moftakhar R, Anton C, Smreczak M, Carpenter JS, Boo S, Rai A, Roberts T, Tarabishy A, Gutmann L, Brooks C, Brick J, Domico J, Reimann G, Hinrichs K, Becker M, Heiss E, Selle C, Witteler A, Al-Boutros S, Danch MJ, Ranft A, Rohde S, Burg K, Weimar C, Zegarac V, Hartmann C, Schlamann M, Göricke S, Ringlestein A, Wanke I, Mönninghoff C, Dietzold M, Budzik R, Davis T, Eubank G, Hicks WJ, Pema P, Vora N, Mejilla J, Taylor M, Clark W, Rontal A, Fields J, Peterson B, Nesbit G, Lutsep H, Bozorgchami H, Priest R, Ologuntoye O, Barnwell S, Dogan A, Herrick K, Takahasi C, Beadell N, Brown B, Jamieson S, Hussain MS, Russman A, Hui F, Wisco D, Uchino K, Khawaja Z, Katzan I, Toth G, Cheng-Ching E, Bain M, Man S, Farrag A, George P, John S, Shankar L, Drofa A, Dahlgren R, Bauer A, Itreat A, Taqui A, Cerejo R, Richmond A, Ringleb P, Bendszus M, Möhlenbruch M, Reiff T, Amiri H, Purrucker J, Herweh C, Pham M, Menn O, Ludwig I, Acosta I, Villar C, Morgan W, Sombutmai C, Hellinger F, Allen E, Bellew M, Gandhi R, Bonwit E, Aly J, Ecker RD, Seder D, Morris J, Skaletsky M, Belden J, Baker C, Connolly LS, Papanagiotou P, Roth C, Kastrup A, Politi M, Brunner F, Alexandrou M, Merdivan H, Ramsey C, Given II C, Renfrow S, Deshmukh V, Sasadeusz K, Vincent F, Thiesing JT, Putnam J, Bhatt A, Kansara A, Caceves D, Lowenkopf T, Yanase L, Zurasky J, Dancer S, Freeman B, Scheibe-Mirek T, Robison J, Rontal A, Roll J, Clark D, Rodriguez M, Fitzsimmons BFM, Zaidat O, Lynch JR, Lazzaro M, Larson T, Padmore L, Das E, Farrow-Schmidt A, Hassan A, Tekle W, Cate C, Jansen O, Cnyrim C, Wodarg F, Wiese C, Binder A, Riedel C, Rohr A, Lang N, Laufs H, Krieter S, Remonda L, Diepers M, Añon J, Nedeltchev K, Kahles T, Biethahn S, Lindner M, Chang V, Gächter C, Esperon C, Guglielmetti M, Arenillas Lara JF, Martínez Galdámez M, Calleja Sanz AI, Cortijo Garcia E, Garcia Bermejo P, Perez S, Mulero Carrillo P, Crespo Vallejo E, Ruiz Piñero M, Lopez Mesonero L, Reyes Muñoz FJ, Brekenfeld C, Buhk JH, Krützelmann A, Thomalla G, Cheng B, Beck C, Hoppe J, Goebell E, Holst B, Grzyska U, Wortmann G, Starkman S, Duckwiler G, Jahan R, Rao N, Sheth S, Ng K, Noorian A, Szeder V, Nour M, McManus M, Huang J, Tarpley J, Tateshima S, Gonzalez N, Ali L, Liebeskind D, Hinman J, Calderon-Arnulphi M, Liang C, Guzy J, Koch S, DeSousa K, Gordon-Perue G, Haussen D, Elhammady M, Peterson E, Pandey V, Dharmadhikari S, Khandelwal P, Malik A, Pafford R, Gonzalez P, Ramdas K, Andersen G, Damgaard D, Von Weitzel-Mudersbach P, Simonsen C, Ruiz de Morales Ayudarte N, Poulsen M, Sørensen L, Karabegovich S, Hjørringgaard M, Hjort N, Harbo T, Sørensen K, Deshaies E, Padalino D, Swarnkar A, Latorre JG, Elnour E, El-Zammar Z, Villwock M, Farid H, Balgude A, Cross L, Hansen K, Holtmannspötter M, Kondziella D, Hoejgaard J, Taudorf S, Soendergaard H, Wagner A, Cronquist M, Stavngaard T, Cortsen M, Krarup LH, Hyldal T, Haring HP, Guggenberger S, Hamberger M, Trenkler J, Sonnberger M, Nussbaumer K, Dominger C, Bach E, Jagadeesan BD, Taylor R, Kim J, Shea K, Tummala R, Zacharatos H, Sandhu D, Ezzeddine M, Grande A, Hildebrandt D, Miller K, Scherber J, Hendrickson A, Jumaa M, Zaidi S, Hendrickson T, Snyder V, Killer-Oberpfalzer M, Mutzenbach J, Weymayr F, Broussalis E, Stadler K, Jedlitschka A, Malek A, Mueller-Kronast N, Beck P, Martin C, Summers D, Day J, Bettinger I, Holloway W, Olds K, Arkin S, Akhtar N, Boutwell C, Crandall S, Schwartzman M, Weinstein C, Brion B, Prothmann S, Kleine J, Kreiser K, Boeckh-Behrens T, Poppert H, Wunderlich S, Koch ML, Biberacher V, Huberle A, Gora-Stahlberg G, Knier B, Meindl T, Utpadel-Fischler D. Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data. Lancet Neurol 2018; 17:895-904. [DOI: 10.1016/s1474-4422(18)30242-4] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/29/2022]
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Wagemakers A, Visser MC, de Wever B, Hovius JW, van de Donk NWCJ, Hendriks EJ, Peferoen L, Muller FF, Ang CW. Case report: persistently seronegative neuroborreliosis in an immunocompromised patient. BMC Infect Dis 2018; 18:362. [PMID: 30071836 PMCID: PMC6090844 DOI: 10.1186/s12879-018-3273-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/25/2018] [Indexed: 12/01/2022] Open
Abstract
Background Infection with Borrelia burgdorferi sensu lato complex (B. b. sl) spirochetes can cause Lyme borreliosis, manifesting as localized infection (e.g. erythema migrans) or disseminated disease (e.g. Lyme neuroborreliosis). Generally, patients with disseminated Lyme borreliosis will produce an antibody response several weeks post-infection. So far, no case of neuroborreliosis has been described with persistently negative serology one month after infection. Case presentation We present a patient with a history of Mantle cell lymphoma and treatment with R-CHOP (rituximab, doxorubicine, vincristine, cyclofosfamide, prednisone), with a meningo-encephalitis, who was treated for a suspected lymphoma relapse. However, no malignant cells or other signs of malignancy were found, and microbial tests did not reveal any clues, including Borrelia serology. He did not recall being bitten by ticks, and a Borrelia PCR on CSF was negative. After spontaneous improvement of symptoms, he was discharged without definite diagnosis. Several weeks later, he was readmitted with a relapse of symptoms of meningo-encephalitis. This time however, a Borrelia PCR on CSF was positive, confirmed by two independent laboratories, and the patient received ceftriaxone upon which he partially recovered. Interestingly, during the diagnostic process of this exceptionally difficult case, a variety of different serological assays for Borrelia antibodies remained negative. Only P41 (flagellin) IgG was detected by blot and the Liaison IgG became equivocal 2 months after initial testing. Conclusions To the best of our knowledge this is the first case of neuroborreliosis that is seronegative on repeated sera and multiple test modalities. This unique case demonstrates the difficulty to diagnose neuroborreliosis in severely immunocompromised patients. In this case, a delay in diagnosis was caused by broad differential diagnosis, an absent known history of tick bites, negative serology and the low sensitivity of PCR on CSF. Therefore, awareness of the diagnostic limitations to detect Borrelia infection in this specific patient category is warranted. Electronic supplementary material The online version of this article (10.1186/s12879-018-3273-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Wagemakers
- Department of medical microbiology, VU medical center, De Boelelaan 1117, Amsterdam, 1081, HV, The Netherlands.
| | - M C Visser
- Department of neurology, VU medical center, De Boelelaan 1117, Amsterdam, 1081, HV, The Netherlands
| | - B de Wever
- Department of medical microbiology, Academic medical center, Meibergdreef 9, Amsterdam, 1105, AZ, The Netherlands
| | - J W Hovius
- Department of internal medicine/Amsterdam multidisciplinary Lyme center, Academic medical center, Meibergdreef 9, Amsterdam, 1105, AZ, The Netherlands
| | - N W C J van de Donk
- Department of hematology, VU medical center, De Boelelaan 1117, Amsterdam, 1081, HV, The Netherlands
| | - E J Hendriks
- Department of radiology and nuclear medicine, VU medical center, De Boelelaan 1117, Amsterdam, 1081, HV, The Netherlands
| | - L Peferoen
- Department of pathology, VU medical center, De Boelelaan 1117, Amsterdam, 1081, HV, The Netherlands
| | - F F Muller
- Department of neurology, VU medical center, De Boelelaan 1117, Amsterdam, 1081, HV, The Netherlands
| | - C W Ang
- Department of medical microbiology, VU medical center, De Boelelaan 1117, Amsterdam, 1081, HV, The Netherlands
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Campbell BCV, van Zwam WH, Goyal M, Menon BK, Dippel DWJ, Demchuk AM, Bracard S, White P, Dávalos A, Majoie CBLM, van der Lugt A, Ford GA, de la Ossa NP, Kelly M, Bourcier R, Donnan GA, Roos YBWEM, Bang OY, Nogueira RG, Devlin TG, van den Berg LA, Clarençon F, Burns P, Carpenter J, Berkhemer OA, Yavagal DR, Pereira VM, Ducrocq X, Dixit A, Quesada H, Epstein J, Davis SM, Jansen O, Rubiera M, Urra X, Micard E, Lingsma HF, Naggara O, Brown S, Guillemin F, Muir KW, van Oostenbrugge RJ, Saver JL, Jovin TG, Hill MD, Mitchell PJ, Berkhemer OA, Fransen PSS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJH, van Walderveen MAA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle J, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach Z, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, van den Berg R, Koudstaal PJ, van Zwam WH, Roos YB, van der Lugt A, van Oostenbrugge RJ, Wakhloo A, Moonis M, Henninger N, Goddeau R, Massari F, Minaeian A, Lozano JD, Ramzan M, Stout C, Patel A, Majoie CB, Tunguturi A, Onteddu S, Carandang R, Howk M, Ribó M, Sanjuan E, Rubiera M, Pagola J, Flores A, Muchada M, Dippel DW, Meler P, Huerga E, Gelabert S, Coscojuela P, Tomasello A, Rodriguez D, Santamarina E, Maisterra O, Boned S, Seró L, Brown MM, Rovira A, Molina CA, Millán M, Muñoz L, Pérez de la Ossa N, Gomis M, Dorado L, López-Cancio E, Palomeras E, Munuera J, Liebig T, García Bermejo P, Remollo S, Castaño C, García-Sort R, Cuadras P, Puyalto P, Hernández-Pérez M, Jiménez M, Martínez-Piñeiro A, Lucente G, Stijnen T, Dávalos A, Chamorro A, Urra X, Obach V, Cervera A, Amaro S, Llull L, Codas J, Balasa M, Navarro J, Andersson T, Ariño H, Aceituno A, Rudilosso S, Renu A, Macho JM, San Roman L, Blasco J, López A, Macías N, Cardona P, Mattle H, Quesada H, Rubio F, Cano L, Lara B, de Miquel MA, Aja L, Serena J, Cobo E, Albers GW, Lees KR, Wahlgren N, Arenillas J, Roberts R, Minhas P, Al-Ajlan F, Salluzzi M, Zimmel L, Patel S, Eesa M, Martí-Fàbregas J, Jankowitz B, van der Heijden E, Serena J, Salvat-Plana M, López-Cancio E, Bracard S, Ducrocq X, Anxionnat R, Baillot PA, Barbier C, Derelle AL, Lacour JC, Ghannouti N, Richard S, Samson Y, Sourour N, Baronnet-Chauvet F, Clarencon F, Crozier S, Deltour S, Di Maria F, Le Bouc R, Leger A, Fleitour N, Mutlu G, Rosso C, Szatmary Z, Yger M, Zavanone C, Bakchine S, Pierot L, Caucheteux N, Estrade L, Kadziolka K, Hooijenga I, Leautaud A, Renkes C, Serre I, Desal H, Guillon B, Boutoleau-Bretonniere C, Daumas-Duport B, De Gaalon S, Derkinderen P, Evain S, Puppels C, Herisson F, Laplaud DA, Lebouvier T, Lintia-Gaultier A, Pouclet-Courtemanche H, Rouaud T, Rouaud Jaffrenou V, Schunck 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Morrish WF, Eesa M, Newcommon NJ, Shuaib A, Schwindt B, Butcher KS, Jeerakathil T, Buck B, Khan K, Naik SS, Emery DJ, Owen RJ, Kotylak TB, Ashforth RA, Yeo TA, McNally D, Siddiqui M, Saqqur M, Hussain D, Kalashyan H, Manosalva A, Kate M, Gioia L, Hasan S, Mohammad A, Muratoglu M, Williams D, Thornton J, Cullen A, Brennan P, O'Hare A, Looby S, Hyland D, Duff S, McCusker M, Hallinan B, Lee S, McCormack J, Moore A, O'Connor M, Donegan C, Brewer L, Martin A, Murphy S, O'Rourke K, Smyth S, Kelly P, Lynch T, Daly T, O'Brien P, O'Driscoll A, Martin M, Daly T, Collins R, Coughlan T, McCabe D, Murphy S, O'Neill D, Mulroy M, Lynch O, Walsh T, O'Donnell M, Galvin T, Harbison J, McElwaine P, Mulpeter K, McLoughlin C, Reardon M, Harkin E, Dolan E, Watts M, Cunningham N, Fallon C, Gallagher S, Cotter P, Crowe M, Doyle R, Noone I, Lapierre M, Coté VA, Lanthier S, Odier C, Durocher A, Raymond J, Weill A, Daneault N, Deschaintre Y, Jankowitz B, Baxendell L, Massaro L, Jackson-Graves C, Decesare S, Porter P, Armbruster K, Adams A, Billigan J, Oakley J, Ducruet A, Jadhav A, Giurgiutiu DV, Aghaebrahim A, Reddy V, Hammer M, Starr M, Totoraitis V, Wechsler L, Streib S, Rangaraju S, Campbell D, Rocha M, Gulati D, Silver FL, Krings T, Kalman L, Cayley A, Williams J, Stewart T, Wiegner R, Casaubon LK, Jaigobin C, del Campo JM, Elamin E, Schaafsma JD, Willinsky RA, Agid R, Farb R, ter Brugge K, Sapkoda BL, Baxter BW, Barton K, Knox A, Porter A, Sirelkhatim A, Devlin T, Dellinger C, Pitiyanuvath N, Patterson J, Nichols J, Quarfordt S, Calvert J, Hawk H, Fanale C, Frei DF, Bitner A, Novak A, Huddle D, Bellon R, Loy D, Wagner J, Chang I, Lampe E, Spencer B, Pratt R, Bartt R, Shine S, Dooley G, Nguyen T, Whaley M, McCarthy K, Teitelbaum J, Tampieri D, Poon W, Campbell N, Cortes M, Dowlatshahi D, Lum C, Shamloul R, Robert S, Stotts G, Shamy M, Steffenhagen N, Blacquiere D, Hogan M, AlHazzaa M, Basir G, Lesiuk H, Iancu D, Santos M, Choe H, Weisman DC, Jonczak K, Blue-Schaller A, Shah Q, MacKenzie L, Klein B, Kulandaivel K, Kozak O, Gzesh DJ, Harris LJ, Khoury JS, Mandzia J, Pelz D, Crann S, Fleming L, Hesser K, Beauchamp B, Amato-Marzialli B, Boulton M, Lopez- Ojeda P, Sharma M, Lownie S, Chan R, Swartz R, Howard P, Golob D, Gladstone D, Boyle K, Boulos M, Hopyan J, Yang V, Da Costa L, Holmstedt CA, Turk AS, Navarro R, Jauch E, Ozark S, Turner R, Phillips S, Shankar J, Jarrett J, Gubitz G, Maloney W, Vandorpe R, Schmidt M, Heidenreich J, Hunter G, Kelly M, Whelan R, Peeling L, Burns PA, Hunter A, Wiggam I, Kerr E, Watt M, Fulton A, Gordon P, Rennie I, Flynn P, Smyth G, O'Leary S, Gentile N, Linares G, McNelis P, Erkmen K, Katz P, Azizi A, Weaver M, Jungreis C, Faro S, Shah P, Reimer H, Kalugdan V, Saposnik G, Bharatha A, Li Y, Kostyrko P, Santos M, Marotta T, Montanera W, Sarma D, Selchen D, Spears J, Heo JH, Jeong K, Kim DJ, Kim BM, Kim YD, Song D, Lee KJ, Yoo J, Bang OY, Rho S, Lee J, Jeon P, Kim KH, Cha J, Kim SJ, Ryoo S, Lee MJ, Sohn SI, Kim CH, Ryu HG, Hong JH, Chang HW, Lee CY, Rha J, Davis SM, Donnan GA, Campbell BCV, Mitchell PJ, Churilov L, Yan B, Dowling R, Yassi N, Oxley TJ, Wu TY, Silver G, McDonald A, McCoy R, Kleinig TJ, Scroop R, Dewey HM, Simpson M, Brooks M, Coulton B, Krause M, Harrington TJ, Steinfort B, Faulder K, Priglinger M, Day S, Phan T, Chong W, Holt M, Chandra RV, Ma H, Young D, Wong K, Wijeratne T, Tu H, Mackay E, Celestino S, Bladin CF, Loh PS, Gilligan A, Ross Z, Coote S, Frost T, Parsons MW, Miteff F, Levi CR, Ang T, Spratt N, Kaauwai L, Badve M, Rice H, de Villiers L, Barber PA, McGuinness B, Hope A, Moriarty M, Bennett P, Wong A, Coulthard A, Lee A, Jannes J, Field D, Sharma G, Salinas S, Cowley E, Snow B, Kolbe J, Stark R, King J, Macdonnell R, Attia J, D'Este C, Saver JL, Goyal M, Diener HC, Levy EI, Bonafé A, Mendes Pereira V, Jahan R, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, von Kummer R, Smith W, Turjman F, Hamilton S, Chiacchierini R, Amar A, Sanossian N, Loh Y, Devlin T, Baxter B, Hawk H, Sapkota B, Quarfordt S, Sirelkhatim A, Dellinger C, Barton K, Reddy VK, Ducruet A, Jadhav A, Horev A, Giurgiutiu DV, Totoraitis V, Hammer M, Jankowitz B, Wechsler L, Rocha M, Gulati D, Campbell D, Star M, Baxendell L, Oakley J, Siddiqui A, Hopkins LN, Snyder K, Sawyer R, Hall S, Costalat V, Riquelme C, Machi P, Omer E, Arquizan C, Mourand I, Charif M, Ayrignac X, Menjot de Champfleur N, Leboucq N, Gascou G, Moynier M, du Mesnil de Rochemont R, Singer O, Berkefeld J, Foerch C, Lorenz M, Pfeilschifer W, Hattingen E, Wagner M, You SJ, Lescher S, Braun H, Dehkharghani S, Belagaje SR, Anderson A, Lima A, Obideen M, Haussen D, Dharia R, Frankel M, Patel V, Owada K, Saad A, Amerson L, Horn C, Doppelheuer S, Schindler K, Lopes DK, Chen M, Moftakhar R, Anton C, Smreczak M, Carpenter JS, Boo S, Rai A, Roberts T, Tarabishy A, Gutmann L, Brooks C, Brick J, Domico J, Reimann G, Hinrichs K, Becker M, Heiss E, Selle C, Witteler A, Al-Boutros S, Danch 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S, Deshmukh V, Sasadeusz K, Vincent F, Thiesing JT, Putnam J, Bhatt A, Kansara A, Caceves D, Lowenkopf T, Yanase L, Zurasky J, Dancer S, Freeman B, Scheibe-Mirek T, Robison J, Rontal A, Roll J, Clark D, Rodriguez M, Fitzsimmons BFM, Zaidat O, Lynch JR, Lazzaro M, Larson T, Padmore L, Das E, Farrow-Schmidt A, Hassan A, Tekle W, Cate C, Jansen O, Cnyrim C, Wodarg F, Wiese C, Binder A, Riedel C, Rohr A, Lang N, Laufs H, Krieter S, Remonda L, Diepers M, Añon J, Nedeltchev K, Kahles T, Biethahn S, Lindner M, Chang V, Gächter C, Esperon C, Guglielmetti M, Arenillas Lara JF, Martínez Galdámez M, Calleja Sanz AI, Cortijo Garcia E, Garcia Bermejo P, Perez S, Mulero Carrillo P, Crespo Vallejo E, Ruiz Piñero M, Lopez Mesonero L, Reyes Muñoz FJ, Brekenfeld C, Buhk JH, Krützelmann A, Thomalla G, Cheng B, Beck C, Hoppe J, Goebell E, Holst B, Grzyska U, Wortmann G, Starkman S, Duckwiler G, Jahan R, Rao N, Sheth S, Ng K, Noorian A, Szeder V, Nour M, McManus M, Huang J, Tarpley J, Tateshima S, Gonzalez N, Ali L, Liebeskind D, Hinman J, Calderon-Arnulphi M, Liang C, Guzy J, Koch S, DeSousa K, Gordon-Perue G, Haussen D, Elhammady M, Peterson E, Pandey V, Dharmadhikari S, Khandelwal P, Malik A, Pafford R, Gonzalez P, Ramdas K, Andersen G, Damgaard D, Von Weitzel-Mudersbach P, Simonsen C, Ruiz de Morales Ayudarte N, Poulsen M, Sørensen L, Karabegovich S, Hjørringgaard M, Hjort N, Harbo T, Sørensen K, Deshaies E, Padalino D, Swarnkar A, Latorre JG, Elnour E, El-Zammar Z, Villwock M, Farid H, Balgude A, Cross L, Hansen K, Holtmannspötter M, Kondziella D, Hoejgaard J, Taudorf S, Soendergaard H, Wagner A, Cronquist M, Stavngaard T, Cortsen M, Krarup LH, Hyldal T, Haring HP, Guggenberger S, Hamberger M, Trenkler J, Sonnberger M, Nussbaumer K, Dominger C, Bach E, Jagadeesan BD, Taylor R, Kim J, Shea K, Tummala R, Zacharatos H, Sandhu D, Ezzeddine M, Grande A, Hildebrandt D, Miller K, Scherber J, Hendrickson A, Jumaa M, Zaidi S, Hendrickson T, Snyder V, Killer-Oberpfalzer M, Mutzenbach J, Weymayr F, Broussalis E, Stadler K, Jedlitschka A, Malek A, Mueller-Kronast N, Beck P, Martin C, Summers D, Day J, Bettinger I, Holloway W, Olds K, Arkin S, Akhtar N, Boutwell C, Crandall S, Schwartzman M, Weinstein C, Brion B, Prothmann S, Kleine J, Kreiser K, Boeckh-Behrens T, Poppert H, Wunderlich S, Koch ML, Biberacher V, Huberle A, Gora-Stahlberg G, Knier B, Meindl T, Utpadel-Fischler D, Zech M, Kowarik M, Seifert C, Schwaiger B, Puri A, Hou S. Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data. Lancet Neurol 2018; 17:47-53. [DOI: 10.1016/s1474-4422(17)30407-6] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/05/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
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Mulder MJ, Ergezen S, Lingsma HF, Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lycklama à Nijeholt G, Emmer BJ, van der Worp HB, Nederkoorn PJ, Roos YB, van Oostenbrugge RJ, van Zwam WH, Majoie CB, van der Lugt A, Dippel DW, Schonewille WJ, Vos JA, Wermer MJ, van Walderveen MA, Staals J, Hofmeijer J, van Oostayen JA, Boiten J, Brouwer PA, de Bruijn SF, van Dijk LC, Kappelle LJ, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van den Berg JS, van Rooij WJJ, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, van Walderveen MA, Bot JC, Marquering HA, Beenen LF, Sprengers ME, Jenniskens SF, van den Berg R, Yoo AJ, Koudstaal PJ, Boiten J, van Dijk EJ, Wermer MJ, Flach HZ, Steyerberg EW. Baseline Blood Pressure Effect on the Benefit and Safety of Intra-Arterial Treatment in MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands). Stroke 2017; 48:1869-1876. [DOI: 10.1161/strokeaha.116.016225] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 02/23/2017] [Accepted: 03/01/2017] [Indexed: 12/21/2022]
Abstract
Background and Purpose—
High blood pressure (BP) is associated with poor outcome and the occurrence of symptomatic intracranial hemorrhage in acute ischemic stroke. Whether BP influences the benefit or safety of intra-arterial treatment (IAT) is not known. We aimed to assess the relation of BP with functional outcome, occurrence of symptomatic intracranial hemorrhage and effect of IAT.
Methods—
This is a post hoc analysis of the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands). BP was measured at baseline, before IAT or stroke unit admission. We estimated the association of baseline BP with the score on the modified Rankin Scale at 90 days and safety parameters with ordinal and logistic regression analysis. Effect of BP on the effect of IAT was tested with multiplicative interaction terms.
Results—
Systolic BP (SBP) had the best correlation with functional outcome. This correlation was U-shaped; both low and high baseline SBP were associated with poor functional outcome. Higher SBP was associated with symptomatic intracranial hemorrhage (adjusted odds ratio, 1.25 for every 10 mm Hg higher SBP [95% confidence interval, 1.09–1.44]). Between SBP and IAT, there was no interaction for functional outcome, symptomatic intracranial hemorrhage, or other safety parameters; the absolute benefit of IAT was evident for the whole SBP range. The same was found for diastolic BP.
Conclusions—
BP does not affect the benefit or safety of IAT in patients with acute ischemic stroke caused by proximal intracranial vessel occlusion. Our data provide no arguments to withhold or delay IAT based on BP.
Clinical Trial Registration—
URL:
http://www.isrctn.com
. Unique identifier: ISRCTN10888758.
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Affiliation(s)
- Maxim J.H.L. Mulder
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Saliha Ergezen
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Hester F. Lingsma
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Olvert A. Berkhemer
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Puck S.S. Fransen
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Debbie Beumer
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Lucie A. van den Berg
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Geert Lycklama à Nijeholt
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Bart J. Emmer
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - H. Bart van der Worp
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Paul J. Nederkoorn
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Yvo B.W.E.M. Roos
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Robert J. van Oostenbrugge
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Wim H. van Zwam
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Charles B.L.M. Majoie
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Aad van der Lugt
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Diederik W.J. Dippel
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | | | - Jan Albert Vos
- Radiology, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | | | | | - Julie Staals
- Department of Neurology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), the Netherlands
| | | | | | - Jelis Boiten
- Neurology, MC Haaglanden, the Hague, the Netherlands
| | | | | | | | - L. Jaap Kappelle
- Department of Neurology, University Medical Center Utrecht, the Netherlands
| | - Rob H. Lo
- Radiology, University Medical Center Utrecht, the Netherlands
| | - Ewoud J. van Dijk
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joost de Vries
- Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Paul L.M. de Kort
- Department of Neurology, Sint Elisabeth Hospital, Tilburg, the Netherlands
| | | | | | | | - Leo A.M. Aerden
- Department of Neurology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | | | - Marieke C. Visser
- Department of Neurology, VU Medical Center, Amsterdam, the Netherlands
| | | | - Patrick C. Vroomen
- Department of Neurology, University Medical Center Groningen, the Netherlands
| | - Omid Eshghi
- Radiology, University Medical Center Groningen, the Netherlands
| | | | | | - Koos Keizer
- Department of Neurology, Catharina Hospital, Eindhoven, the Netherlands
| | | | | | - Dick G. Gerrits
- Radiology, Medical Spectrum Twente, Enschede, the Netherlands)
| | | | - Giorgos B. Karas
- Radiology, Sint Lucas Andreas Hospital, Amsterdam, the Netherlands
| | | | | | - Henk A. Marquering
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands
| | - Ludo F. Beenen
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | | | | | - René van den Berg
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Peter J. Koudstaal
- Department of Neurology, Erasmus MC University Medical Center, the Netherlands
| | - Jelis Boiten
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherland
| | - Ewoud J. van Dijk
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | - Ewout W. Steyerberg
- Public Health, Erasmus MC University Medical Center, the Netherlands; Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands
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20
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van Os HJA, Mulder IA, Broersen A, Algra A, van der Schaaf IC, Kappelle LJ, Velthuis BK, Terwindt GM, Schonewille WJ, Visser MC, Ferrari MD, van Walderveen MAA, Wermer MJH. Migraine and Cerebrovascular Atherosclerosis in Patients With Ischemic Stroke. Stroke 2017; 48:1973-1975. [PMID: 28526767 DOI: 10.1161/strokeaha.116.016133] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/22/2017] [Accepted: 03/31/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Migraine is a well-established risk factor for ischemic stroke, but migraine is also related to other vascular diseases. This study aims to investigate the association between migraine and cerebrovascular atherosclerosis in patients with acute ischemic stroke. METHODS We retrieved data on patients with ischemic stroke from the DUST (Dutch Acute Stroke Study). Migraine history was assessed with a migraine screener and confirmed by telephone interview based on the ICHD criteria (International Classification of Headache Disorders). We assessed intra- and extracranial atherosclerotic changes and quantified intracranial internal carotid artery calcifications as measure of atherosclerotic burden on noncontrast computed tomography and computed tomographic angiography. We calculated risk ratios with adjustments for possible confounders with multivariable Poisson regression analyses. RESULTS We included 656 patients, aged 18 to 99 years, of whom 53 had a history of migraine (29 with aura). Patients with migraine did not have more frequent atherosclerotic changes in intracranial (51% versus 74%; adjusted risk ratio, 0.82; 95% confidence interval, 0.64-1.05) or extracranial vessels (62% versus 79%; adjusted risk ratio, 0.93; 95% confidence interval, 0.77-1.12) than patients without migraine and had comparable internal carotid artery calcification volumes (largest versus medium and smallest volume tertile, 23% versus 35%; adjusted risk ratio, 0.93; 95% confidence interval, 0.57-1.52). CONCLUSIONS Migraine is not associated with excess atherosclerosis in large vessels in patients with acute ischemic stroke. Our findings suggest that the biological mechanisms by which migraine results in ischemic stroke are not related to macrovascular cerebral atherosclerosis.
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Affiliation(s)
- Hendrikus J A van Os
- From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.), Radiology (A.B., M.A.A.v.W.), and Clinical Epidemiology (A.A.), Leiden University Medical Center, the Netherlands; Department of Radiology (I.C.v.d.S., B.K.V.), Neurology (L.J.K.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, the Netherlands; Department of Neurology, St Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); and Department of Neurology, VU Medical Center, Amsterdam, the Netherlands (M.C.V.).
| | - Inge A Mulder
- From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.), Radiology (A.B., M.A.A.v.W.), and Clinical Epidemiology (A.A.), Leiden University Medical Center, the Netherlands; Department of Radiology (I.C.v.d.S., B.K.V.), Neurology (L.J.K.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, the Netherlands; Department of Neurology, St Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); and Department of Neurology, VU Medical Center, Amsterdam, the Netherlands (M.C.V.)
| | - Alexander Broersen
- From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.), Radiology (A.B., M.A.A.v.W.), and Clinical Epidemiology (A.A.), Leiden University Medical Center, the Netherlands; Department of Radiology (I.C.v.d.S., B.K.V.), Neurology (L.J.K.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, the Netherlands; Department of Neurology, St Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); and Department of Neurology, VU Medical Center, Amsterdam, the Netherlands (M.C.V.)
| | - Ale Algra
- From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.), Radiology (A.B., M.A.A.v.W.), and Clinical Epidemiology (A.A.), Leiden University Medical Center, the Netherlands; Department of Radiology (I.C.v.d.S., B.K.V.), Neurology (L.J.K.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, the Netherlands; Department of Neurology, St Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); and Department of Neurology, VU Medical Center, Amsterdam, the Netherlands (M.C.V.)
| | - Irene C van der Schaaf
- From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.), Radiology (A.B., M.A.A.v.W.), and Clinical Epidemiology (A.A.), Leiden University Medical Center, the Netherlands; Department of Radiology (I.C.v.d.S., B.K.V.), Neurology (L.J.K.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, the Netherlands; Department of Neurology, St Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); and Department of Neurology, VU Medical Center, Amsterdam, the Netherlands (M.C.V.)
| | - L Jaap Kappelle
- From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.), Radiology (A.B., M.A.A.v.W.), and Clinical Epidemiology (A.A.), Leiden University Medical Center, the Netherlands; Department of Radiology (I.C.v.d.S., B.K.V.), Neurology (L.J.K.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, the Netherlands; Department of Neurology, St Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); and Department of Neurology, VU Medical Center, Amsterdam, the Netherlands (M.C.V.)
| | - Birgitta K Velthuis
- From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.), Radiology (A.B., M.A.A.v.W.), and Clinical Epidemiology (A.A.), Leiden University Medical Center, the Netherlands; Department of Radiology (I.C.v.d.S., B.K.V.), Neurology (L.J.K.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, the Netherlands; Department of Neurology, St Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); and Department of Neurology, VU Medical Center, Amsterdam, the Netherlands (M.C.V.)
| | - Gisela M Terwindt
- From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.), Radiology (A.B., M.A.A.v.W.), and Clinical Epidemiology (A.A.), Leiden University Medical Center, the Netherlands; Department of Radiology (I.C.v.d.S., B.K.V.), Neurology (L.J.K.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, the Netherlands; Department of Neurology, St Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); and Department of Neurology, VU Medical Center, Amsterdam, the Netherlands (M.C.V.)
| | - Wouter J Schonewille
- From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.), Radiology (A.B., M.A.A.v.W.), and Clinical Epidemiology (A.A.), Leiden University Medical Center, the Netherlands; Department of Radiology (I.C.v.d.S., B.K.V.), Neurology (L.J.K.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, the Netherlands; Department of Neurology, St Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); and Department of Neurology, VU Medical Center, Amsterdam, the Netherlands (M.C.V.)
| | - Marieke C Visser
- From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.), Radiology (A.B., M.A.A.v.W.), and Clinical Epidemiology (A.A.), Leiden University Medical Center, the Netherlands; Department of Radiology (I.C.v.d.S., B.K.V.), Neurology (L.J.K.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, the Netherlands; Department of Neurology, St Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); and Department of Neurology, VU Medical Center, Amsterdam, the Netherlands (M.C.V.)
| | - Michel D Ferrari
- From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.), Radiology (A.B., M.A.A.v.W.), and Clinical Epidemiology (A.A.), Leiden University Medical Center, the Netherlands; Department of Radiology (I.C.v.d.S., B.K.V.), Neurology (L.J.K.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, the Netherlands; Department of Neurology, St Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); and Department of Neurology, VU Medical Center, Amsterdam, the Netherlands (M.C.V.)
| | - Marianne A A van Walderveen
- From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.), Radiology (A.B., M.A.A.v.W.), and Clinical Epidemiology (A.A.), Leiden University Medical Center, the Netherlands; Department of Radiology (I.C.v.d.S., B.K.V.), Neurology (L.J.K.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, the Netherlands; Department of Neurology, St Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); and Department of Neurology, VU Medical Center, Amsterdam, the Netherlands (M.C.V.)
| | - Marieke J H Wermer
- From the Department of Neurology (H.J.A.v.O., I.A.M., G.M.T., M.D.F., M.J.H.W.), Radiology (A.B., M.A.A.v.W.), and Clinical Epidemiology (A.A.), Leiden University Medical Center, the Netherlands; Department of Radiology (I.C.v.d.S., B.K.V.), Neurology (L.J.K.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, the Netherlands; Department of Neurology, St Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.); and Department of Neurology, VU Medical Center, Amsterdam, the Netherlands (M.C.V.)
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21
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Hauer AJ, Ruigrok YM, Algra A, van Dijk EJ, Koudstaal PJ, Luijckx GJ, Nederkoorn PJ, van Oostenbrugge RJ, Visser MC, Wermer MJ, Kappelle LJ, Klijn CJM. Age-Specific Vascular Risk Factor Profiles According to Stroke Subtype. J Am Heart Assoc 2017; 6:JAHA.116.005090. [PMID: 28483775 PMCID: PMC5524074 DOI: 10.1161/jaha.116.005090] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Ischemic and hemorrhagic stroke are increasingly recognized as heterogeneous diseases with distinct subtypes and etiologies. Information on variation in distribution of vascular risk factors according to age in stroke subtypes is limited. We investigated the prevalence of vascular risk factors in stroke subtypes in relation to age. METHODS AND RESULTS We studied a prospective multicenter university hospital-based cohort of 4033 patients. For patients with ischemic stroke caused by large artery atherosclerosis, small vessel disease, or cardioembolism and for patients with spontaneous intracerebral hemorrhage or aneurysmal subarachnoid hemorrhage, we calculated prevalences of vascular risk factors in 4 age groups: <55, 55 to 65, 65 to 75, and ≥75 years, and mean differences with 95% CIs in relation to the reference age group. Patients aged <55 years were significantly more often of non-white origin (in particular in spontaneous intracerebral hemorrhage and aneurysmal subarachnoid hemorrhage patients) and most often smoked (most prominent for aneurysmal subarachnoid hemorrhage patients). Patients aged <55 years with ischemic stroke caused by large artery atherosclerosis or small vessel disease more often had hypertension, hyperlipidemia, and diabetes mellitus than patients with ischemic stroke of cardiac origin. Overall, the frequency of hypertension, hyperlipidemia, and diabetes mellitus increased with age among all stroke subtypes, whereas smoking decreased with age. Regardless of age, accumulation of potentially modifiable risk factors was most pronounced in patients with ischemic stroke caused by large artery atherosclerosis or small vessel disease. CONCLUSIONS The prevalence of common cardiovascular risk factors shows different age-specific patterns among various stroke subtypes. Recognition of these patterns may guide tailored stroke prevention efforts aimed at specific risk groups.
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Affiliation(s)
- Allard J Hauer
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ynte M Ruigrok
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ale Algra
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ewoud J van Dijk
- Department of Neurology, Donders Institute of Brain Behaviour & Cognition, Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter J Koudstaal
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gert-Jan Luijckx
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Marieke C Visser
- Department of Neurology, VU Medical Center, Amsterdam, The Netherlands
| | - Marieke J Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Catharina J M Klijn
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands .,Department of Neurology, Donders Institute of Brain Behaviour & Cognition, Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
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22
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Groot AE, van Schaik IN, Visser MC, Nederkoorn PJ, Limburg M, Aramideh M, de Beer F, Zwetsloot CP, Halkes P, de Kruijk J, Kruyt ND, van der Meulen W, Spaander F, van der Ree T, Kwa VIH, Van den Berg-Vos RM, Roos YB, Coutinho JM. Association between i.v. thrombolysis volume and door-to-needle times in acute ischemic stroke. J Neurol 2016; 263:807-13. [PMID: 26946499 PMCID: PMC4826653 DOI: 10.1007/s00415-016-8076-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 02/16/2016] [Accepted: 02/16/2016] [Indexed: 11/30/2022]
Abstract
Centralization of intravenous thrombolysis (IVT) for acute ischemic stroke in high-volume centers is believed to improve the door-to-needle times (DNT), but limited data support this assumption. We examined the association between DNT and IVT volume in a large Dutch province. We identified consecutive patients treated with IVT between January 2009 and 2013. Based on annualized IVT volume, hospitals were categorized as low-volume (≤ 24), medium-volume (25-49) or high-volume (≥ 50). In logistic regression analysis, low-volume hospitals were used as reference category. Of 17,332 stroke patients from 11 participating hospitals, 1962 received IVT (11.3 %). We excluded 140 patients because of unknown DNT (n = 86) or in-hospital stroke (n = 54). There were two low-volume (total 101 patients), five medium-volume (747 patients) and four high-volume hospitals (974 patients). Median DNT was shorter in high-volume hospitals (30 min) than in medium-volume (42 min, p < 0.001) and low-volume hospitals (38 min, p < 0.001). Patients admitted to high-volume hospitals had a higher chance of DNT < 30 min (adjusted OR 3.13, 95 % CI 1.70-5.75), lower risk of symptomatic intracerebral hemorrhage (adjusted OR 0.39, 95 % CI 0.16-0.92), and a lower mortality risk (adjusted OR 0.45, 95 % CI 0.21-1.01), compared to low-volume centers. There was no difference in DNT between low- and medium-volume hospitals. Onset-to-needle times (ONT) did not differ between the groups. Hospitals in this Dutch province generally achieved short DNTs. Despite this overall good performance, higher IVT volumes were associated with shorter DNTs and lower complication risks. The ONT was not associated with IVT volume.
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Affiliation(s)
- Adrien E Groot
- Department of Neurology, Academic Medical Center, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Ivo N van Schaik
- Department of Neurology, Academic Medical Center, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Marieke C Visser
- Department of Neurology, VU Medical Center, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Academic Medical Center, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Martien Limburg
- Department of Neurology, Flevoziekenhuis, Hospitaalweg 1, 1315, RA, Almere, The Netherlands
| | - Majid Aramideh
- Department of Neurology, Medical Centre Alkmaar, Wilhelminalaan 12, 1815, JD, Alkmaar, The Netherlands
| | - Frank de Beer
- Department of Neurology, Kennemer Gasthuis, Boerhaavelaan 22, 2035, RC, Haarlem, The Netherlands
| | - Caspar P Zwetsloot
- Department of Neurology, Waterland, Waterlandlaan 250, 1441, RN, Purmerend, The Netherlands
| | - Patricia Halkes
- Department of Neurology, Medical Centre Alkmaar, Wilhelminalaan 12, 1815, JD, Alkmaar, The Netherlands
| | - Jelle de Kruijk
- Department of Neurology, Tergooi Ziekenhuis, Rijksstraat 1, 1261, AN, Blaricum, The Netherlands
| | - Nyika D Kruyt
- Department of Neurology, Slotervaart, Louwesweg 6, 1066, EC, Amsterdam, The Netherlands.,Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Willem van der Meulen
- Department of Neurology, Rode Kruis Ziekenhuis, Vondellaan 13, 1942, LE, Beverwijk, The Netherlands
| | - Fianne Spaander
- Department of Neurology, Slotervaart, Louwesweg 6, 1066, EC, Amsterdam, The Netherlands
| | - Taco van der Ree
- Department of Neurology, Westfries Gasthuis, Maelsonstraat 3, 1624, NP, Hoorn, The Netherlands
| | - Vincent I H Kwa
- Department of Neurology, Onze Lieve Vrouw Gasthuis, Oosterpark 9, 1091, AC, Amsterdam, The Netherlands
| | - Renske M Van den Berg-Vos
- Department of Neurology, Sint Lucas Andreas Ziekenhuis, Jan Tooropstraat 164, 1061, AE, Amsterdam, The Netherlands
| | - Yvo B Roos
- Department of Neurology, Academic Medical Center, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Jonathan M Coutinho
- Department of Neurology, Academic Medical Center, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
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23
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Berkhemer OA, Jansen IG, Beumer D, Fransen PS, van den Berg LA, Yoo AJ, Lingsma HF, Sprengers ME, Jenniskens SF, Lycklama à Nijeholt GJ, van Walderveen MA, van den Berg R, Bot JC, Beenen LF, Boers AM, Slump CH, Roos YB, van Oostenbrugge RJ, Dippel DW, van der Lugt A, van Zwam WH, Marquering HA, Majoie CB, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJ, Staals J, Hofmeijer J, van Oostayen JA, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle LJ, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van den Berg JS, van Hassel BA, Aerden LA, Dallinga RJ, Visser MC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Koudstaal PJ, Flach HZ, Steyerberg EW, Brown MM, Liebig T, Stijnen T. Collateral Status on Baseline Computed Tomographic Angiography and Intra-Arterial Treatment Effect in Patients With Proximal Anterior Circulation Stroke. Stroke 2016; 47:768-76. [PMID: 26903582 DOI: 10.1161/strokeaha.115.011788] [Citation(s) in RCA: 197] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 12/10/2015] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Recent randomized trials have proven the benefit of intra-arterial treatment (IAT) with retrievable stents in acute ischemic stroke. Patients with poor or absent collaterals (preexistent anastomoses to maintain blood flow in case of a primary vessel occlusion) may gain less clinical benefit from IAT. In this post hoc analysis, we aimed to assess whether the effect of IAT was modified by collateral status on baseline computed tomographic angiography in the Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN).
Methods—
MR CLEAN was a multicenter, randomized trial of IAT versus no IAT. Primary outcome was the modified Rankin Scale at 90 days. The primary effect parameter was the adjusted common odds ratio for a shift in direction of a better outcome on the modified Rankin Scale. Collaterals were graded from 0 (absent) to 3 (good). We used multivariable ordinal logistic regression analysis with interaction terms to estimate treatment effect modification by collateral status.
Results—
We found a significant modification of treatment effect by collaterals (
P
=0.038). The strongest benefit (adjusted common odds ratio 3.2 [95% confidence intervals 1.7–6.2]) was found in patients with good collaterals (grade 3). The adjusted common odds ratio was 1.6 [95% confidence intervals 1.0–2.7] for moderate collaterals (grade 2), 1.2 [95% confidence intervals 0.7–2.3] for poor collaterals (grade 1), and 1.0 [95% confidence intervals 0.1–8.7] for patients with absent collaterals (grade 0).
Conclusions—
In MR CLEAN, baseline computed tomographic angiography collateral status modified the treatment effect. The benefit of IAT was greatest in patients with good collaterals on baseline computed tomographic angiography. Treatment benefit appeared less and may be absent in patients with absent or poor collaterals.
Clinical Trial Registration—
URL:
http://www.trialregister.nl
and
http://www.controlled-trials.com
. Unique identifier: (NTR)1804 and ISRCTN10888758, respectively.
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Affiliation(s)
- Olvert A. Berkhemer
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Ivo G.H. Jansen
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Debbie Beumer
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Puck S.S. Fransen
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Lucie A. van den Berg
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Albert J. Yoo
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Hester F. Lingsma
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Marieke E.S. Sprengers
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Sjoerd F.M. Jenniskens
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Geert J. Lycklama à Nijeholt
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Marianne A.A. van Walderveen
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - René van den Berg
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Joseph C.J. Bot
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Ludo F.M. Beenen
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Anna M.M. Boers
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Cornelis H. Slump
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Yvo B.W.E.M. Roos
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Robert J. van Oostenbrugge
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Diederik W.J. Dippel
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Aad van der Lugt
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Wim H. van Zwam
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Henk A. Marquering
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Charles B.L.M. Majoie
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
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van Seeters T, Biessels GJ, Kappelle LJ, van der Schaaf IC, Dankbaar JW, Horsch AD, Niesten JM, Luitse MJA, Majoie CBLM, Vos JA, Schonewille WJ, van Walderveen MAA, Wermer MJH, Duijm LEM, Keizer K, Bot JCJ, Visser MC, van der Lugt A, Dippel DWJ, Kesselring FOHW, Hofmeijer J, Lycklama À Nijeholt GJ, Boiten J, van Rooij WJ, de Kort PLM, Roos YBWEM, Meijer FJA, Pleiter CC, Mali WPTM, van der Graaf Y, Velthuis BK. CT angiography and CT perfusion improve prediction of infarct volume in patients with anterior circulation stroke. Neuroradiology 2016; 58:327-37. [PMID: 26767380 PMCID: PMC4819789 DOI: 10.1007/s00234-015-1636-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 12/17/2015] [Indexed: 01/26/2023]
Abstract
Introduction We investigated whether baseline CT angiography (CTA) and CT perfusion (CTP) in acute ischemic stroke could improve prediction of infarct presence and infarct volume on follow-up imaging. Methods We analyzed 906 patients with suspected anterior circulation stroke from the prospective multicenter Dutch acute stroke study (DUST). All patients underwent baseline non-contrast CT, CTA, and CTP and follow-up non-contrast CT/MRI after 3 days. Multivariable regression models were developed including patient characteristics and non-contrast CT, and subsequently, CTA and CTP measures were added. The increase in area under the curve (AUC) and R2 was assessed to determine the additional value of CTA and CTP. Results At follow-up, 612 patients (67.5 %) had a detectable infarct on CT/MRI; median infarct volume was 14.8 mL (interquartile range (IQR) 2.8–69.6). Regarding infarct presence, the AUC of 0.82 (95 % confidence interval (CI) 0.79–0.85) for patient characteristics and non-contrast CT was improved with addition of CTA measures (AUC 0.85 (95 % CI 0.82–0.87); p < 0.001) and was even higher after addition of CTP measures (AUC 0.89 (95 % CI 0.87–0.91); p < 0.001) and combined CTA/CTP measures (AUC 0.89 (95 % CI 0.87–0.91); p < 0.001). For infarct volume, adding combined CTA/CTP measures (R2 = 0.58) was superior to patient characteristics and non-contrast CT alone (R2 = 0.44) and to addition of CTA alone (R2 = 0.55) or CTP alone (R2 = 0.54; all p < 0.001). Conclusion In the acute stage, CTA and CTP have additional value over patient characteristics and non-contrast CT for predicting infarct presence and infarct volume on follow-up imaging. These findings could be applied for patient selection in future trials on ischemic stroke treatment. Electronic supplementary material The online version of this article (doi:10.1007/s00234-015-1636-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tom van Seeters
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132 3584 CX, Utrecht, The Netherlands.
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Jaap Kappelle
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Irene C van der Schaaf
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132 3584 CX, Utrecht, The Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132 3584 CX, Utrecht, The Netherlands
| | - Alexander D Horsch
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132 3584 CX, Utrecht, The Netherlands
| | - Joris M Niesten
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132 3584 CX, Utrecht, The Netherlands
| | - Merel J A Luitse
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132 3584 CX, Utrecht, The Netherlands
| | | | - Jan Albert Vos
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | | | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lucien E M Duijm
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Koos Keizer
- Department of Neurology, Catharina Hospital, Eindhoven, The Netherlands
| | - Joseph C J Bot
- Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Marieke C Visser
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Diederik W J Dippel
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | | | | | - Jelis Boiten
- Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands
| | | | - Paul L M de Kort
- Department of Neurology, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - Yvo B W E M Roos
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - Frederick J A Meijer
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Willem P T M Mali
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132 3584 CX, Utrecht, The Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, HP E01.132 3584 CX, Utrecht, The Netherlands
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Fransen PSS, Berkhemer OA, Lingsma HF, Beumer D, van den Berg LA, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJH, van Walderveen MAA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama À Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle LJ, Lo RH, van Dijk EJ, de Vries J, de Kort PLM, van den Berg JSP, van Hasselt BAAM, Aerden LAM, Dallinga RJ, Visser MC, Bot JCJ, Vroomen PC, Eshghi O, Schreuder THCML, Heijboer RJJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach HZ, Marquering HA, Sprengers MES, Jenniskens SFM, Beenen LFM, van den Berg R, Koudstaal PJ, van Zwam WH, Roos YBWEM, van Oostenbrugge RJ, Majoie CBLM, van der Lugt A, Dippel DWJ. Time to Reperfusion and Treatment Effect for Acute Ischemic Stroke: A Randomized Clinical Trial. JAMA Neurol 2015; 73:190-6. [PMID: 26716735 DOI: 10.1001/jamaneurol.2015.3886] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Intra-arterial treatment (IAT) for acute ischemic stroke caused by intracranial arterial occlusion leads to improved functional outcome in patients treated within 6 hours after onset. The influence of treatment delay on treatment effect is not yet known. OBJECTIVE To evaluate the influence of time from stroke onset to the start of treatment and from stroke onset to reperfusion on the effect of IAT. DESIGN, SETTING, AND PARTICIPANTS The Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) was a multicenter, randomized clinical open-label trial of IAT vs no IAT in 500 patients. The time to the start of treatment was defined as the time from onset of symptoms to groin puncture (TOG). The time from onset of treatment to reperfusion (TOR) was defined as the time to reopening the vessel occlusion or the end of the procedure in cases for which reperfusion was not achieved. Data were collected from December 3, 2010, to June 3, 2014, and analyzed (intention to treat) from July 1, 2014, to September 19, 2015. MAIN OUTCOMES AND MEASURES Main outcome was the modified Rankin Scale (mRS) score for functional outcome (range, 0 [no symptoms] to 6 [death]). Multiple ordinal logistic regression analysis estimated the effect of treatment and tested for the interaction of time to randomization, TOG, and TOR with treatment. The effect of treatment as a risk difference on reaching independence (mRS score, 0-2) was computed as a function of TOG and TOR. Calculations were adjusted for age, National Institutes of Health Stroke Scale score, previous stroke, atrial fibrillation, diabetes mellitus, and intracranial arterial terminus occlusion. RESULTS Among 500 patients (58% male; median age, 67 years), the median TOG was 260 (interquartile range [IQR], 210-311) minutes; median TOR, 340 (IQR, 274-395) minutes. An interaction between TOR and treatment (P = .04) existed, but not between TOG and treatment (P = .26). The adjusted risk difference (95% CI) was 25.9% (8.3%-44.4%) when reperfusion was reached at 3 hours, 18.8% (6.6%-32.6%) at 4 hours, and 6.7% (0.4%-14.5%) at 6 hours. CONCLUSION AND RELEVANCE For every hour of reperfusion delay, the initially large benefit of IAT decreases; the absolute risk difference for a good outcome is reduced by 6% per hour of delay. Patients with acute ischemic stroke require immediate diagnostic workup and IAT in case of intracranial arterial vessel occlusion. TRIAL REGISTRATION trialregister.nl Identifier: NTR1804.
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Affiliation(s)
- Puck S S Fransen
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands2Department of Radiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Olvert A Berkhemer
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands3Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Hester F Lingsma
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Debbie Beumer
- Department of Neurology, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | | | | | | | - Jan Albert Vos
- Department of Radiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Julie Staals
- Department of Neurology, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | | | | | | | - Jelis Boiten
- Department of Neurology, Medisch Centrum Haaglanden, the Hague, the Netherlands
| | - Patrick A Brouwer
- Department of Radiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Bart J Emmer
- Department of Radiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Lukas C van Dijk
- Department of Radiology, Haga Hospital, the Hague, the Netherlands
| | - L Jaap Kappelle
- Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rob H Lo
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ewoud J van Dijk
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joost de Vries
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Paul L M de Kort
- Department of Neurology, St Elisabeth Hospital, Tilburg, the Netherlands
| | | | | | - Leo A M Aerden
- Department of Neurology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - René J Dallinga
- Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - Marieke C Visser
- Department of Neurology, VU Medical Center, Amsterdam, the Netherlands
| | - Joseph C J Bot
- Department of Radiology, VU Medical Center, Amsterdam, the Netherlands
| | - Patrick C Vroomen
- Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands
| | - Omid Eshghi
- Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Roel J J Heijboer
- Department of Radiology, Atrium Medical Center, Heerlen, the Netherlands
| | - Koos Keizer
- Department of Neurology, Catharina Hospital, Eindhoven, the Netherlands
| | | | | | - Dick G Gerrits
- Department of Radiology, Medical Spectrum Twente, Enschede, the Netherlands
| | | | - Giorgos B Karas
- Department of Radiology, St Lucas Andreas Hospital, Amsterdam, the Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - H Zwenneke Flach
- Department of Neurology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - Henk A Marquering
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands39Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Sjoerd F M Jenniskens
- Department of Radiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ludo F M Beenen
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - René van den Berg
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Peter J Koudstaal
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Wim H van Zwam
- Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Yvo B W E M Roos
- Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands
| | - Robert J van Oostenbrugge
- Department of Neurology, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | | | - Aad van der Lugt
- Department of Radiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Diederik W J Dippel
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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26
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Borst J, Berkhemer OA, Roos YB, van Bavel E, van Zwam WH, van Oostenbrugge RJ, van Walderveen MA, Lingsma HF, van der Lugt A, Dippel DW, Yoo AJ, Marquering HA, Majoie CB, Fransen PS, Beumer D, van den Berg LA, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJ, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle LJ, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach HZ, Sprengers ME, Jenniskens SF, Beenen LF, van den Berg R, Koudstaal PJ, Brown MM, Liebig T, Stijnen T, Andersson T, Mattle H, Wahlgren N, van der Heijden E, Ghannouti N, Fleitour N, Hooijenga I, Puppels C, Pellikaan W, Geerling A, Lindl-Velema A, van Vemde G, de Ridder A, Greebe P, de Bont-Stikkelbroeck J, de Meris J, Janssen K, Struijk W, Simons T, Messchendorp G, van der Minne F, Bongenaar H, Licher S, Boodt N, Ros A, Venema E, Slokkers I, Ganpat RJ, Mulder M, Saiedie N, Heshmatollah A, Schipperen S, Vinken S, van Boxtel T, Koets J, Boers M, Santos E, Jansen I, Kappelhof M, Lucas M, Geuskens R, Barros RS, Dobbe R, Csizmadia M. Value of Computed Tomographic Perfusion–Based Patient Selection for Intra-Arterial Acute Ischemic Stroke Treatment. Stroke 2015; 46:3375-82. [DOI: 10.1161/strokeaha.115.010564] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/09/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Jordi Borst
- From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of
| | - Olvert A. Berkhemer
- From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of
| | - Yvo B.W.E.M. Roos
- From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of
| | - Ed van Bavel
- From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of
| | - Wim H. van Zwam
- From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of
| | - Robert J. van Oostenbrugge
- From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of
| | - Marianne A.A. van Walderveen
- From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of
| | - Hester F. Lingsma
- From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of
| | - Aad van der Lugt
- From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of
| | - Diederik W.J. Dippel
- From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of
| | - Albert J. Yoo
- From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of
| | - Henk A. Marquering
- From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of
| | - Charles B.L.M. Majoie
- From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of
| | - Puck S.S. Fransen
- Departments of Neurology and Radiology, Erasmus MC University Medical Center Rotterdam, The Netherlands
| | - Debbie Beumer
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, The Netherlands and Department of Neurology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands
| | | | | | - Jan Albert Vos
- Department of Radiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Paul J. Nederkoorn
- Department of Neurology, Academic Medical Center Amsterdam, The Netherlands
| | | | - Julie Staals
- Department of Neurology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands
| | | | | | | | - Jelis Boiten
- Department of Neurology, MC Haaglanden, the Hague, The Netherlands
| | - Patrick A. Brouwer
- Department of Radiology, Erasmus MC University Medical Center Rotterdam, The Netherlands
| | - Bart J. Emmer
- Department of Radiology, Erasmus MC University Medical Center Rotterdam, The Netherlands
| | | | | | - L. Jaap Kappelle
- Department of Neurology, University Medical Center Utrecht, The Netherlands
| | - Rob H. Lo
- Department of Radiology, University Medical Center Utrecht, The Netherlands
| | - Ewoud J. van Dijk
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joost de Vries
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul L.M. de Kort
- Department of Neurology, Sint Elisabeth Hospital, Tilburg, The Netherlands
| | | | | | - Leo A.M. Aerden
- Department of Neurology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - René J. Dallinga
- Department of Radiology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Marieke C. Visser
- Department of Neurology, VU Medical Center, Amsterdam, The Netherlands
| | - Joseph C.J. Bot
- Department of Radiology, VU Medical Center, Amsterdam, The Netherlands
| | - Patrick C. Vroomen
- Department of Neurology, University Medical Center Groningen, The Netherlands
| | - Omid Eshghi
- Department of Radiology, University Medical Center Groningen, The Netherlands
| | | | - Roel J.J. Heijboer
- Department of Radiology, Atrium Medical Center, Heerlen, The Netherlands
| | - Koos Keizer
- Department of Neurology, Catharina Hospital, Eindhoven, The Netherlands
| | | | | | - Dick G. Gerrits
- Department of Radiology, Medical Spectrum Twente, Enschede, The Netherlands
| | | | - Giorgos B. Karas
- Department of Radiology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - Ewout W. Steyerberg
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, The Netherlands
| | - H. Zwenneke Flach
- Department of Neurology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | | | | | - Ludo F.M. Beenen
- Department of Radiology, Academic Medical Center Amsterdam, The Netherlands
| | - René van den Berg
- Department of Radiology, Academic Medical Center Amsterdam, The Netherlands
| | - Peter J. Koudstaal
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, The Netherlands
| | | | | | - Theo Stijnen
- Leiden University Medical Center, Leiden, the Netherlands
| | - Tommy Andersson
- Neuro Interventionist, Karolinska Univeristy Hospital, Stockholm, Sweden
| | | | | | | | | | | | | | | | | | - Annet Geerling
- Radboud University Nijmegen Medical Center, the Netherlands
| | | | | | | | - Paut Greebe
- University Medical Center Utrecht, the Netherlands
| | | | | | | | | | | | | | | | | | - Silvan Licher
- Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Nikki Boodt
- Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Adriaan Ros
- Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Esmee Venema
- Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Ilse Slokkers
- Erasmus MC University Medical Center Rotterdam, the Netherlands
| | | | - Maxim Mulder
- Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Nawid Saiedie
- Erasmus MC University Medical Center Rotterdam, the Netherlands
| | | | | | - Stefan Vinken
- Erasmus MC University Medical Center Rotterdam, the Netherlands
| | | | - Jeroen Koets
- Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Merel Boers
- Academic Medical Center Amsterdam, the Netherlands
| | | | - Ivo Jansen
- Academic Medical Center Amsterdam, the Netherlands
| | | | - Marit Lucas
- Academic Medical Center Amsterdam, the Netherlands
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van Seeters T, Biessels GJ, Kappelle LJ, van der Schaaf IC, Dankbaar JW, Horsch AD, Niesten JM, Luitse MJ, Majoie CB, Vos JA, Schonewille WJ, van Walderveen MA, Wermer MJ, Duijm LE, Keizer K, Bot JC, Visser MC, van der Lugt A, Dippel DW, Kesselring FO, Hofmeijer J, Lycklama à Nijeholt GJ, Boiten J, van Rooij WJ, de Kort PL, Roos YB, van Dijk EJ, Pleiter CC, Mali WP, van der Graaf Y, Velthuis BK. The Prognostic Value of CT Angiography and CT Perfusion in Acute Ischemic Stroke. Cerebrovasc Dis 2015; 40:258-69. [DOI: 10.1159/000441088] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 09/09/2015] [Indexed: 11/19/2022] Open
Abstract
Background: CT angiography (CTA) and CT perfusion (CTP) are important diagnostic tools in acute ischemic stroke. We investigated the prognostic value of CTA and CTP for clinical outcome and determined whether they have additional prognostic value over patient characteristics and non-contrast CT (NCCT). Methods: We included 1,374 patients with suspected acute ischemic stroke in the prospective multicenter Dutch acute stroke study. Sixty percent of the cohort was used for deriving the predictors and the remaining 40% for validating them. We calculated the predictive values of CTA and CTP predictors for poor clinical outcome (modified Rankin Scale score 3-6). Associations between CTA and CTP predictors and poor clinical outcome were assessed with odds ratios (OR). Multivariable logistic regression models were developed based on patient characteristics and NCCT predictors, and subsequently CTA and CTP predictors were added. The increase in area under the curve (AUC) value was determined to assess the additional prognostic value of CTA and CTP. Model validation was performed by assessing discrimination and calibration. Results: Poor outcome occurred in 501 patients (36.5%). Each of the evaluated CTA measures strongly predicted outcome in univariable analyses: the positive predictive value (PPV) was 59% for Alberta Stroke Program Early CT Score (ASPECTS) ≤7 on CTA source images (OR 3.3; 95% CI 2.3-4.8), 63% for presence of a proximal intracranial occlusion (OR 5.1; 95% CI 3.7-7.1), 66% for poor leptomeningeal collaterals (OR 4.3; 95% CI 2.8-6.6), and 58% for a >70% carotid or vertebrobasilar stenosis/occlusion (OR 3.2; 95% CI 2.2-4.6). The same applied to the CTP measures, as the PPVs were 65% for ASPECTS ≤7 on cerebral blood volume maps (OR 5.1; 95% CI 3.7-7.2) and 53% for ASPECTS ≤7 on mean transit time maps (OR 3.9; 95% CI 2.9-5.3). The prognostic model based on patient characteristics and NCCT measures was highly predictive for poor clinical outcome (AUC 0.84; 95% CI 0.81-0.86). Adding CTA and CTP predictors to this model did not improve the predictive value (AUC 0.85; 95% CI 0.83-0.88). In the validation cohort, the AUC values were 0.78 (95% CI 0.73-0.82) and 0.79 (95% CI 0.75-0.83), respectively. Calibration of the models was satisfactory. Conclusions: In patients with suspected acute ischemic stroke, admission CTA and CTP parameters are strong predictors of poor outcome and can be used to predict long-term clinical outcome. In multivariable prediction models, however, their additional prognostic value over patient characteristics and NCCT is limited in an unselected stroke population.
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van Middelaar T, Richard E, van der Worp HB, van den Munckhof P, Nieuwkerk PT, Visser MC, Stam J, Nederkoorn PJ. Quality of life after surgical decompression for a space-occupying middle cerebral artery infarct: A cohort study. BMC Neurol 2015; 15:156. [PMID: 26311142 PMCID: PMC4551524 DOI: 10.1186/s12883-015-0407-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 08/13/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND In patients with a space-occupying middle cerebral artery (MCA) infarct surgical decompression reduces the risk of death, but increases the chance of survival with severe disability. We assessed quality of life (QoL), symptoms of depression, and caregiver burden at long-term follow-up. METHODS Patients treated in two academic centres between 2007 and 2012 were included. Follow-up was at least six months. Patients and caregivers were interviewed separately. QoL was assessed with a visual analogue scale and the 36-item Short-Form health survey (SF-36); depression with the Hospital Anxiety and Depression Scale; and caregiver burden with the Caregiver Strain Index. RESULTS Twenty five patients were enrolled, of whom seven had an infarct in the dominant hemisphere. After a median follow-up of 26 months (IQR 11-46) the median SF-36 mental component score was 54.4 (IQR 45-60), indicating a mental QoL comparable to that in the general population. The median SF-36 physical component score was 32.7 (IQR 22-38), indicating a worse physical QoL. Dominance of the hemisphere did not influence QoL. 79 % of patients and 65 % of caregivers would, in retrospect, again choose for surgery. 26 % of patients had signs of depression and 64 % of caregivers were substantially burdened in their daily life. CONCLUSIONS Mental QoL after surgical decompression for space-occupying MCA infarct is comparable to that in the general population, whereas physical QoL is worse. Dominance of the hemisphere did not influence QoL. The majority of caregivers experience substantial burden. Most patients and caregivers stand by their decision for hemicraniectomy.
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Affiliation(s)
- Tessa van Middelaar
- Department of Neurology, Academic Medical Center (AMC) Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Edo Richard
- Department of Neurology, Academic Medical Center (AMC) Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.
| | - Pepijn van den Munckhof
- Department of Neurosurgery, Academic Medical Center (AMC) Amsterdam, Amsterdam, The Netherlands.
| | - Pythia T Nieuwkerk
- Department of Medical Psychology, Academic Medical Center (AMC), Amsterdam, The Netherlands.
| | - Marieke C Visser
- Department of Neurology, VU University Medical Center (VUmc), Amsterdam, The Netherlands.
| | - Jan Stam
- Department of Neurology, Academic Medical Center (AMC) Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Paul J Nederkoorn
- Department of Neurology, Academic Medical Center (AMC) Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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de Boer ME, Depla M, Wojtkowiak J, Visser MC, Widdershoven GAM, Francke AL, Hertogh CMPM. Life-and-death decision-making in the acute phase after a severe stroke: Interviews with relatives. Palliat Med 2015; 29:451-7. [PMID: 25634632 DOI: 10.1177/0269216314563427] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Decision-making in the acute phase after a severe stroke is complex and may involve life-and-death decisions. Apart from the medical condition and prognosis, quality of life and the deliberation of palliative care should be part of the decision-making process. Relatives play an important role by informing physicians about the patient's values and preferences. However, little is known about how the patients' relatives experience the decision-making process. AIM To elicit the perspective of relatives of severe stroke patients with regard to the decision-making process in the acute phase in order to understand how they participate in treatment decisions. DESIGN An exploratory qualitative interview approach guided by the principles of grounded theory. SETTINGS/PARTICIPANTS Relatives of severe stroke patients (n = 15) were interviewed about their experiences in the decision-making process in the acute phase. RESULTS Four categories reflecting relatives' experiences were identified: (1) making decisions under time pressure, (2) the feeling of 'who am I' to decide, (3) reluctance in saying 'let her die' and (4) coping with unexpected changes. Following the treatment proposal of the physician was found to be the prevailing tendency of relatives in the decision-making process. CONCLUSION A better understanding of the latent world of experiences of relatives that influence the decision-making process may help physicians and other health-care providers to better involve relatives in decision-making and enhance the care, including palliative care, for patients with severe stroke in line with their values and preferences. Communication between physician and relatives seems vital in this process.
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Affiliation(s)
- Marike E de Boer
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Marja Depla
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Joanna Wojtkowiak
- Department of Care and Wellbeing, University of Humanistic Studies, Amsterdam, The Netherlands
| | - Marieke C Visser
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Guy A M Widdershoven
- Department of Medical Humanities, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Anneke L Francke
- NIVEL - Netherlands Institute for Health Services Research, Utrecht, The Netherlands Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Berkhemer OA, Fransen PSS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJH, van Walderveen MAA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle LJ, Lo RH, van Dijk EJ, de Vries J, de Kort PLM, van Rooij WJJ, van den Berg JSP, van Hasselt BAAM, Aerden LAM, Dallinga RJ, Visser MC, Bot JCJ, Vroomen PC, Eshghi O, Schreuder THCML, Heijboer RJJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach HZ, Marquering HA, Sprengers MES, Jenniskens SFM, Beenen LFM, van den Berg R, Koudstaal PJ, van Zwam WH, Roos YBWEM, van der Lugt A, van Oostenbrugge RJ, Majoie CBLM, Dippel DWJ. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372:11-20. [PMID: 25517348 DOI: 10.1056/nejmoa1411587] [Citation(s) in RCA: 4479] [Impact Index Per Article: 497.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND In patients with acute ischemic stroke caused by a proximal intracranial arterial occlusion, intraarterial treatment is highly effective for emergency revascularization. However, proof of a beneficial effect on functional outcome is lacking. METHODS We randomly assigned eligible patients to either intraarterial treatment plus usual care or usual care alone. Eligible patients had a proximal arterial occlusion in the anterior cerebral circulation that was confirmed on vessel imaging and that could be treated intraarterially within 6 hours after symptom onset. The primary outcome was the modified Rankin scale score at 90 days; this categorical scale measures functional outcome, with scores ranging from 0 (no symptoms) to 6 (death). The treatment effect was estimated with ordinal logistic regression as a common odds ratio, adjusted for prespecified prognostic factors. The adjusted common odds ratio measured the likelihood that intraarterial treatment would lead to lower modified Rankin scores, as compared with usual care alone (shift analysis). RESULTS We enrolled 500 patients at 16 medical centers in The Netherlands (233 assigned to intraarterial treatment and 267 to usual care alone). The mean age was 65 years (range, 23 to 96), and 445 patients (89.0%) were treated with intravenous alteplase before randomization. Retrievable stents were used in 190 of the 233 patients (81.5%) assigned to intraarterial treatment. The adjusted common odds ratio was 1.67 (95% confidence interval [CI], 1.21 to 2.30). There was an absolute difference of 13.5 percentage points (95% CI, 5.9 to 21.2) in the rate of functional independence (modified Rankin score, 0 to 2) in favor of the intervention (32.6% vs. 19.1%). There were no significant differences in mortality or the occurrence of symptomatic intracerebral hemorrhage. CONCLUSIONS In patients with acute ischemic stroke caused by a proximal intracranial occlusion of the anterior circulation, intraarterial treatment administered within 6 hours after stroke onset was effective and safe. (Funded by the Dutch Heart Foundation and others; MR CLEAN Netherlands Trial Registry number, NTR1804, and Current Controlled Trials number, ISRCTN10888758.).
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Nederkoorn PJ, van Dijk EJ, Koudstaal PJ, Luijckx GJ, van Oostenbrugge RJ, Visser MC, Wermer MJH, Ruigrok YM, Algra A, Kappelle LJ. The Dutch String-of-Pearls Stroke Study: protocol of a large prospective multicenter genetic cohort study. Int J Stroke 2014; 10:120-2. [PMID: 25131301 DOI: 10.1111/ijs.12359] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 06/30/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND In the last couple of years, genome-wide association studies have largely altered the scope in genetic research in diseases in which both environmental and genetic risk factors contribute to the disease. To date, the genetic risk loci identified in stroke have lagged behind those in other complex diseases, possibly because of the heterogeneity of stroke phenotypes. Sufficiently large cohorts with well-defined and detailed phenotyping of stroke patients are needed to identify additional genetic risk loci. DESIGN The String-of-Pearls Institute is a unique partnership between all eight University Medical Centers in the Netherlands. It was established in 2007 by the Netherlands Federation of University Medical Centers, and it conducts a large prospective cohort study in which comprehensive clinical data, detailed phenotyping of stroke, imaging data, and biomaterials are collected in a large cohort of stroke patients. AIMS The study aims (1) to collect a sufficiently large prospective cohort of stroke patients, with well-defined phenotypes; (2) to collect blood samples and DNA in a standardized infrastructure, allowing for storing and analyzing the samples in a uniform way; (3) to investigate associations between genetic risk loci and stroke; (4) to create possibilities to perform epidemiological studies in a well-defined hospital-based cohort of stroke patients; and (5) to allow for pooling data with other large ongoing genetic stroke studies.
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Affiliation(s)
- Paul J Nederkoorn
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
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Moleiro C, Madureira S, Verdelho A, Ferro JM, Poggesi A, Chabriat H, Erkinjuntti T, Fazekas F, Hennerici M, O'Brien J, Pantoni L, Salvadori E, Scheltens P, Visser MC, Wahlund LO, Waldemar G, Wallin A, Inzitari D. Confirmatory factor analysis of the Neuropsychological Assessment Battery of the LADIS study: a longitudinal analysis. J Clin Exp Neuropsychol 2013; 35:269-78. [PMID: 23398381 DOI: 10.1080/13803395.2013.770822] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Age-related white matter changes have been associated with cognitive functioning, even though their role is not fully understood. This work aimed to test a 3-factor model of the neuropsychological assessment battery and evaluate how the model fit the data longitudinally. Confirmatory factor analysis (CFA) was used to investigate the dimensions of a structured set of neuropsychological tests administered to a multicenter, international sample of independent older adults (LADIS study). Six hundred and thirty-eight older adults completed baseline neuropsychological, clinical, functional and motor assessments, which were repeated each year for a 3-year follow-up. CFA provided support for a 3-factor model. These factors involve the dimensions of executive functions, memory functions, and speed and motor control abilities. Performance decreased in most neuropsychological measures. Results showed that executive functioning, memory and speed of motor abilities are valid latent variables of neuropsychological performance among older adults, and that this structure is relatively consistent longitudinally, even though performance decreases with time.
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Affiliation(s)
- Carla Moleiro
- Instituto Universitário de Lisboa (ISCTE-IUL), CIS-IUL, Lisbon, Portugal.
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Kreisel SH, Blahak C, Bäzner H, Inzitari D, Pantoni L, Poggesi A, Chabriat H, Erkinjuntti T, Fazekas F, Ferro JM, Langhorne P, O'Brien J, Scheltens P, Visser MC, Wahlund LO, Waldemar G, Wallin A, Hennerici MG. Deterioration of Gait and Balance over Time: The Effects of Age-Related White Matter Change - The LADIS Study. Cerebrovasc Dis 2013; 35:544-53. [DOI: 10.1159/000350725] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 03/04/2013] [Indexed: 11/19/2022] Open
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Poggesi A, Gouw A, van der Flier W, Pracucci G, Chabriat H, Erkinjuntti T, Fazekas F, Ferro JM, Hennerici M, Langhorne P, O'Brien JT, Visser MC, Wahlund LO, Waldemar G, Wallin A, Scheltens P, Inzitari D, Pantoni L. Cerebral white matter changes are associated with abnormalities on neurological examination in non-disabled elderly: the LADIS study. J Neurol 2012. [PMID: 23180181 DOI: 10.1007/s00415-012-6748-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cerebral white matter changes (WMC) are associated with motor, cognitive, mood, urinary disturbances, and disability, but little is known about the prevalence of neurological signs in patients with these brain lesions. We assessed the presence and occurrence of neurological abnormalities over a 3-year period and their possible associations with WMC in a cohort of initially non-disabled elderly subjects. Data from the multicenter Leukoaraiosis And DISability study were used. A standard neurological examination was performed at baseline and at each of the annual follow-up visits. A standard MRI scan was performed at baseline and after 3-years. WMC severity was graded as mild, moderate, or severe on the Fazekas scale, while the Rotterdam scale was used to assess progression. Infarcts and their occurrence were also assessed. Six hundred and thirty-nine non-disabled subjects were enrolled (mean age 74.1 ± 5.0, M/F: 288/351). Severe WMC at baseline were associated with gait and stance abnormalities, upper motor signs, and fingertap slowing. This effect was independent of age, sex, lacunar and non-lacunar infarcts. The occurrence of stance abnormalities, upper motor signs, primitive reflexes and fingertap slowing during the 3-year follow-up period was associated with both baseline WMC load and their progression. The occurrence of the same abnormalities plus extrapyramidal and primitive reflexes was associated with incident lacunar infarcts. In our cohort of non-disabled elders, severe WMC were associated with the presence and the occurrence of neurological signs, independently of other vascular brain lesions, confirming that these lesions have clinical relevance.
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Affiliation(s)
- Anna Poggesi
- Department of Neurological and Psychiatric Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
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Meeuwsen EJ, Melis RJF, Van Der Aa GCHM, Golüke-Willemse GAM, De Leest BJM, Van Raak FHJM, Schölzel-Dorenbos CJM, Verheijen DCM, Verhey FRJ, Visser MC, Wolfs CA, Adang EMM, Olde Rikkert MGM. Effectiveness of dementia follow-up care by memory clinics or general practitioners: randomised controlled trial. BMJ 2012; 344:e3086. [PMID: 22589500 PMCID: PMC3352696 DOI: 10.1136/bmj.e3086] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the effectiveness of post-diagnosis dementia treatment and coordination of care by memory clinics compared with general practitioners. DESIGN Multicentre randomised controlled trial. SETTING Nine memory clinics and 159 general practitioners in the Netherlands. PARTICIPANTS 175 patients with a new diagnosis of mild to moderate dementia living in the community and their informal caregivers. INTERVENTIONS Usual care provided by memory clinic or general practitioner. MAIN OUTCOME MEASURES Caregiver rated quality of life of the patient measured with the quality of life in Alzheimer's disease instrument and self perceived burden of the informal caregiver measured with the sense of competence questionnaire (intention to treat analysis). RESULTS The quality of life of the patients in the memory clinic group was 0.5 (95% confidence interval -0.7 to 1.6) points higher than in the general practitioner group. Caregivers' burden was 2.4 (-5.8 to 1.0) points lower in the memory clinic group than in the general practitioner group. CONCLUSION No evidence was found that memory clinics were more effective than general practitioners with regard to post-diagnosis treatment and coordination care for patients with dementia. Without further evidence on the effectiveness of these modalities, other arguments, such as cost minimisation, patients' preferences, or regional health service planning, can determine which type of dementia care is offered. TRIAL REGISTRATION Clinical trials NCT00554047.
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Affiliation(s)
- Els J Meeuwsen
- Department of Geriatrics/Alzheimer Centre Nijmegen, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, Netherlands.
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Vegting IL, Nanayakkara PWB, van Dongen AE, Vandewalle E, van Galen J, Kramer MHH, Bonjer J, Koole GM, Visser MC. Analysing completion times in an academic emergency department: coordination of care is the weakest link. Neth J Med 2011; 69:392-398. [PMID: 21978983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Congestion with prolonged stay in the emergency department (ED) is associated with poor health outcomes. Many factors contribute to ED congestion. This study investigates the length of time spent in the ED (time to completion) and the factors contributing to prolonged stay in an academic ED. Data of ED patients were prospectively collected during four weeks in February 2010. Presentation time, referrer, discharge destination, and medical specialities involved were registered in 2510 patients. Additional detailed data about relevant time steps were collected from 66 patients in the triage category Emergency Severity Index (ESI) 3. The Pearson's chi-square test and the Mann-Whitney test were used for statistical analysis. Time to completion was longer than four hours in 13% of patients (average in total population 2:23 hours). In ESI 3 patients, 24% stayed longer than four hours in the ED (p<0.001). Internal medicine had most patients exceeding the four-hour target (37%), followed by neurology (29%). Undergoing a CT scan, treatment by multiple specialities, age above 65 years and hospital admission were associated with exceeding the four-hour target (p<0.001). The elapsed time between receiving test results and admission/discharge also influenced the completion time (p<0.001). A significant percentage of vulnerable and ill patients with triage category ESI 3 exceeded the four-hour completion time in our ED. Absence of coordination of care when multiple specialists were involved and delay in the process of decision-making after completion of all diagnostics on the ED were among other factors responsible for this prolonged stay. Improving the coordination of care will, in our opinion, speed up the decision-making process and lead to shortening of completion times in many patients.
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Affiliation(s)
- I L Vegting
- Department of Emergency Medicine, VU University Medical Centre, Amsterdam, The Netherlands
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Inzitari D, Pracucci G, Poggesi A, Carlucci G, Barkhof F, Chabriat H, Erkinjuntti T, Fazekas F, Ferro JM, Hennerici M, Langhorne P, O'Brien J, Scheltens P, Visser MC, Wahlund LO, Waldemar G, Wallin A, Pantoni L. Changes in white matter as determinant of global functional decline in older independent outpatients: three year follow-up of LADIS (leukoaraiosis and disability) study cohort. BMJ 2009; 339:b2477. [PMID: 19581317 PMCID: PMC2714680 DOI: 10.1136/bmj.b2477] [Citation(s) in RCA: 292] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2009] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess the impairment in daily living activities in older people with age related changes in white matter according to the severity of these changes. DESIGN Observational data collection and follow-up of a cohort of older people undergoing brain magnetic resonance imaging after non-disabling complaints. SETTING 11 European centres. PARTICIPANTS 639 non-disabled older patients (mean age 74.1 (SD 5.0), 45.1% men) in whom brain magnetic resonance imaging showed mild, moderate, or severe age related changes in white matter (Fazekas scale). Magnetic resonance imaging assessment also included cerebral infarcts and atrophy. MAIN OUTCOME MEASURE Transition from no disability (defined as a score of 0 or 1 on the instrumental activities of daily living scale) to disability (score >/=2) or death over three year follow-up. Secondary outcomes were incident dementia and stroke. RESULTS Over a mean follow-up period of 2.42 years (SD 0.97, median 2.94 years), information on the main outcome was available for 633 patients. The annual rate of transition or death was 10.5%, 15.1%, and 29.5%, respectively, for patients with mild, moderate, or severe age related changes in white matter (Kaplan-Meier log rank test P<0.001). In a Cox model comparing severe with mild changes and adjusted for clinical factors of functional decline, the risk of transition to disability or death was more than twofold higher (hazard ratio 2.36, 95% confidence interval 1.65 to 3.81). The other predictors were age group, history of atrial fibrillation, and complaint of gait disturbances. The effect of severe changes remained significant independently of baseline degree of atrophy and number of infarcts. Incident stroke and dementia only slightly modified this effect. CONCLUSION The three year results of the LADIS study suggest that in older adults who seek medical attention for non-disabling complaints, severe age related changes in white matter independently and strongly predict rapid global functional decline.
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Affiliation(s)
- Domenico Inzitari
- Department of Neurological and Psychiatric Sciences, University of Florence, Viale Morgagni 85, 50134 Firenze, Italy.
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Blahak C, Baezner H, Pantoni L, Poggesi A, Chabriat H, Erkinjuntti T, Fazekas F, Ferro JM, Langhorne P, O'Brien J, Visser MC, Wahlund LO, Waldemar G, Wallin A, Inzitari D, Hennerici MG. Deep frontal and periventricular age related white matter changes but not basal ganglia and infratentorial hyperintensities are associated with falls: cross sectional results from the LADIS study. J Neurol Neurosurg Psychiatry 2009; 80:608-13. [PMID: 19204027 DOI: 10.1136/jnnp.2008.154633] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Global age related white matter changes (ARWMC) are associated with progressive gait disturbances and falls, hypothesised to result from interruptions of cortico-subcortical circuits controlling balance, posture and locomotion. METHODS The location of ARWMC in a large cohort of elderly non-disabled individuals with reported falls was analysed, using the cross sectional data of the Leukoaraiosis and Disability (LADIS) study. Detailed anatomical distributions of ARWMC assessed by MRI studies were analysed with respect to falls and balance performance. RESULTS The severity of global ARWMC was significantly associated with a history of falls in the year prior to study inclusion (22.2% in the mild, 31.6% in the moderate and 37.3% in the severe ARWMC group according to the Fazekas scale; p = 0.002). Analysing the anatomical distribution of ARWMC, using the semiquantitative Scheltens scale, in multivariate analysis, periventricular (p = 0.006) and frontal deep (p = 0.033) ARWMC were independently associated with falls. Furthermore, logistic regression identified frontal deep (p = 0.003) ARWMC, but not basal ganglia and infratentorial hyperintensities, as significantly associated with balance disturbances. CONCLUSION The association of frontal and periventricular ARWMC with falls supports the hypothesis that interruption of frontal subcortical motor circuits lead to balance disturbances and hence to an increased risk for falls in ARWMC.
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Affiliation(s)
- C Blahak
- Department of Neurology, Universitätsklinikum Mannheim, Theodor-Kutzer Ufer 1-3, D-68167 Mannheim, Germany.
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Ropele S, Seewann A, Gouw AA, van der Flier WM, Schmidt R, Pantoni L, Inzitari D, Erkinjuntti T, Scheltens P, Wahlund LO, Waldemar G, Chabriat H, Ferro J, Hennerici M, O'Brien J, Wallin A, Langhorne P, Visser MC, Barkhof F, Fazekas F. Quantitation of brain tissue changes associated with white matter hyperintensities by diffusion-weighted and magnetization transfer imaging: the LADIS (Leukoaraiosis and Disability in the Elderly) study. J Magn Reson Imaging 2009; 29:268-74. [PMID: 19161174 DOI: 10.1002/jmri.21580] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To explore the value of diffusion-weighted imaging (DWI) and magnetization transfer imaging (MTI) for the improved detection and quantification of cerebral tissue changes associated with ageing and white matter hyperintensities (WMH). MATERIALS AND METHODS DWI (n = 340) and MTI (n = 177) were performed in nine centers of the multinational Leukoaraiosis And DISability (LADIS) study investigating the impact of WMH on 65- to 85-year-old individuals without prior disability. We assessed the apparent diffusion coefficient (ADC) and magnetization transfer ratio (MTR) of normal appearing brain tissue (NABT) and within WMH and related them to subjects' age and WHM severity according to the Fazekas score. RESULTS ADC and MTR values showed a significant inter-site variation, which was stronger for the MTR. After z-transformation multiple regression analysis revealed WMH severity and age as significant predictors of global ADC and MTR changes. Only lesional ADC, but not MTR was related to WMH severity. CONCLUSION ADC and MTR are both sensitive for age and WMH related changes in NABT. The ADC is more sensitive for tissue changes within WMH and appears to be more robust for multicenter settings.
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Affiliation(s)
- Stefan Ropele
- Department of Neurology, Medical University of Graz, Austria.
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40
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Jokinen H, Kalska H, Ylikoski R, Madureira S, Verdelho A, van der Flier WM, Scheltens P, Barkhof F, Visser MC, Fazekas F, Schmidt R, O'Brien J, Waldemar G, Wallin A, Chabriat H, Pantoni L, Inzitari D, Erkinjuntti T. Longitudinal cognitive decline in subcortical ischemic vascular disease--the LADIS Study. Cerebrovasc Dis 2009; 27:384-91. [PMID: 19276621 DOI: 10.1159/000207442] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Accepted: 12/15/2008] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cross-sectional studies have indicated that subcortical ischemic vascular disease (SIVD), as defined according to imaging criteria, is associated with a specific clinical and cognitive profile. Much less is known about the long-term cognitive consequences of SIVD. The aim of the study was to investigate the longitudinal cognitive performance and incident dementia in subjects with and without SIVD in a sample of older adults with white matter lesions. METHODS In the Leukoaraiosis and Disability (LADIS) study, 639 participants were examined with annual clinical and neuropsychological evaluations for 3 years. The subjects meeting the MRI criteria of SIVD at baseline were compared to the other subjects of the sample with linear mixed models. RESULTS The overall level of cognitive performance over the follow-up period was inferior in multiple cognitive domains in SIVD subjects as compared to the reference group. The subjects with SIVD presented significantly steeper decline of performance in the Stroop test (parts I and II), Trail Making A test, Verbal fluency test, and Mini-Mental State Examination. They also had a threefold risk of developing dementia during follow-up independently of age, sex, education and medial temporal lobe atrophy. CONCLUSIONS SIVD, as a manifestation of cerebral small vessel disease, is related to progressive cognitive impairment and a considerable risk of developing dementia. SIVD seems to specifically contribute to the deterioration of psychomotor speed, executive control, and global cognitive function.
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Affiliation(s)
- Hanna Jokinen
- Department of Psychology, University of Helsinki, Helsinki, Finland.
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41
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Meeuwsen EJ, German P, Melis RJF, Adang EM, Golüke-Willemse GA, Krabbe PF, de Leest BJ, van Raak FHJM, Schölzel-Dorenbos CJM, Visser MC, Wolfs CA, Vliek S, Rikkert MGMO. Cost-effectiveness of post-diagnosis treatment in dementia coordinated by Multidisciplinary Memory Clinics in comparison to treatment coordinated by general practitioners: an example of a pragmatic trial. J Nutr Health Aging 2009; 13:242-8. [PMID: 19262961 DOI: 10.1007/s12603-009-0066-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND With the rising number of dementia patients with associated costs and the recognition that there is room for improvement in the provision of dementia care, the question arises on how to efficiently provide high quality dementia care. OBJECTIVE To describe the design of a study to determine multidisciplinary memory clinics' (MMC) effectiveness and cost-effectiveness in post-diagnosis treatment and care-coordination of dementia patients and their caregivers compared to the post-diagnosis treatment and care-coordination by general practitioners (GP). Next, this article provides the theoretical background of pragmatic trials, often needed in complex interventions, with the AD- Euro study as an example of such a pragmatic approach in a clinical trial. METHOD The study is a pragmatic multicentre, randomised clinical trial with an economic evaluation alongside, which aims to recruit 220 independently living patients with a new dementia diagnosis and their informal caregivers. After baseline measurements, patient and caregiver are allocated to the treatment arm MMC or GP and are visited for follow up measurements at 6 and 12 months. Primary outcome measures are Health Related Quality of Life of the patient as rated by the caregiver using the Quality of Life in Alzheimer's Disease instrument (Qol-AD) and self-perceived caregiving burden of the informal caregiver measured using the Sense of Competence Questionnaire (SCQ). To establish cost-effectiveness a cost-utility analysis using utilities generated by the EuroQol instrument (EQ-5D) will be conducted from a societal perspective. Analyses will be done in an intention-to-treat fashion. RESULTS The inclusion period started in January 2008 and will commence until at least December 2008. After finalising follow up the results of the study are expected to be available halfway through 2010. DISCUSSION The study will provide an answer to whether follow-up of dementia patients can best be done in specialised outpatient memory clinics or in primary care settings with regard to quality and costs. It will enable decision making on how to provide good and efficient health care services in dementia. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT00554047.
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Affiliation(s)
- E J Meeuwsen
- Department of Geriatric Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Jokinen H, Kalska H, Ylikoski R, Madureira S, Verdelho A, Gouw A, Scheltens P, Barkhof F, Visser MC, Fazekas F, Schmidt R, O’Brien J, Hennerici M, Baezner H, Waldemar G, Wallin A, Chabriat H, Pantoni L, Inzitari D, Erkinjuntti T. MRI-Defined Subcortical Ischemic Vascular Disease: Baseline Clinical and Neuropsychological Findings. Cerebrovasc Dis 2009; 27:336-44. [DOI: 10.1159/000202010] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 11/03/2008] [Indexed: 11/19/2022] Open
Abstract
<i>Background:</i> Subcortical ischemic vascular disease (SIVD) is a common, but often overlooked cause of vascular cognitive impairment. Diagnostic research criteria for SIVD are based on magnetic resonance imaging (MRI) findings including substantial white matter lesions (WML) and multiple lacunar infarcts. Empirical studies validating these imaging criteria are still few. The purpose of the study was to describe the clinical and cognitive characteristics of the MRI-defined SIVD in a mixed sample of functionally independent elderly subjects with WML. <i>Methods:</i> The subjects of the Leukoaraiosis and Disability (LADIS) study, aged 65–84 years, underwent comprehensive clinical and neuropsychological examinations, and brain MRI at the baseline assessment. The subjects meeting the SIVD imaging criteria (n = 89) were compared to the other subjects of the sample (n = 524). <i>Results:</i> SIVD was associated with lower education, hypertension and, independently, with obesity. The subjects with SIVD had more often motor impairment, a history of falls, and subtle impairment in activities of daily living, but they did not differ for depressive symptoms. SIVD subjects performed significantly inferiorly in tests of global cognitive function, psychomotor speed, attention and executive functions, verbal fluency, and working memory. <i>Conclusion:</i> In this population of nondisabled older adults with WML, SIVD was related to specific clinical and functional characteristics. Neuropsychological features included psychomotor slowing as well as deficits in attention and executive functions.
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Serné EH, Rauwerda JA, Wisselink W, Visser MC, Roos YBWEM, Smulders YM. [Blood pressure control in patients with a symptomatic carotid artery stenosis]. Ned Tijdschr Geneeskd 2008; 152:2617-2622. [PMID: 19102437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Carotid artery stenosis is an important cause of transient ischaemic attacks (TIAs) and ischaemic strokes, and is associated with a particularly high risk of recurrent stroke both in the acute phase and the long-term. Early secondary preventive measures would therefore seem warranted. Carotid endarterectomy (CEA) is an effectively therapy in patients with a severe symptomatic stenosis. Hypertension is an important risk factor for recurrent stroke both in the acute phase and the long-term. Moreover, hypertension is an important risk factor for complications of CEA. In patients on the waiting list for CEA, following a TIA or a non-disabling ischaemic stroke, it would seem worthwhile to attempt to start antihypertensive treatment after approximately 24 h, and to at least strive after a preoperative systolic blood pressure of < 180 mmHg and a diastolic blood pressure of < 90 mmHg. In patients who cannot undergo surgery in the desirable short run, hypotensive treatment must be considered in the context of secondary prevention. The blood pressure target level depends on the presence or absence of a severe unilateral or bilateral stenosis (> 70% lumen diameter). In postoperative hypertension one must strive after a blood pressure < 140/90 mmHg, thereby avoiding an excessively rapid hypotensive response (> 25% daily). Patients with a TIA or an ischaemic stroke and a carotid artery stenosis must also be treated with antiplatelet agents and a statin, while other vascular risk factors must be controlled.
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Affiliation(s)
- E H Serné
- VU Medisch Centrum, afd. Interne Geneeskunde, Postbus 7057, 1007 MB Amsterdam.
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44
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Poggesi A, Pracucci G, Chabriat H, Erkinjuntti T, Fazekas F, Verdelho A, Hennerici M, Langhorne P, O'Brien J, Scheltens P, Visser MC, Crisby M, Waldemar G, Wallin A, Inzitari D, Pantoni L. Urinary Complaints in Nondisabled Elderly People with Age-Related White Matter Changes: The Leukoaraiosis And DISability (LADIS) Study. J Am Geriatr Soc 2008; 56:1638-43. [PMID: 18691285 DOI: 10.1111/j.1532-5415.2008.01832.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Anna Poggesi
- Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy
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45
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Miranda B, Madureira S, Verdelho A, Ferro J, Pantoni L, Salvadori E, Chabriat H, Erkinjuntti T, Fazekas F, Hennerici M, O'Brien J, Scheltens P, Visser MC, Wahlund LO, Waldemar G, Wallin A, Inzitarion D. Self-perceived memory impairment and cognitive performance in an elderly independent population with age-related white matter changes. J Neurol Neurosurg Psychiatry 2008; 79:869-73. [PMID: 18077477 DOI: 10.1136/jnnp.2007.131078] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine whether self-perceived memory impairment is associated with the severity of white matter changes (WMC) and is related to cognitive impairment. METHODS Data were drawn from the multinational Leukoaraiosis and Disability Study (LADIS), which investigates the impact of WMC on global functioning. WMC severity was rated using the Fazekas scale. Medial temporal lobe atrophy (MTA) was scored visually and mean values were calculated. The neuropsychological battery consisted of the Mini-Mental State Examination, a modified version of the VADAS-Cog, Trail making and Stroop tests. A question about self-perceived memory impairment was used as a measure for presence of memory complaints. Cognitive performance was analysed test-by-test and in three main domains: memory, executive functions and speed/motor control. The Geriatric Depression Scale (GDS) was used as a measure of depressive symptoms. RESULTS Six hundred and thirty-eight subjects were included in this study. No association was found between memory complaints and the severity of WMC. Subjects with memory complaints (n = 399) had a higher GDS score [t((637)) = -7.15; p<0.02] and performed worse on almost all cognitive tests and on the three cognitive domains. Multiple linear regression showed that the worse performance on the memory domain was associated with memory complaints independently of depressive symptoms, WMC severity and MTA (R(2) = 0.183; F = 17.09, beta = -0.126; p<0.05). CONCLUSION In a sample of non-disabled elderly subjects with WMC, self-perceived memory impairment is significantly associated with objective memory impairment independently of the WMC severity, depressive symptoms and MTA.
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Affiliation(s)
- B Miranda
- Serviço de Neurologia, Centro de Estudos Egas Moniz, Hospital de Santa Maria, Lisboa, Portugal.
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Baezner H, Blahak C, Poggesi A, Pantoni L, Inzitari D, Chabriat H, Erkinjuntti T, Fazekas F, Ferro JM, Langhorne P, O'Brien J, Scheltens P, Visser MC, Wahlund LO, Waldemar G, Wallin A, Hennerici MG. Association of gait and balance disorders with age-related white matter changes: the LADIS study. Neurology 2008; 70:935-42. [PMID: 18347315 DOI: 10.1212/01.wnl.0000305959.46197.e6] [Citation(s) in RCA: 288] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In the Leukoaraiosis and Disability (LADIS) Study, 11 European centers are evaluating the role of age-related white matter changes (ARWMC) as an independent determinant of the transition to disability in the elderly (65 to 84 years). We aimed at determining the influence of ARWMC on different objective measures of gait and balance. METHODS Six hundred thirty-nine nondisabled individuals were prospectively enrolled and are being followed-up for 3 years. Subjects are graded in three standardized categories of ARWMC (mild, moderate, and severe) according to central MRI reading. Quantitative tests of gait and balance include the Short Physical Performance Battery (SPPB; range: 0 [poor] to 12 [normal]), a timed 8-m walk, and a timed single leg stance test. RESULTS In cross-sectional analysis, deficiencies in gait and balance performance were correlated with the severity of ARWMC (SPPB: 10.2 +/- 2.1 in the mild, 9.9 +/- 2.0 in the moderate, 8.9 +/- 2.6 in the severe group; p < 0.001). Walking speed correlated with the severity of ARWMC (1.24 +/- 0.28 m/second in the mild, 1.18 +/- 0.32 m/second in the moderate, and 1.09 +/- 0.31 m/second in the severe group; p < 0.001). Balance was best in individuals with mild ARWMC (single leg stance time: 18.9 +/- 10.8 seconds) compared with moderate and severe ARWMC (16.4 +/- 10.8 and 13.6 +/- 11.2 seconds) (p < 0.001). Physically inactive individuals had a higher risk of a pathologic SPPB score (moderate vs mild ARWMC: odds ratio 1.60, 95% CI 1.02 to 2.52; severe vs mild ARWMC: odds ratio 1.75, 95% CI 1.09 to 2.80). CONCLUSIONS Our findings support a strong association between the severity of age-related white matter changes and the severity of gait and motor compromise. Physical activity might have the potential to reduce the risk of limitations in mobility.
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Affiliation(s)
- H Baezner
- Mannheim University Hospital, University of Heidelberg, Department of Neurology, Theodor Kutzer Ufer, D-68135 Mannheim, Germany.
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Baart JA, Boeke AJP, van Diermen DE, Visser MC, Kappelle LJ, Wisselink W, Allard RHB, van der Waal I. [Carotid calcification on a panoramic radiograph: what to do?]. Ned Tijdschr Tandheelkd 2008; 115:150-152. [PMID: 18444502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A 71-year-old man is discussed in whom the oral and maxillofacial surgeon observed, by chance, a radiopacity on the panoramic radiograph that was highly suggestive of a calcification at the bifurcation of the internal and external carotid artery. While, on the basis of international literature, various treatments are advanced with respect to the importance of vascular investigation and possible surgical removal of significant calcification, at present the view in The Netherlands is that the family doctor has the responsibility to assess whether such patient should be referred for further evaluation by the neurologist or vascular surgeon. The same applies to the possible indication for prescription of antitrombotics.
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Affiliation(s)
- J A Baart
- Uit de afdeling Mondziekten en Kaakchirurgie/Orale Pathologie van het Vrije Universiteit medisch centrum (VUmc)/Academisch Centrum Tandheelkunde Amsterdam (ACTA)
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Verdelho A, Madureira S, Ferro JM, Basile AM, Chabriat H, Erkinjuntti T, Fazekas F, Hennerici M, O'Brien J, Pantoni L, Salvadori E, Scheltens P, Visser MC, Wahlund LO, Waldemar G, Wallin A, Inzitari D. Differential impact of cerebral white matter changes, diabetes, hypertension and stroke on cognitive performance among non-disabled elderly. The LADIS study. J Neurol Neurosurg Psychiatry 2007; 78:1325-30. [PMID: 17470472 PMCID: PMC2095587 DOI: 10.1136/jnnp.2006.110361] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Revised: 03/27/2007] [Accepted: 03/31/2007] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND PURPOSE Age related white matter changes (ARWMC) are frequent in non-demented old subjects and are associated with impaired cognitive function. Our aim was to study the influence of vascular risk factors and ARWMC on the neuropsychological performance of an independent elderly population, to see if vascular risk factors impair cognition in addition to the effects of ARWMC. METHODS Independent subjects, aged 65-84 years, with any degree of ARWMC were assessed using a comprehensive neuropsychological battery including the Mini-Mental State Examination (MMSE), VADAS-Cog (Alzheimer's disease assessment scale) and the Stroop and Trail Making test. Vascular risk factors were recorded and ARWMC (measured by MRI) were graded into three classes. The impact of vascular risk factors and ARWMC on neuropsychological performance was assessed by linear regression analyses, with adjustment for age and education. RESULTS 638 patients (74.1 (5) years old, 55% women) were included. Patients with severe ARWMC performed significantly worse on global tests of cognition, executive functions, speed and motor control, attention, naming and visuoconstructional praxis. Diabetes interfered with tests of executive function, attention, speed and motor control, memory and naming. Arterial hypertension and stroke influenced executive functions and attention. The effect of these vascular risk factors was independent of the severity of ARWMC, age and education. CONCLUSION ARWMC is related to worse performance in executive function, attention and speed. Diabetes, hypertension and previous stroke influenced neuropsychological performance, independently of the severity of ARWMC, stressing the need to control vascular risk factors in order to prevent cognitive decline in the elderly.
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Affiliation(s)
- Ana Verdelho
- Neurology Department, Centro de Estudos Egas Moniz, Santa Maria Hospital, Lisbon, Portugal.
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Abstract
This study investigates the bottlenecks in the emergency care chain of cardiac in-patient flow. The primary goal is to determine the optimal bed allocation over the care chain given a maximum number of refused admissions. Another objective is to provide deeper insight in the relation between natural variation in arrivals and length of stay and occupancy rates. The strong focus on raising occupancy rates of hospital management is unrealistic and counterproductive. Economies of scale cannot be neglected. An important result is that refused admissions at the First Cardiac Aid (FCA) are primarily caused by unavailability of beds downstream the care chain. Both variability in LOS and fluctuations in arrivals result in large workload variations. Techniques from operations research were successfully used to describe the complexity and dynamics of emergency in-patient flow.
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Affiliation(s)
- Arnoud M de Bruin
- Division IV (room PK 6X.185), VU University Medical Centre, De Boelelaan 1117, PO Box 7075, Amsterdam, The Netherlands.
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Inzitari D, Simoni M, Pracucci G, Poggesi A, Basile AM, Chabriat H, Erkinjuntti T, Fazekas F, Ferro JM, Hennerici M, Langhorne P, O'Brien J, Barkhof F, Visser MC, Wahlund LO, Waldemar G, Wallin A, Pantoni L. Risk of rapid global functional decline in elderly patients with severe cerebral age-related white matter changes: the LADIS study. Arch Intern Med 2007; 167:81-8. [PMID: 17210882 DOI: 10.1001/archinte.167.1.81] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Age-related white matter changes (ARWMCs), frequently detected on neuroimaging, are associated with motor, cognitive, urinary, and mood disorders. The LADIS (LeukoAraiosis and DISability) Study primarily aims to assess ARWMCs as a determinant of global functional decline in the elderly population. METHODS We enrolled 639 patients (mean age, 74.1 +/- 5.0 years; 45.1% male) referred for nondisabling complaints, who had ARWMCs detected on brain magnetic resonance imaging (MRI) of mild, moderate, or severe grade according to the Fazekas scale. At the 1-year follow-up, 619 were reassessed using the Instrumental Activities of Daily Living (IADL) scale. Of these, 506 were totally independent at baseline, and 113 were impaired in only 1 item of the IADL scale. We studied the 1-year transition to 2 or more activities limited and selective functional impairments as cofactors of functional decline. RESULTS The rate of transition was 9%, 15%, and 26%, in the mild, moderate, and severe ARWMC group, respectively. Comparing the severe with the mild ARWMC groups and adjusting for age and for other predictors of decline, the risk was more than 2-fold higher (odds ratio; 2.38; 95% confidence interval, 1.29-4.38) in patients with 0 or 1 activity limited, and 3-fold higher (odds ratio, 3.02; 95% confidence interval, 1.34-6.78) among patients fully independent at baseline. Both motor and cognitive deterioration predominantly explained the effect of ARWMCs on global functional decline. CONCLUSION Elderly patients who are functionally independent and who have severe ARWMCs are at considerable risk of becoming more dependent in a short period, mostly owing to motor and cognitive deterioration.
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Affiliation(s)
- Domenico Inzitari
- Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy.
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