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Hund HM, Boodt N, Hansen D, Haffmans WA, Lycklama À Nijeholt GJ, Hofmeijer J, Dippel DWJ, van der Lugt A, van Es ACGM, van Beusekom HMM, Roos YBWEM, van Oostenbrugge RJ, van Zwam WH, Boiten J, Vos JA, Jansen IGH, Mulder MJHL, Goldhoorn RJB, Compagne KCJ, Kappelhof M, Brouwer J, den Hartog SJ, Hinsenveld WH, Roozenbeek B, Emmer BJ, Coutinho JM, Schonewille WJ, Wermer MJH, van Walderveen MAA, Staals J, Martens JM, de Bruijn SF, van Dijk LC, van der Worp HB, Lo RH, van Dijk EJ, Boogaarts HD, de Vries J, de Kort PLM, van Tuijl J, Peluso JP, Fransen P, van den Berg JSP, van Hasselt BAAM, Aerden LAM, Dallinga RJ, Uyttenboogaart M, Eschgi O, Bokkers RPH, Schreuder THCML, Heijboer RJJ, Keizer K, Yo LSF, den Hertog HM, Bulut T, Brouwers PJAM, Sprengers MES, Jenniskens SFM, van den Berg R, Yoo AJ, Beenen LFM, Postma AA, Roosendaal SD, van der Kallen BFW, van den Wijngaard IR, Bot J, van Doormaal PJ, Meijer A, Ghariq E, van Proosdij MP, Krietemeijer GM, Dinkelaar W, Appelman APA, Hammer B, Pegge S, van der Hoorn A, Vinke S, Flach HZ, Lingsma HF, el Ghannouti N, Sterrenberg M, Pellikaan W, Sprengers R, Elfrink M, Simons M, Vossers M, de Meris J, Vermeulen T, Geerlings A, van Vemde G, Simons T, Messchendorp G, Nicolaij N, Bongenaar H, Bodde K, Kleijn S, Lodico J, Droste H, Wollaert M, Verheesen S, Jeurrissen D, Bos E, Drabbe Y, Sandiman M, Aaldering N, Zweedijk B, Vervoort J, Ponjee E, Romviel S, Kanselaar K, Barning D, Venema E, Chalos V, Geuskens RR, van Straaten T, Ergezen S, Harmsma RRM, Muijres D, de Jong A, Berkhemer OA, Boers AMM, Huguet J, Groot PFC, Mens MA, van Kranendonk KR, Treurniet KM, Tolhuisen ML, Alves H, Weterings AJ, Kirkels EL, Voogd EJHF, Schupp LM, Collette SL, Groot AED, LeCouffe NE, Konduri PR, Prasetya H, Arrarte-Terreros N, Ramos LA. Association between thrombus composition and stroke etiology in the MR CLEAN Registry biobank. Neuroradiology 2023; 65:933-943. [PMID: 36695859 PMCID: PMC10105654 DOI: 10.1007/s00234-023-03115-y] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/06/2023] [Indexed: 01/26/2023]
Abstract
PURPOSE The composition of thrombi retrieved during endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) due to large vessel occlusion (LVO) may differ depending on their origin. In this study, we investigated the association between thrombus composition and stroke etiology in a large population of patients from the Dutch MR CLEAN Registry treated with EVT in daily clinical practice. METHODS The thrombi of 332 patients with AIS were histologically analyzed for red blood cells (RBC), fibrin/platelets (F/P), and white blood cells (leukocytes) using a machine learning algorithm. Stroke etiology was assessed using the Trial of Org 10,172 in acute stroke treatment (TOAST) classification. RESULTS The thrombi of cardioembolic origin contained less RBC and more F/P than those of non-cardioembolic origin (25.8% vs 41.2% RBC [p = 0.003] and 67.1% vs 54.5% F/P [p = 0.004]). The likelihood of a non-cardioembolic source of stroke increased with increasing thrombus RBC content (OR 1.02; [95% CI 1.00-1.06] for each percent increase) and decreased with a higher F/P content (OR 1.02; [95% CI 1.00-1.06]). Thrombus composition in patients with a cardioembolic origin and undetermined origin was similar. CONCLUSION Thrombus composition is significantly associated with stroke etiology, with an increase in RBC and a decrease in F/P raising the odds for a non-cardioembolic cause. No difference between composition of cardioembolic thrombi and of undetermined origin was seen. This emphasizes the need for more extensive monitoring for arrhythmias and/or extended cardiac analysis in case of an undetermined origin.
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Affiliation(s)
- Hajo M Hund
- Department of Cardiology, Erasmus MC University Medical Center, Room EE23.93, PO 2040, 3000CA, Rotterdam, The Netherlands.,Department of Radiology, Haaglanden Medical Centrum, The Hague, The Netherlands
| | - Nikki Boodt
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Daniel Hansen
- Department of Cardiology, Erasmus MC University Medical Center, Room EE23.93, PO 2040, 3000CA, Rotterdam, The Netherlands
| | - Willem A Haffmans
- Department of Cardiology, Erasmus MC University Medical Center, Room EE23.93, PO 2040, 3000CA, Rotterdam, The Netherlands
| | | | - Jeannette Hofmeijer
- Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands.,Department of Clinical Neurophysiology, University of Twente, Enschede, The Netherlands
| | - Diederik W J Dippel
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Adriaan C G M van Es
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Heleen M M van Beusekom
- Department of Cardiology, Erasmus MC University Medical Center, Room EE23.93, PO 2040, 3000CA, Rotterdam, The Netherlands.
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Amini M, van Leeuwen N, Eijkenaar F, van de Graaf R, Samuels N, van Oostenbrugge R, van den Wijngaard IR, van Doormaal PJ, Roos YBWEM, Majoie C, Roozenbeek B, Dippel D, Burke J, Lingsma HF, Dippel DWJ, van der Lugt A, Majoie CBLM, Roos YBWEM, van Oostenbrugge RJ, van Zwam WH, Boiten J, Vos JA, Brouwer J, den Hartog SJ, Hinsenveld WH, Kappelhof M, Compagne KCJ, Goldhoorn RJB, Mulder MJHL, Jansen IGH, Dippel DWJ, Roozenbeek B, van der Lugt A, van Es ACGM, Majoie CBLM, Roos YBWEM, Emmer BJ, Coutinho JM, Schonewille WJ, Vos JA, Wermer MJH, van Walderveen MAA, Staals J, van Oostenbrugge RJ, van Zwam WH, Hofmeijer J, Martens JM, Lycklama à Nijeholt GJ, Boiten J, de Bruijn SF, van Dijk LC, van der Worp HB, Lo RH, van Dijk EJ, Boogaarts HD, de Vries J, de Kort PLM, van Tuijl J, Peluso JJP, Fransen P, van den Berg JSP, van Hasselt BAAM, Aerden LAM, Dallinga RJ, Uyttenboogaart M, Eschgi O, Bokkers RPH, Schreuder THCML, Heijboer RJJ, Keizer K, Yo LSF, den Hertog HM, Sturm EJC, Brouwers P, Majoie CBLM, van Zwam WH, van der Lugt A, Lycklama à Nijeholt GJ, van Walderveen MAA, Sprengers MES, Jenniskens SFM, van den Berg R, Yoo AJ, Beenen LFM, Postma AA, Roosendaal SD, van der Kallen BFW, van den Wijngaard IR, van Es ACGM, Emmer BJ, Martens JM, Yo LSF, Vos JA, Bot J, van Doormaal PJ, Meijer A, Ghariq E, Bokkers RPH, van Proosdij MP, Krietemeijer GM, Peluso JP, Boogaarts HD, Lo R, Gerrits D, Dinkelaar W, Appelman APA, Hammer B, Pegge S, van der Hoorn A, Vinke S, Dippel DWJ, van der Lugt A, Majoie CBLM, Roos YBWEM, van Oostenbrugge RJ, van Zwam WH, Lycklama à Nijeholt GJ, Boiten J, Vos JA, Schonewille WJ, Hofmeijer J, Martens JM, van der Worp HB, Lo RH, van Oostenbrugge RJ, Hofmeijer J, Flach HZ, Lingsma HF, el Ghannouti N, Sterrenberg M, Puppels C, Pellikaan W, Sprengers R, Elfrink M, Simons M, Vossers M, de Meris J, Vermeulen T, Geerlings A, van Vemde G, Simons T, van Rijswijk C, Messchendorp G, Nicolaij N, Bongenaar H, Bodde K, Kleijn S, Lodico J, Droste H, Wollaert M, Verheesen S, Jeurrissen D, Bos E, Drabbe Y, Sandiman M, Elfrink M, Aaldering N, Zweedijk B, Khalilzada M, Vervoort J, Droste H, Nicolaij N, Simons M, Ponjee E, Romviel S, Kanselaar K, Bos E, Barning D, Venema E, Chalos V, Geuskens RR, van Straaten T, Ergezen S, Harmsma RRM, Muijres D, de Jong A, Berkhemer OA, Boers AMM, Huguet J, Groot PFC, Mens MA, van Kranendonk KR, Treurniet KM, Jansen IGH, Tolhuisen ML, Alves H, Weterings AJ, Kirkels ELF, Voogd EJHF, Schupp LM, Collette S, Groot AED, LeCouffe NE, Konduri PR, Prasetya H, Arrarte-Terreros N, Ramos LA. Estimation of treatment effects in observational stroke care data: comparison of statistical approaches. BMC Med Res Methodol 2022; 22:103. [PMID: 35399057 PMCID: PMC8996562 DOI: 10.1186/s12874-022-01590-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Various statistical approaches can be used to deal with unmeasured confounding when estimating treatment effects in observational studies, each with its own pros and cons. This study aimed to compare treatment effects as estimated by different statistical approaches for two interventions in observational stroke care data.
Patients and methods
We used prospectively collected data from the MR CLEAN registry including all patients (n = 3279) with ischemic stroke who underwent endovascular treatment (EVT) from 2014 to 2017 in 17 Dutch hospitals. Treatment effects of two interventions – i.e., receiving an intravenous thrombolytic (IVT) and undergoing general anesthesia (GA) before EVT – on good functional outcome (modified Rankin Scale ≤2) were estimated. We used three statistical regression-based approaches that vary in assumptions regarding the source of unmeasured confounding: individual-level (two subtypes), ecological, and instrumental variable analyses. In the latter, the preference for using the interventions in each hospital was used as an instrument.
Results
Use of IVT (range 66–87%) and GA (range 0–93%) varied substantially between hospitals. For IVT, the individual-level (OR ~ 1.33) resulted in significant positive effect estimates whereas in instrumental variable analysis no significant treatment effect was found (OR 1.11; 95% CI 0.58–1.56). The ecological analysis indicated no statistically significant different likelihood (β = − 0.002%; P = 0.99) of good functional outcome at hospitals using IVT 1% more frequently. For GA, we found non-significant opposite directions of points estimates the treatment effect in the individual-level (ORs ~ 0.60) versus the instrumental variable approach (OR = 1.04). The ecological analysis also resulted in a non-significant negative association (0.03% lower probability).
Discussion and conclusion
Both magnitude and direction of the estimated treatment effects for both interventions depend strongly on the statistical approach and thus on the source of (unmeasured) confounding. These issues should be understood concerning the specific characteristics of data, before applying an approach and interpreting the results. Instrumental variable analysis might be considered when unobserved confounding and practice variation is expected in observational multicenter studies.
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Santos EMM, Arrarte Terreros N, Kappelhof M, Borst J, Boers AMM, Lingsma HF, Berkhemer OA, Dippel DWJ, Majoie CB, Marquering HA, Niessen WJ. Associations of thrombus perviousness derived from entire thrombus segmentation with functional outcome in patients with acute ischemic stroke. J Biomech 2021; 128:110700. [PMID: 34482225 DOI: 10.1016/j.jbiomech.2021.110700] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/29/2021] [Accepted: 08/12/2021] [Indexed: 11/28/2022]
Abstract
Thrombus perviousness is strongly associated with functional outcome and intravenous alteplase treatment success in patients with acute ischemic stroke. Accuracy of thrombus attenuation increase (TAI) assessment may be compromised by a heterogeneous thrombus composition and interobserver variations of currently used manual measurements. We hypothesized that TAI is more strongly associated with clinical outcomes when evaluated on the entire thrombus. In 195 patients, five TAI measures were performed: one manual by placing three regions of interest (TAImanual) and four automated ones assessing densities from the entire thrombus. The automated TAI measures were calculated by comparing quartiles; Q1, Q2, and Q3 of the non-contrast and contrast enhanced thrombus density distribution and using the lag of the maximum of the cross correlations (MCC). Associations with functional outcome (mRS at 90 days) were assessed with univariate and multivariable analyses. All entire TAI measures were significantly associated with functional outcome with odd ratios (OR) of 1.63(95 %CI:1.19-2.25, p = 0.003) for Q1, 1.56(95 %CI:1.16-2.10, p = 0.003) for Q2, 1.24(95 %CI:1.00-1.54, p = 0.045) for Q3, and 1.70(95 %CI:1.24-2.34, p = 0.001) for MCC per 10 HU increase in univariate models. TAImanual was not significantly associated with functional outcome (p = 0.055). In the multivariable logistic regression models including age, NIHSS, and recanalization, only TAI measures derived from the entire thrombus were independently associated with favorable outcome; OR of 1.64(95 %CI:1.01-2.66, p = 0.048) for Q2 and 1.82(1.13-2.95, p = 0.014) for MCC per 10 HU increase of thrombus attenuation. The novel perviousness measures of the entire thrombus are more strongly associated with functional outcome than the traditional manual perviousness assessments.
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Affiliation(s)
- Emilie M M Santos
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, the Netherlands; Department of Biomedical Engineering and Physics, Amsterdam UMC, Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus Universtiy Medical Center, Rotterdam, the Netherlands; Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Nerea Arrarte Terreros
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, the Netherlands; Department of Biomedical Engineering and Physics, Amsterdam UMC, Amsterdam, the Netherlands
| | - Manon Kappelhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jordi Borst
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Anna M M Boers
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, the Netherlands; Institute of Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Hester F Lingsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Olvert A Berkhemer
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus Universtiy Medical Center, Rotterdam, the Netherlands; Department of Neurology, Erasmus Universtiy Medical Center, Rotterdam, the Netherlands
| | - Diederik W J Dippel
- Department of Neurology, Erasmus Universtiy Medical Center, Rotterdam, the Netherlands
| | - Charles B Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Henk A Marquering
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, the Netherlands; Department of Biomedical Engineering and Physics, Amsterdam UMC, Amsterdam, the Netherlands.
| | - Wiro J Niessen
- Department of Radiology and Nuclear Medicine, Erasmus Universtiy Medical Center, Rotterdam, the Netherlands; Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands
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van Kranendonk KR, Treurniet KM, Boers AMM, Berkhemer OA, Coutinho JM, Lingsma HF, van Zwam WH, van der Lugt A, van Oostenbrugge RJ, Dippel DWJ, Roos YBWEM, Marquering HA, Majoie CBLM. Added Prognostic Value of Hemorrhagic Transformation Quantification in Patients With Acute Ischemic Stroke. Front Neurol 2020; 11:582767. [PMID: 33240206 PMCID: PMC7683432 DOI: 10.3389/fneur.2020.582767] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/29/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction and Aim: Hemorrhagic transformation (HT) frequently occurs after acute ischemic stroke and negatively influences the functional outcome. Usually, HT is classified by its radiological appearance. Discriminating between the subtypes can be complicated, and interobserver variation is considerable. Therefore, we aim to quantify rather than classify hemorrhage volumes and determine the association of hemorrhage volume with functional outcome in comparison with the European Cooperative Acute Stroke Study II classification. Patients and Methods: We included patients from the MR CLEAN trial with follow-up imaging. Hemorrhage volume was estimated by manual delineation of the lesion, and HT was classified according to the European Cooperative Acute Stroke Study II classification [petechial hemorrhagic infarction types 1 (HI1) and 2 (HI2) and parenchymal hematoma types 1 (PH1) and 2 (PH2)] on follow-up CT 24 h to 2 weeks after treatment. We assessed functional outcome using the modified Rankin Scale 90 days after stroke onset. Ordinal logistic regression with and without adjustment for potential confounders was used to describe the association of hemorrhage volume with functional outcome. We created regression models including and excluding total lesion volume as a confounder. Results: We included 478 patients. Of these patients, 222 had HT. Median hemorrhage volume was 3.37 ml (0.80–12.6) and per HT subgroup; HI1: 0.2 (0.0–1.7), HI2: 3.2 (1.7–6.1), PH1: 6.3 (4.2–13), and PH2: 47 (19–101). Hemorrhage volume was associated with functional outcome [adjusted common odds ratio (acOR): 0.83, 95% CI: 0.73–0.95] but not anymore after adjustment for total lesion volume (acOR: 0.99, 95% CI: 0.86–1.15, per 10 ml). Hemorrhage volume in patients with PH2 was significantly associated with functional outcome after adjusting total lesion volume (acOR: 0.70, 95% CI: 0.50–0.98). Conclusion: HT volume is associated with functional outcomes in patients with acute ischemic stroke but not independent of total lesion volume. The extent of a PH2 was associated with outcome, suggesting that measuring hemorrhage volume only provides an additional benefit in the prediction of the outcome when a PH2 is present.
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Affiliation(s)
- Katinka R van Kranendonk
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Kilian M Treurniet
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Radiology, Haaglanden Medical Center (HMC), Den Haag, Netherlands
| | | | - Olvert A Berkhemer
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Neurology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Radiology & Nuclear Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Hester F Lingsma
- Department of Public Health, Center for Medical Decision Making, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Wim H van Zwam
- Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht (CARIM), University Medical Center, Maastricht, Netherlands
| | - Aad van der Lugt
- Department of Radiology & Nuclear Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Robert J van Oostenbrugge
- Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
| | - Diederik W J Dippel
- Department of Neurology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Yvo B W E M Roos
- Department of Neurology, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Henk A Marquering
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Biomedical Engineering and Physics, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, Netherlands
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van der Steen WE, Marquering HA, Ramos LA, van den Berg R, Coert BA, Boers AMM, Vergouwen MDI, Rinkel GJE, Velthuis BK, Roos YBWEM, Majoie CBLM, Vandertop WP, Verbaan D. Prediction of Outcome Using Quantified Blood Volume in Aneurysmal SAH. AJNR Am J Neuroradiol 2020; 41:1015-1021. [PMID: 32409315 DOI: 10.3174/ajnr.a6575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 03/26/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In patients with SAH, the amount of blood is strongly associated with clinical outcome. However, it is commonly estimated with a coarse grading scale, potentially limiting its predictive value. Therefore, we aimed to develop and externally validate prediction models for clinical outcome, including quantified blood volumes, as candidate predictors. MATERIALS AND METHODS Clinical and radiologic candidate predictors were included in a logistic regression model. Unfavorable outcome was defined as a modified Rankin Scale score of 4-6. An automatic hemorrhage-quantification algorithm calculated the total blood volume. Blood was manually classified as cisternal, intraventricular, or intraparenchymal. The model was selected with bootstrapped backward selection and validated with the R 2, C-statistic, and calibration plots. If total blood volume remained in the final model, its performance was compared with models including location-specific blood volumes or the modified Fisher scale. RESULTS The total blood volume, neurologic condition, age, aneurysm size, and history of cardiovascular disease remained in the final models after selection. The externally validated predictive accuracy and discriminative power were high (R 2 = 56% ± 1.8%; mean C-statistic = 0.89 ± 0.01). The location-specific volume models showed a similar performance (R 2 = 56% ± 1%, P = .8; mean C-statistic = 0.89 ± 0.00, P = .4). The modified Fisher models were significantly less accurate (R 2 = 45% ± 3%, P < .001; mean C-statistic = 0.85 ± 0.01, P = .03). CONCLUSIONS The total blood volume-based prediction model for clinical outcome in patients with SAH showed a high predictive accuracy, higher than a prediction model including the commonly used modified Fisher scale.
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Affiliation(s)
- W E van der Steen
- From the Departments of Biomedical Engineering and Physics (W.E.v.d.S., H.A.M., L.A.R., A.M.M.B.)
- Radiology and Nuclear Medicine (W.E.v.d.S., H.A.M., R.v.d.B., C.B.L.M.M.)
- Neurology (W.E.v.d.S., Y.B.W.E.M.R.)
- Neurosurgical Center Amsterdam (W.E.v.d.S., B.A.C., W.P.V., D.V.), Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - H A Marquering
- From the Departments of Biomedical Engineering and Physics (W.E.v.d.S., H.A.M., L.A.R., A.M.M.B.)
- Radiology and Nuclear Medicine (W.E.v.d.S., H.A.M., R.v.d.B., C.B.L.M.M.)
| | - L A Ramos
- From the Departments of Biomedical Engineering and Physics (W.E.v.d.S., H.A.M., L.A.R., A.M.M.B.)
- Clinical Epidemiology, Biostatistics and Bioinformatics (L.A.R.)
| | - R van den Berg
- Radiology and Nuclear Medicine (W.E.v.d.S., H.A.M., R.v.d.B., C.B.L.M.M.)
| | - B A Coert
- Neurosurgical Center Amsterdam (W.E.v.d.S., B.A.C., W.P.V., D.V.), Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - A M M Boers
- From the Departments of Biomedical Engineering and Physics (W.E.v.d.S., H.A.M., L.A.R., A.M.M.B.)
| | - M D I Vergouwen
- Departments of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.D.I.V., G.J.E.R.)
| | - G J E Rinkel
- Departments of Neurology and Neurosurgery, Brain Center Rudolf Magnus (M.D.I.V., G.J.E.R.)
| | - B K Velthuis
- Radiology (B.K.V.), University Medical Center, Utrecht University, Utrecht, the Netherlands
| | | | - C B L M Majoie
- Radiology and Nuclear Medicine (W.E.v.d.S., H.A.M., R.v.d.B., C.B.L.M.M.)
| | - W P Vandertop
- Neurosurgical Center Amsterdam (W.E.v.d.S., B.A.C., W.P.V., D.V.), Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - D Verbaan
- Neurosurgical Center Amsterdam (W.E.v.d.S., B.A.C., W.P.V., D.V.), Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Boers AMM, Jansen IGH, Brown S, Lingsma HF, Beenen LFM, Devlin TG, Román LS, Heo JH, Ribó M, Almekhlafi MA, Liebeskind DS, Teitelbaum J, Cuadras P, du Mesnil de Rochemont R, Beaumont M, Brown MM, Yoo AJ, Donnan GA, Mas JL, Oppenheim C, Dowling RJ, Moulin T, Agrinier N, Lopes DK, Aja Rodríguez L, Compagne KCJ, Al-Ajlan FS, Madigan J, Albers GW, Soize S, Blasco J, Davis SM, Nogueira RG, Dávalos A, Menon BK, van der Lugt A, Muir KW, Roos YBWEM, White P, Mitchell PJ, Demchuk AM, van Zwam WH, Jovin TG, van Oostenbrugge RJ, Dippel DWJ, Campbell BCV, Guillemin F, Bracard S, Hill MD, Goyal M, Marquering HA, Majoie CBLM. Mediation of the Relationship Between Endovascular Therapy and Functional Outcome by Follow-up Infarct Volume in Patients With Acute Ischemic Stroke. JAMA Neurol 2019; 76:194-202. [PMID: 30615038 DOI: 10.1001/jamaneurol.2018.3661] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Importance The positive treatment effect of endovascular therapy (EVT) is assumed to be caused by the preservation of brain tissue. It remains unclear to what extent the treatment-related reduction in follow-up infarct volume (FIV) explains the improved functional outcome after EVT in patients with acute ischemic stroke. Objective To study whether FIV mediates the relationship between EVT and functional outcome in patients with acute ischemic stroke. Design, Setting, and Participants Patient data from 7 randomized multicenter trials were pooled. These trials were conducted between December 2010 and April 2015 and included 1764 patients randomly assigned to receive either EVT or standard care (control). Follow-up infarct volume was assessed on computed tomography or magnetic resonance imaging after stroke onset. Mediation analysis was performed to examine the potential causal chain in which FIV may mediate the relationship between EVT and functional outcome. A total of 1690 patients met the inclusion criteria. Twenty-five additional patients were excluded, resulting in a total of 1665 patients, including 821 (49.3%) in the EVT group and 844 (50.7%) in the control group. Data were analyzed from January to June 2017. Main Outcome and Measure The 90-day functional outcome via the modified Rankin Scale (mRS). Results Among 1665 patients, the median (interquartile range [IQR]) age was 68 (57-76) years, and 781 (46.9%) were female. The median (IQR) time to FIV measurement was 30 (24-237) hours. The median (IQR) FIV was 41 (14-120) mL. Patients in the EVT group had significantly smaller FIVs compared with patients in the control group (median [IQR] FIV, 33 [11-99] vs 51 [18-134] mL; P = .007) and lower mRS scores at 90 days (median [IQR] score, 3 [1-4] vs 4 [2-5]). Follow-up infarct volume was a predictor of functional outcome (adjusted common odds ratio, 0.46; 95% CI, 0.39-0.54; P < .001). Follow-up infarct volume partially mediated the relationship between treatment type with mRS score, as EVT was still significantly associated with functional outcome after adjustment for FIV (adjusted common odds ratio, 2.22; 95% CI, 1.52-3.21; P < .001). Treatment-reduced FIV explained 12% (95% CI, 1-19) of the relationship between EVT and functional outcome. Conclusions and Relevance In this analysis, follow-up infarct volume predicted functional outcome; however, a reduced infarct volume after treatment with EVT only explained 12% of the treatment benefit. Follow-up infarct volume as measured on computed tomography and magnetic resonance imaging is not a valid proxy for estimating treatment effect in phase II and III trials of acute ischemic stroke.
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Affiliation(s)
- Anna M M Boers
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands.,Department of Robotics and Mechatronics, University of Twente, Enschede, the Netherlands
| | - Ivo G H Jansen
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | - Scott Brown
- Altair Biostatistics, Mooresville, North Carolina
| | - Hester F Lingsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ludo F M Beenen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | - Thomas G Devlin
- Department of Neurology, Erlanger Hospital, University of Tennessee at Chattanooga
| | - Luis San Román
- Department of Interventional Neuroradiology, Hospital Clinic of Barcelona, Barcelona, Catalonia, Spain
| | - Ji-Hoe Heo
- Department of Neurology, Yonsei University, Seoul, South Korea
| | - Marc Ribó
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Catalonia, Spain
| | - Mohammed A Almekhlafi
- Department of Neurology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Jeanne Teitelbaum
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Patricia Cuadras
- Department of Radiology, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | | | - Marine Beaumont
- Inserm CIC-IT 1433, University of Lorraine and University Hospital of Nancy, Nancy, France
| | - Martin M Brown
- Institute of Neurology, University College London, London, United Kingdom
| | - Albert J Yoo
- Division of Neurointervention, Texas Stroke Institute, Dallas
| | - Geoffrey A Donnan
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Jean Louis Mas
- Department of Neurology, Sainte-Anne Hospital and Paris-Descartes University, INSERM U894, Paris, France
| | - Catherine Oppenheim
- Department of Neuroradiology, Sainte-Anne Hospital and Paris-Descartes University, INSERM U894, Paris, France
| | - Richard J Dowling
- Department of Radiology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Thierry Moulin
- Department of Neurology, University Hospital of Besançon, University of Franche-Comté, Besançon, France
| | - Nelly Agrinier
- Inserm, Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, CIC1433-Epidémiologie Clinique, Nancy, France
| | - Demetrius K Lopes
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois
| | - Lucía Aja Rodríguez
- Neuroradiology Department, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain
| | - Kars C J Compagne
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Fahad S Al-Ajlan
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Gregory W Albers
- Department of Neurology, Stanford Stroke Center, Palo Alto, California
| | - Sebastien Soize
- Department of Neuroradiology, University Hospital of Reims, Reims, France
| | - Jordi Blasco
- Department of Interventional Neuroradiology, Hospital Clinic of Barcelona, Barcelona, Catalonia, Spain
| | - Stephen M Davis
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Raul G Nogueira
- Department of Neurology, Neurosurgery and Radiology, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia
| | - Antoni Dávalos
- Department of Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Bijoy K Menon
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary, Alberta, Canada
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Keith W Muir
- Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Yvo B W E M Roos
- Department of Neurology, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | - Phil White
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Peter J Mitchell
- Department of Radiology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew M Demchuk
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary, Alberta, Canada
| | - Wim H van Zwam
- Department of Radiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Tudor G Jovin
- Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Robert J van Oostenbrugge
- Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Diederik W J Dippel
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Francis Guillemin
- Inserm, Centre Hospitalier Régional et Universitaire de Nancy, Université de Lorraine, CIC1433-Epidémiologie Clinique, Nancy, France
| | - Serge Bracard
- Department of Diagnostic and Interventional Neuroradiology, INSERM U947, University of Lorraine and University Hospital of Nancy, Nancy, France
| | - Michael D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary, Alberta, Canada
| | - Mayank Goyal
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary, Alberta, Canada
| | - Henk A Marquering
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
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7
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Kimberly WT, Dutra BG, Boers AMM, Alves HCBR, Berkhemer OA, van den Berg L, Sheth KN, Roos YBWEM, van der Lugt A, Beenen LFM, Dippel DWJ, van Zwam WH, van Oostenbrugge RJ, Lingsma HF, Marquering H, Majoie CBLM. Association of Reperfusion With Brain Edema in Patients With Acute Ischemic Stroke: A Secondary Analysis of the MR CLEAN Trial. JAMA Neurol 2019; 75:453-461. [PMID: 29365017 DOI: 10.1001/jamaneurol.2017.5162] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Importance It is uncertain whether therapeutic reperfusion with endovascular treatment yields more or less brain edema. Objective To elucidate the association between reperfusion and brain edema. The secondary objectives were to evaluate whether brain edema could partially be responsible for worse outcomes in patients with later reperfusion or lower Alberta Stroke Program Early Computed Tomography Score. Design, Setting, and Participants This was a post hoc analysis of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), which was a prospective, randomized, multicenter clinical trial of endovascular treatment compared with conventional care of patients with acute anterior circulation ischemic stroke. Of 502 patients enrolled from December 2010 to June 2014, 2 patients declined to participate. Additionally, exclusion criteria were absence of follow-up imaging or presence of parenchymal hematoma, resulting in 462 patients included in this study. Brain edema was assessed retrospectively, from December 10, 2016, to July 24, 2017, by measuring midline shift (MLS) in all available follow-up scans. Observers were blinded to clinical data. Main Outcomes and Measures Midline shift was assessed as present or absent and as a continuous variable. Reperfusion status was assessed by the modified thrombolysis in cerebral infarction score in the endovascular treatment arm. The modified arterial occlusive lesion score was used to evaluate the recanalization status in both arms. The modified Rankin scale score at 90 days was used for functional outcome. Results Of 462 patients, the mean (SD) age was 65 (11) years, and 41.8% (n = 193) were women. Successful reperfusion and recanalization were associated with a reduced likelihood of having MLS (adjusted common odds ratio, 0.25; 95% CI, 0.12-0.53; P < .001 and adjusted common odds ratio, 0.34; 95% CI, 0.21-0.55; P < .001, respectively). Midline shift was partially responsible for worse modified Rankin scale scores in patients without reperfusion or recanalization (MLS changed the logistic regression coefficients by 30.3% and 12.6%, respectively). In patients with delayed reperfusion or lower Alberta Stroke Program Early Computed Tomography Score, MLS mediated part of the worse modified Rankin scale scores, corresponding to a change in the regression coefficient of 33.3% and 64.2%, respectively. Conclusions and Relevance Successful reperfusion was associated with reduced MLS. This study identifies an additional benefit of reperfusion in relation to edema, as well as rescuing ischemic brain tissue at risk for infarction. Trial Registration Netherlands Trial Registry number: NTR1804 and Current Controlled Trials number: ISRCTN10888758.
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Affiliation(s)
- W Taylor Kimberly
- Center for Genomic Medicine and Department of Neurology, Massachusetts General Hospital, Boston
| | - Bruna Garbugio Dutra
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Anna M M Boers
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Heitor C B R Alves
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Olvert A Berkhemer
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands.,Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Lucie van den Berg
- Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands
| | - Kevin N Sheth
- Department of Neurology, Yale New Haven Hospital, New Haven, Connecticut
| | - Yvo B W E M Roos
- Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands
| | - Aad van der Lugt
- Department of Radiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ludo F M Beenen
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Diederik W J Dippel
- 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.,Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Robert J van Oostenbrugge
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Hester F Lingsma
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Henk Marquering
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands.,Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands
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8
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van Kranendonk KR, Treurniet KM, Boers AMM, Berkhemer OA, van den Berg LA, Chalos V, Lingsma HF, van Zwam WH, van der Lugt A, van Oostenbrugge RJ, Dippel DWJ, Roos YBWEM, Marquering HA, Majoie CBLM. Hemorrhagic transformation is associated with poor functional outcome in patients with acute ischemic stroke due to a large vessel occlusion. J Neurointerv Surg 2018; 11:464-468. [PMID: 30297537 DOI: 10.1136/neurintsurg-2018-014141] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [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: 06/01/2018] [Revised: 08/20/2018] [Accepted: 08/22/2018] [Indexed: 11/04/2022]
Abstract
Background and purposeHemorrhagic transformation (HT) is a complication that may cause neurological deterioration in patients with acute ischemic stroke. Various radiological subtypes of HT can be distinguished. Their influence on functional outcome is currently unclear. The purpose of this study was to assess the associations between HT subtypes and functional outcome in acute ischemic stroke patients with proven large vessel occlusion included in the MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic stroke in The Netherlands).MethodsAll patients with follow-up imaging were included. HT was classified on follow-up CT scans according to the European Cooperative Acute Stroke Study II classification. Functional outcome was assessed using the modified Rankin Scale (mRS) 90 days after stroke onset. Ordinal logistic regression analysis with adjustment for potential confounders was used to determine the association of HT subtypes with functional outcome.ResultsOf 478 patients, 222 had HT. Of these, 76 (16%) patients were classified as hemorrhagic infarction type 1, 71 (15%) as hemorrhagic infarction type 2, 36 (8%) as parenchymal hematoma type 1, and 39 (8%) as parenchymal hematoma type 2. Hemorrhagic infarction type 2 (adjusted common OR (acOR) 0.54, 95% CI: 0.32 to 0.89) and parenchymal hematoma type 2 (acOR 0.37, 95% CI 0.17 to 0.78) were significantly associated with a worse functional outcome. Hemorrhagic infarction type 1 and parenchymal hematoma type 1 were not significantly associated, although their point estimates pointed in the direction of worse outcome.ConclusionThis study suggests that parenchymal hematoma type 2 is relevant for functional outcome after an acute ischemic stroke, and smaller HTs might also influence long term functional outcome.Trail registration numberISRCTN10888758.
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Affiliation(s)
- Katinka R van Kranendonk
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Kilian M Treurniet
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Anna M M Boers
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
- Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - Olvert A Berkhemer
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
- Department of Neurology, Erasmus MC-University Medical Rotterdam, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Vicky Chalos
- Department of Neurology, Erasmus MC-University Medical Rotterdam, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Public Health, Center for Medical Decision Making, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hester F Lingsma
- Department of Public Health, Center for Medical Decision Making, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Wim H van Zwam
- Department of Radiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert J van Oostenbrugge
- Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Diederik W J Dippel
- Department of Neurology, Erasmus MC-University Medical Rotterdam, Amsterdam, The Netherlands
| | - Yvo B W E M Roos
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - Henk A Marquering
- Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
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9
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Ernst M, Boers AMM, Forkert ND, Berkhemer OA, Roos YB, Dippel DWJ, van der Lugt A, van Oostenbrugge RJ, van Zwam WH, Vettorazzi E, Fiehler J, Marquering HA, Majoie CBLM, Gellissen S. Impact of Ischemic Lesion Location on the mRS Score in Patients with Ischemic Stroke: A Voxel-Based Approach. AJNR Am J Neuroradiol 2018; 39:1989-1994. [PMID: 30287456 DOI: 10.3174/ajnr.a5821] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 08/07/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies indicated that ischemic lesion volume might be a useful surrogate marker for functional outcome in ischemic stroke but should be considered in the context of lesion location. In contrast to previous studies using the ROI approach, which has several drawbacks, the present study aimed to measure the impact of ischemic lesion location on functional outcome using a more precise voxelwise approach. MATERIALS AND METHODS Datasets of patients with acute ischemic strokes from the Multicenter Randomized Clinical Trial of Endovascular Therapy for Acute Ischemic Stroke in the Netherlands (MR CLEAN) were used. Primary outcome was functional outcome as assessed by the modified Rankin Scale 3 months after stroke. Ischemic lesion volume was determined on CT scans 3-9 days after stroke. Voxel-based lesion-symptom mapping techniques, including covariates that are known to be associated with functional outcome, were used to determine the impact of ischemic lesion location for outcome. RESULTS Of the 500 patients in the MR CLEAN trial, 216 were included for analysis. The mean age was 63 years. Lesion-symptom mapping with inclusion of covariates revealed that especially left-hemispheric lesions in the deep periventricular white matter and adjacent internal capsule showed a great influence on functional outcome. CONCLUSIONS Our study confirms that infarct location has an important impact on functional outcome of patients with stroke and should be considered in prediction models. After we adjusted for covariates, the left-hemispheric corticosubcortical fiber tracts seemed to be of higher functional importance compared with cortical lesions.
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Affiliation(s)
- M Ernst
- From the Departments of Diagnostic and Interventional Neuroradiology (M.E., J.F., S.G.)
| | - A M M Boers
- Departments of Radiology and Nuclear Medicine (A.M.M.B., O.A.B., H.A.M., C.B.L.M.M.).,Biomedical Engineering and Physics (A.M.M.B., H.A.M.).,Department of Robotics and Mechatronics (A.M.M.B.), University of Twente, Enschede, the Netherlands
| | - N D Forkert
- Department of Radiology and Hotchkiss Brain Institute (N.D.F.), University of Calgary, Calgary, Alberta, Canada
| | - O A Berkhemer
- Departments of Radiology and Nuclear Medicine (A.M.M.B., O.A.B., H.A.M., C.B.L.M.M.).,Departments of Neurology (O.A.B., D.W.J.D.).,Department of Radiology (O.A.B.), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Y B Roos
- Neurology (Y.B.R.), Academic Medical Center, Amsterdam, the Netherlands
| | | | - A van der Lugt
- Radiology (A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - R J van Oostenbrugge
- Department of Neurology (R.J.v.O.), Maastricht University Medical Center and Cardiovascular Research Institute, Maastricht, the Netherlands
| | - W H van Zwam
- Department of Radiology and Cardiovascular Research Institute Maastricht (W.H.v.Z.), Maastricht University Medical Center, Maastricht, the Netherlands
| | - E Vettorazzi
- Medical Biometry and Epidemiology (E.V.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Fiehler
- From the Departments of Diagnostic and Interventional Neuroradiology (M.E., J.F., S.G.)
| | - H A Marquering
- Departments of Radiology and Nuclear Medicine (A.M.M.B., O.A.B., H.A.M., C.B.L.M.M.).,Biomedical Engineering and Physics (A.M.M.B., H.A.M.)
| | - C B L M Majoie
- Departments of Radiology and Nuclear Medicine (A.M.M.B., O.A.B., H.A.M., C.B.L.M.M.)
| | - S Gellissen
- From the Departments of Diagnostic and Interventional Neuroradiology (M.E., J.F., S.G.)
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10
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Román LS, Menon BK, Blasco J, Hernández-Pérez M, Dávalos A, Majoie CBLM, Campbell BCV, Guillemin F, Lingsma H, Anxionnat R, Epstein J, Saver JL, Marquering H, Wong JH, Lopes D, Reimann G, Desal H, Dippel DWJ, Coutts S, du Mesnil de Rochemont R, Yavagal D, Ferre JC, Roos YBWEM, Liebeskind DS, Lenthall R, Molina C, Al Ajlan FS, Reddy V, Dowlatshahi D, Sourour NA, Oppenheim C, Mitha AP, Davis SM, Weimar C, van Oostenbrugge RJ, Cobo E, Kleinig TJ, Donnan GA, van der Lugt A, Demchuk AM, Berkhemer OA, Boers AMM, Ford GA, Muir KW, Brown BS, Jovin T, van Zwam WH, Mitchell PJ, Hill MD, White P, Bracard S, Goyal M, 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, 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 Oostenbrugge RJ, Cervera A, Amaro S, Llull L, Codas J, Balasa M, Navarro J, Ariño H, Aceituno A, Rudilosso S, Renu A, Majoie CB, Macho JM, San Roman L, Blasco J, López A, Macías N, Cardona P, Quesada H, Rubio F, Cano L, Lara B, Dippel DW, de Miquel MA, Aja L, Serena J, Cobo E, Albers GW, Lees KR, Arenillas J, Roberts R, Minhas P, Al-Ajlan F, Brown MM, Salluzzi M, Zimmel L, Patel S, Eesa M, Martí-Fàbregas J, Jankowitz B, Serena J, Salvat-Plana M, López-Cancio E, Bracard S, Liebig T, Ducrocq X, Anxionnat R, Baillot PA, Barbier C, Derelle AL, Lacour JC, Richard S, Samson Y, Sourour N, Baronnet-Chauvet F, Stijnen T, Clarencon F, Crozier S, Deltour S, Di Maria F, Le Bouc R, Leger A, Mutlu G, Rosso C, Szatmary Z, Yger M, Andersson T, Zavanone C, Bakchine S, Pierot L, Caucheteux N, Estrade L, Kadziolka K, Leautaud A, Renkes C, Serre I, Desal H, Mattle H, Guillon B, Boutoleau-Bretonniere C, Daumas-Duport B, De Gaalon S, Derkinderen P, Evain S, Herisson F, Laplaud DA, Lebouvier T, 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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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Compagne KCJ, Boers AMM, Marquering HA, Berkhemer OA, Yoo AJ, Beenen LFM, van Oostenbrugge RJ, van Zwam WH, Roos YBWEM, Majoie CB, van Es ACGM, van der Lugt A, Dippel DWJ, Lingsma H. Follow-up infarct volume as a mediator of endovascular treatment effect on functional outcome in ischaemic stroke. Eur Radiol 2018; 29:736-744. [PMID: 29987421 PMCID: PMC6302877 DOI: 10.1007/s00330-018-5578-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 03/16/2018] [Revised: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 12/04/2022]
Abstract
Objective The putative mechanism for the favourable effect of endovascular treatment (EVT) on functional outcome after acute ischaemic stroke is preventing follow-up infarct volume (FIV) progression. We aimed to assess to what extent difference in FIV explains the effect of EVT on functional outcome in a randomised trial of EVT versus no EVT (MR CLEAN). Methods FIV was assessed on non-contrast CT scan 5–7 days after stroke. Functional outcome was the score on the modified Rankin Scale at 3 months. We tested the causal pathway from intervention, via FIV to functional outcome with a mediation model, using linear and ordinal regression, adjusted for relevant baseline covariates, including stroke severity. Explained effect was assessed by taking the ratio of the log odds ratios of treatment with and without adjustment for FIV. Results Of the 500 patients included in MR CLEAN, 60 died and four patients underwent hemicraniectomy before FIV was assessed, leaving 436 patients for analysis. Patients in the intervention group had better functional outcomes (adjusted common odds ratio (acOR) 2.30 (95% CI 1.62–3.26) than controls and smaller FIV (median 53 vs. 81 ml) (difference 28 ml; 95% CI 13–41). Smaller FIV was associated with better outcome (acOR per 10 ml 0.60, 95% CI 0.52–0.68). After adjustment for FIV the effect of intervention on functional outcome decreased but remained substantial (acOR 2.05, 95% CI 1.44–2.91). This implies that preventing FIV progression explains 14% (95% CI 0–34) of the beneficial effect of EVT on outcome. Conclusion The effect of EVT on FIV explains only part of the treatment effect on functional outcome. Key Points • Endovascular treatment in acute ischaemic stroke patients prevents progression of follow-up infarct volume on non-contrast CT at 5–7 days. • Follow-up infarct volume was related to functional outcome, but only explained a modest part of the effect of intervention on functional outcome. • A large proportion of treatment effect on functional outcome remains unexplained, suggesting FIV alone cannot be used as an early surrogate imaging marker of functional outcome. Electronic supplementary material The online version of this article (10.1007/s00330-018-5578-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K C J Compagne
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, PO Box 2040 3000, CA, Rotterdam, The Netherlands. .,Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - A M M Boers
- Department of Radiology and Nuclear Medicine, Academic Medical Center (AMC), Amsterdam, The Netherlands.,Biomedical Engineering and Physics, Academic Medical Center (AMC), Amsterdam, The Netherlands.,Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - H A Marquering
- Department of Radiology and Nuclear Medicine, Academic Medical Center (AMC), Amsterdam, The Netherlands.,Biomedical Engineering and Physics, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - O A Berkhemer
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, PO Box 2040 3000, CA, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - A J Yoo
- Division of Neurointervention, Texas Stroke Institute, Dallas-Fort Worth, TX, USA
| | - L F M Beenen
- Department of Radiology and Nuclear Medicine, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - R J van Oostenbrugge
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - W H van Zwam
- Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.,Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Y B W E M Roos
- Neurology, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - C B Majoie
- Department of Radiology and Nuclear Medicine, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - A C G M van Es
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, PO Box 2040 3000, CA, Rotterdam, The Netherlands
| | - A van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, PO Box 2040 3000, CA, Rotterdam, The Netherlands
| | - D W J Dippel
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - H Lingsma
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Boers AMM, Sales Barros R, Jansen IGH, Berkhemer OA, Beenen LFM, Menon BK, Dippel DWJ, van der Lugt A, van Zwam WH, Roos YBWEM, van Oostenbrugge RJ, Slump CH, Majoie CBLM, Marquering HA. Value of Quantitative Collateral Scoring on CT Angiography in Patients with Acute Ischemic Stroke. AJNR Am J Neuroradiol 2018; 39:1074-1082. [PMID: 29674417 DOI: 10.3174/ajnr.a5623] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 02/09/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Many studies have emphasized the relevance of collateral flow in patients presenting with acute ischemic stroke. Our aim was to evaluate the relationship of the quantitative collateral score on baseline CTA with the outcome of patients with acute ischemic stroke and test whether the timing of the CTA acquisition influences this relationship. MATERIALS AND METHODS From the Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) data base, all baseline thin-slice CTA images of patients with acute ischemic stroke with intracranial large-vessel occlusion were retrospectively collected. The quantitative collateral score was calculated as the ratio of the vascular appearance of both hemispheres and was compared with the visual collateral score. Primary outcomes were 90-day mRS score and follow-up infarct volume. The relation with outcome and the association with treatment effect were estimated. The influence of the CTA acquisition phase on the relation of collateral scores with outcome was determined. RESULTS A total of 442 patients were included. The quantitative collateral score strongly correlated with the visual collateral score (ρ = 0.75) and was an independent predictor of mRS (adjusted odds ratio = 0.81; 95% CI, .77-.86) and follow-up infarct volume (exponent β = 0.88; P < .001) per 10% increase. The quantitative collateral score showed areas under the curve of 0.71 and 0.69 for predicting functional independence (mRS 0-2) and follow-up infarct volume of >90 mL, respectively. We found significant interaction of the quantitative collateral score with the endovascular therapy effect in unadjusted analysis on the full ordinal mRS scale (P = .048) and on functional independence (P = .049). Modification of the quantitative collateral score by acquisition phase on outcome was significant (mRS: P = .004; follow-up infarct volume: P < .001) in adjusted analysis. CONCLUSIONS Automated quantitative collateral scoring in patients with acute ischemic stroke is a reliable and user-independent measure of the collateral capacity on baseline CTA and has the potential to augment the triage of patients with acute stroke for endovascular therapy.
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Affiliation(s)
- A M M Boers
- From the Departments of Biomedical Engineering and Physics (A.M.M.B., R.S.B., I.G.H.J., H.A.M.) .,Radiology and Nuclear Medicine (A.M.M.B., I.G.H.J., O.A.B., L.F.M.B., C.B.L.M.M., H.A.M.).,Department of Robotics and Mechatronics (A.M.M.B., C.H.S.)
| | - R Sales Barros
- From the Departments of Biomedical Engineering and Physics (A.M.M.B., R.S.B., I.G.H.J., H.A.M.)
| | - I G H Jansen
- From the Departments of Biomedical Engineering and Physics (A.M.M.B., R.S.B., I.G.H.J., H.A.M.).,Radiology and Nuclear Medicine (A.M.M.B., I.G.H.J., O.A.B., L.F.M.B., C.B.L.M.M., H.A.M.)
| | - O A Berkhemer
- Radiology and Nuclear Medicine (A.M.M.B., I.G.H.J., O.A.B., L.F.M.B., C.B.L.M.M., H.A.M.)
| | - L F M Beenen
- Radiology and Nuclear Medicine (A.M.M.B., I.G.H.J., O.A.B., L.F.M.B., C.B.L.M.M., H.A.M.)
| | - B K Menon
- Department of Clinical Neurosciences (B.K.M.), Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary, Alberta, Canada
| | | | - A van der Lugt
- Radiology (A.v.d.L.), Erasmus MC, Rotterdam, the Netherlands
| | - W H van Zwam
- Department of Radiology (W.H.v.Z.), Maastricht UMC, Maastricht, the Netherlands
| | - Y B W E M Roos
- Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands
| | - R J van Oostenbrugge
- Department of Neurology (R.J.v.O.), Maastricht UMC and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - C H Slump
- Department of Robotics and Mechatronics (A.M.M.B., C.H.S.).,MIRA Institute for Biomedical Engineering and Technical Medicine (C.H.S.), University of Twente, Enschede, the Netherlands
| | - C B L M Majoie
- Radiology and Nuclear Medicine (A.M.M.B., I.G.H.J., O.A.B., L.F.M.B., C.B.L.M.M., H.A.M.)
| | - H A Marquering
- From the Departments of Biomedical Engineering and Physics (A.M.M.B., R.S.B., I.G.H.J., H.A.M.).,Radiology and Nuclear Medicine (A.M.M.B., I.G.H.J., O.A.B., L.F.M.B., C.B.L.M.M., H.A.M.)
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13
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van der Steen WE, Zijlstra IA, Verbaan D, Boers AMM, Gathier CS, van den Berg R, Rinkel GJE, Coert BA, Roos YBWEM, Majoie CBLM, Marquering HA. Association of Quantified Location-Specific Blood Volumes with Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage. AJNR Am J Neuroradiol 2018; 39:1059-1064. [PMID: 29650786 DOI: 10.3174/ajnr.a5626] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 02/12/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Delayed cerebral ischemia is a severe complication of aneurysmal SAH and is associated with a high case morbidity and fatality. The total blood volume and the presence of intraventricular blood on CT after aneurysmal SAH are associated with delayed cerebral ischemia. Whether quantified location-specific (cisternal, intraventricular, parenchymal, and subdural) blood volumes are associated with delayed cerebral ischemia has been infrequently researched. This study aimed to associate quantified location-specific blood volumes with delayed cerebral ischemia. MATERIALS AND METHODS Clinical and radiologic data were collected retrospectively from consecutive patients with aneurysmal SAH with available CT scans within 24 hours after ictus admitted to 2 academic centers between January 2009 and December 2011. Total blood volume was quantified using an automatic hemorrhage-segmentation algorithm. Segmented blood was manually classified as cisternal, intraventricular, intraparenchymal, or subdural. Adjusted ORs with 95% confidence intervals for delayed cerebral ischemia per milliliter of location-specific blood were calculated using multivariable logistic regression analysis. RESULTS We included 282 patients. Per milliliter increase in blood volume, the adjusted OR for delayed cerebral ischemia was 1.02 (95% CI, 1.01-1.04) for cisternal, 1.02 (95% CI, 1.00-1.04) for intraventricular, 0.99 (95% CI, 0.97-1.02) for intraparenchymal, and 0.96 (95% CI, 0.86-1.07) for subdural blood. CONCLUSIONS Our findings suggest that in patients with aneurysmal subarachnoid hemorrhage, the cisternal blood volume has a stronger relation with delayed cerebral ischemia than the blood volumes at other locations in the brain.
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Affiliation(s)
- W E van der Steen
- From the Department of Biomedical Engineering and Physics (W.E.v.d.S., A.M.M.B., H.A.M.) .,Department of Radiology (W.E.v.d.S., I.A.Z., A.M.M.B., R.v.d.B., C.B.L.M.M., H.A.M).,Neurosurgical Center Amsterdam (W.E.v.d.S., D.V., B.A.C.).,Department of Neurology (W.E.v.d.S., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands
| | - I A Zijlstra
- Department of Radiology (W.E.v.d.S., I.A.Z., A.M.M.B., R.v.d.B., C.B.L.M.M., H.A.M)
| | - D Verbaan
- Neurosurgical Center Amsterdam (W.E.v.d.S., D.V., B.A.C.)
| | - A M M Boers
- From the Department of Biomedical Engineering and Physics (W.E.v.d.S., A.M.M.B., H.A.M.).,Department of Radiology (W.E.v.d.S., I.A.Z., A.M.M.B., R.v.d.B., C.B.L.M.M., H.A.M).,Department of Robotics and Mechatronics (A.M.M.B.), University of Twente, Enschede, the Netherlands
| | - C S Gathier
- Department of Neurology and Neurosurgery (C.S.G., G.J.E.R.), Brain Center Rudolf Magnus, University Medical Center, Utrecht, the Netherlands
| | - R van den Berg
- Department of Radiology (W.E.v.d.S., I.A.Z., A.M.M.B., R.v.d.B., C.B.L.M.M., H.A.M)
| | - G J E Rinkel
- Department of Neurology and Neurosurgery (C.S.G., G.J.E.R.), Brain Center Rudolf Magnus, University Medical Center, Utrecht, the Netherlands
| | - B A Coert
- Neurosurgical Center Amsterdam (W.E.v.d.S., D.V., B.A.C.)
| | - Y B W E M Roos
- Department of Neurology (W.E.v.d.S., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands
| | - C B L M Majoie
- Department of Radiology (W.E.v.d.S., I.A.Z., A.M.M.B., R.v.d.B., C.B.L.M.M., H.A.M)
| | - H A Marquering
- From the Department of Biomedical Engineering and Physics (W.E.v.d.S., A.M.M.B., H.A.M.).,Department of Radiology (W.E.v.d.S., I.A.Z., A.M.M.B., R.v.d.B., C.B.L.M.M., H.A.M)
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14
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Boers AMM, Jansen IGH, Beenen LFM, Devlin TG, San Roman L, Heo JH, Ribó M, Brown S, Almekhlafi MA, Liebeskind DS, Teitelbaum J, Lingsma HF, van Zwam WH, Cuadras P, du Mesnil de Rochemont R, Beaumont M, Brown MM, Yoo AJ, van Oostenbrugge RJ, Menon BK, Donnan GA, Mas JL, Roos YBWEM, Oppenheim C, van der Lugt A, Dowling RJ, Hill MD, Davalos A, Moulin T, Agrinier N, Demchuk AM, Lopes DK, Aja Rodríguez L, Dippel DWJ, Campbell BCV, Mitchell PJ, Al-Ajlan FS, Jovin TG, Madigan J, Albers GW, Soize S, Guillemin F, Reddy VK, Bracard S, Blasco J, Muir KW, Nogueira RG, White PM, Goyal M, Davis SM, Marquering HA, Majoie CBLM. Association of follow-up infarct volume with functional outcome in acute ischemic stroke: a pooled analysis of seven randomized trials. J Neurointerv Surg 2018; 10:1137-1142. [DOI: 10.1136/neurintsurg-2017-013724] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/26/2018] [Accepted: 03/02/2018] [Indexed: 11/04/2022]
Abstract
BackgroundFollow-up infarct volume (FIV) has been recommended as an early indicator of treatment efficacy in patients with acute ischemic stroke. Questions remain about the optimal imaging approach for FIV measurement.ObjectiveTo examine the association of FIV with 90-day modified Rankin Scale (mRS) score and investigate its dependency on acquisition time and modality.MethodsData of seven trials were pooled. FIV was assessed on follow-up (12 hours to 2 weeks) CT or MRI. Infarct location was defined as laterality and involvement of the Alberta Stroke Program Early CT Score regions. Relative quality and strength of multivariable regression models of the association between FIV and functional outcome were assessed. Dependency of imaging modality and acquisition time (≤48 hours vs >48 hours) was evaluated.ResultsOf 1665 included patients, 83% were imaged with CT. Median FIV was 41 mL (IQR 14–120). A large FIV was associated with worse functional outcome (OR=0.88(95% CI 0.87 to 0.89) per 10 mL) in adjusted analysis. A model including FIV, location, and hemorrhage type best predicted mRS score. FIV of ≥133 mL was highly specific for unfavorable outcome. FIV was equally strongly associated with mRS score for assessment on CT and MRI, even though large differences in volume were present (48 mL (IQR 15–131) vs 22 mL (IQR 8–71), respectively). Associations of both early and late FIV assessments with outcome were similar in strength (ρ=0.60(95% CI 0.56 to 0.64) and ρ=0.55(95% CI 0.50 to 0.60), respectively).ConclusionsIn patients with an acute ischemic stroke due to a proximal intracranial occlusion of the anterior circulation, FIV is a strong independent predictor of functional outcome and can be assessed before 48 hours, oneither CT or MRI.
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15
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Alves HC, Treurniet KM, Dutra BG, Jansen IGH, Boers AMM, Santos EMM, Berkhemer OA, Dippel DWJ, van der Lugt A, van Zwam WH, van Oostenbrugge RJ, Lingsma HF, Roos YBWEM, Yoo AJ, Marquering HA, Majoie CBLM. Associations Between Collateral Status and Thrombus Characteristics and Their Impact in Anterior Circulation Stroke. Stroke 2018; 49:391-396. [PMID: 29321337 DOI: 10.1161/strokeaha.117.019509] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 09/22/2017] [Revised: 11/21/2017] [Accepted: 11/27/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Thrombus characteristics and collateral score are associated with functional outcome in patients with acute ischemic stroke. It has been suggested that they affect each other. The aim of this study is to evaluate the association between clot burden score, thrombus perviousness, and collateral score and to determine whether collateral score influences the association of thrombus characteristics with functional outcome. METHODS Patients with baseline thin-slice noncontrast computed tomography and computed tomographic angiography images from the MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands) were included (n=195). Collateral score and clot burden scores were determined on baseline computed tomographic angiography. Thrombus attenuation increase was determined by comparing thrombus density on noncontrast computed tomography and computed tomographic angiography using a semiautomated method. The association of collateral score with clot burden score and thrombus attenuation increase was evaluated with linear regression. Mediation and effect modification analyses were used to assess the influence of collateral score on the association of clot burden score and thrombus attenuation increase with functional outcome. RESULTS A higher clot burden score (B=0.063; 95% confidence interval, 0.008-0.118) and a higher thrombus attenuation increase (B=0.014; 95% confidence interval, 0.003-0.026) were associated with higher collateral score. Collateral score mediated the association of clot burden score with functional outcome. The association between thrombus attenuation increase and functional outcome was modified by the collateral score, and this association was stronger in patients with moderate and good collaterals. CONCLUSIONS Patients with lower thrombus burden and higher thrombus perviousness scores had higher collateral score. The positive effect of thrombus perviousness on clinical outcome was only present in patients with moderate and high collateral scores. CLINICAL TRIAL REGISTRATION URL: http://www.trialregister.nl. Unique identifier: NTR1804 and URL: http://www.controlled-trials.com Unique identifier: ISRCTN10888758.
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Affiliation(s)
- Heitor C Alves
- From the Department of Radiology and Nuclear Medicine (H.C.A., K.M.T, B.G.D., I.G.H.J., A.M.M.B., E.M.M.S., O.A.B., C.B.L.M.M.), Department of Biomedical Engineering and Physics (H.C.A, B.G.D., A.M.M.B., E.M.M.S., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology (E.M.M.S., A.v.d.L.), Department of Medical Informatics (E.M.M.S., W.J.N.), Department of Neurology (O.A.B., D.W.J.D.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); and Department of Radiology (W.H.v.Z., O.A.B.), Department of Neurology (R.J.v.O.), and Cardiovascular Research Institute Maastricht (W.H.v.Z., R.J.v.O.), Maastricht University MC, the Netherlands.
| | - Kilian M Treurniet
- From the Department of Radiology and Nuclear Medicine (H.C.A., K.M.T, B.G.D., I.G.H.J., A.M.M.B., E.M.M.S., O.A.B., C.B.L.M.M.), Department of Biomedical Engineering and Physics (H.C.A, B.G.D., A.M.M.B., E.M.M.S., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology (E.M.M.S., A.v.d.L.), Department of Medical Informatics (E.M.M.S., W.J.N.), Department of Neurology (O.A.B., D.W.J.D.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); and Department of Radiology (W.H.v.Z., O.A.B.), Department of Neurology (R.J.v.O.), and Cardiovascular Research Institute Maastricht (W.H.v.Z., R.J.v.O.), Maastricht University MC, the Netherlands
| | - Bruna G Dutra
- From the Department of Radiology and Nuclear Medicine (H.C.A., K.M.T, B.G.D., I.G.H.J., A.M.M.B., E.M.M.S., O.A.B., C.B.L.M.M.), Department of Biomedical Engineering and Physics (H.C.A, B.G.D., A.M.M.B., E.M.M.S., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology (E.M.M.S., A.v.d.L.), Department of Medical Informatics (E.M.M.S., W.J.N.), Department of Neurology (O.A.B., D.W.J.D.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); and Department of Radiology (W.H.v.Z., O.A.B.), Department of Neurology (R.J.v.O.), and Cardiovascular Research Institute Maastricht (W.H.v.Z., R.J.v.O.), Maastricht University MC, the Netherlands
| | - Ivo G H Jansen
- From the Department of Radiology and Nuclear Medicine (H.C.A., K.M.T, B.G.D., I.G.H.J., A.M.M.B., E.M.M.S., O.A.B., C.B.L.M.M.), Department of Biomedical Engineering and Physics (H.C.A, B.G.D., A.M.M.B., E.M.M.S., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology (E.M.M.S., A.v.d.L.), Department of Medical Informatics (E.M.M.S., W.J.N.), Department of Neurology (O.A.B., D.W.J.D.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); and Department of Radiology (W.H.v.Z., O.A.B.), Department of Neurology (R.J.v.O.), and Cardiovascular Research Institute Maastricht (W.H.v.Z., R.J.v.O.), Maastricht University MC, the Netherlands
| | - Anna M M Boers
- From the Department of Radiology and Nuclear Medicine (H.C.A., K.M.T, B.G.D., I.G.H.J., A.M.M.B., E.M.M.S., O.A.B., C.B.L.M.M.), Department of Biomedical Engineering and Physics (H.C.A, B.G.D., A.M.M.B., E.M.M.S., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology (E.M.M.S., A.v.d.L.), Department of Medical Informatics (E.M.M.S., W.J.N.), Department of Neurology (O.A.B., D.W.J.D.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); and Department of Radiology (W.H.v.Z., O.A.B.), Department of Neurology (R.J.v.O.), and Cardiovascular Research Institute Maastricht (W.H.v.Z., R.J.v.O.), Maastricht University MC, the Netherlands
| | - Emilie M M Santos
- From the Department of Radiology and Nuclear Medicine (H.C.A., K.M.T, B.G.D., I.G.H.J., A.M.M.B., E.M.M.S., O.A.B., C.B.L.M.M.), Department of Biomedical Engineering and Physics (H.C.A, B.G.D., A.M.M.B., E.M.M.S., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology (E.M.M.S., A.v.d.L.), Department of Medical Informatics (E.M.M.S., W.J.N.), Department of Neurology (O.A.B., D.W.J.D.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); and Department of Radiology (W.H.v.Z., O.A.B.), Department of Neurology (R.J.v.O.), and Cardiovascular Research Institute Maastricht (W.H.v.Z., R.J.v.O.), Maastricht University MC, the Netherlands
| | - Olvert A Berkhemer
- From the Department of Radiology and Nuclear Medicine (H.C.A., K.M.T, B.G.D., I.G.H.J., A.M.M.B., E.M.M.S., O.A.B., C.B.L.M.M.), Department of Biomedical Engineering and Physics (H.C.A, B.G.D., A.M.M.B., E.M.M.S., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology (E.M.M.S., A.v.d.L.), Department of Medical Informatics (E.M.M.S., W.J.N.), Department of Neurology (O.A.B., D.W.J.D.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); and Department of Radiology (W.H.v.Z., O.A.B.), Department of Neurology (R.J.v.O.), and Cardiovascular Research Institute Maastricht (W.H.v.Z., R.J.v.O.), Maastricht University MC, the Netherlands
| | - Diederik W J Dippel
- From the Department of Radiology and Nuclear Medicine (H.C.A., K.M.T, B.G.D., I.G.H.J., A.M.M.B., E.M.M.S., O.A.B., C.B.L.M.M.), Department of Biomedical Engineering and Physics (H.C.A, B.G.D., A.M.M.B., E.M.M.S., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology (E.M.M.S., A.v.d.L.), Department of Medical Informatics (E.M.M.S., W.J.N.), Department of Neurology (O.A.B., D.W.J.D.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); and Department of Radiology (W.H.v.Z., O.A.B.), Department of Neurology (R.J.v.O.), and Cardiovascular Research Institute Maastricht (W.H.v.Z., R.J.v.O.), Maastricht University MC, the Netherlands
| | - Aad van der Lugt
- From the Department of Radiology and Nuclear Medicine (H.C.A., K.M.T, B.G.D., I.G.H.J., A.M.M.B., E.M.M.S., O.A.B., C.B.L.M.M.), Department of Biomedical Engineering and Physics (H.C.A, B.G.D., A.M.M.B., E.M.M.S., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology (E.M.M.S., A.v.d.L.), Department of Medical Informatics (E.M.M.S., W.J.N.), Department of Neurology (O.A.B., D.W.J.D.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); and Department of Radiology (W.H.v.Z., O.A.B.), Department of Neurology (R.J.v.O.), and Cardiovascular Research Institute Maastricht (W.H.v.Z., R.J.v.O.), Maastricht University MC, the Netherlands
| | - Wim H van Zwam
- From the Department of Radiology and Nuclear Medicine (H.C.A., K.M.T, B.G.D., I.G.H.J., A.M.M.B., E.M.M.S., O.A.B., C.B.L.M.M.), Department of Biomedical Engineering and Physics (H.C.A, B.G.D., A.M.M.B., E.M.M.S., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology (E.M.M.S., A.v.d.L.), Department of Medical Informatics (E.M.M.S., W.J.N.), Department of Neurology (O.A.B., D.W.J.D.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); and Department of Radiology (W.H.v.Z., O.A.B.), Department of Neurology (R.J.v.O.), and Cardiovascular Research Institute Maastricht (W.H.v.Z., R.J.v.O.), Maastricht University MC, the Netherlands
| | - Robert J van Oostenbrugge
- From the Department of Radiology and Nuclear Medicine (H.C.A., K.M.T, B.G.D., I.G.H.J., A.M.M.B., E.M.M.S., O.A.B., C.B.L.M.M.), Department of Biomedical Engineering and Physics (H.C.A, B.G.D., A.M.M.B., E.M.M.S., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology (E.M.M.S., A.v.d.L.), Department of Medical Informatics (E.M.M.S., W.J.N.), Department of Neurology (O.A.B., D.W.J.D.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); and Department of Radiology (W.H.v.Z., O.A.B.), Department of Neurology (R.J.v.O.), and Cardiovascular Research Institute Maastricht (W.H.v.Z., R.J.v.O.), Maastricht University MC, the Netherlands
| | - Hester F Lingsma
- From the Department of Radiology and Nuclear Medicine (H.C.A., K.M.T, B.G.D., I.G.H.J., A.M.M.B., E.M.M.S., O.A.B., C.B.L.M.M.), Department of Biomedical Engineering and Physics (H.C.A, B.G.D., A.M.M.B., E.M.M.S., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology (E.M.M.S., A.v.d.L.), Department of Medical Informatics (E.M.M.S., W.J.N.), Department of Neurology (O.A.B., D.W.J.D.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); and Department of Radiology (W.H.v.Z., O.A.B.), Department of Neurology (R.J.v.O.), and Cardiovascular Research Institute Maastricht (W.H.v.Z., R.J.v.O.), Maastricht University MC, the Netherlands
| | - Yvo B W E M Roos
- From the Department of Radiology and Nuclear Medicine (H.C.A., K.M.T, B.G.D., I.G.H.J., A.M.M.B., E.M.M.S., O.A.B., C.B.L.M.M.), Department of Biomedical Engineering and Physics (H.C.A, B.G.D., A.M.M.B., E.M.M.S., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology (E.M.M.S., A.v.d.L.), Department of Medical Informatics (E.M.M.S., W.J.N.), Department of Neurology (O.A.B., D.W.J.D.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); and Department of Radiology (W.H.v.Z., O.A.B.), Department of Neurology (R.J.v.O.), and Cardiovascular Research Institute Maastricht (W.H.v.Z., R.J.v.O.), Maastricht University MC, the Netherlands
| | - Albert J Yoo
- From the Department of Radiology and Nuclear Medicine (H.C.A., K.M.T, B.G.D., I.G.H.J., A.M.M.B., E.M.M.S., O.A.B., C.B.L.M.M.), Department of Biomedical Engineering and Physics (H.C.A, B.G.D., A.M.M.B., E.M.M.S., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology (E.M.M.S., A.v.d.L.), Department of Medical Informatics (E.M.M.S., W.J.N.), Department of Neurology (O.A.B., D.W.J.D.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); and Department of Radiology (W.H.v.Z., O.A.B.), Department of Neurology (R.J.v.O.), and Cardiovascular Research Institute Maastricht (W.H.v.Z., R.J.v.O.), Maastricht University MC, the Netherlands
| | - Henk A Marquering
- From the Department of Radiology and Nuclear Medicine (H.C.A., K.M.T, B.G.D., I.G.H.J., A.M.M.B., E.M.M.S., O.A.B., C.B.L.M.M.), Department of Biomedical Engineering and Physics (H.C.A, B.G.D., A.M.M.B., E.M.M.S., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology (E.M.M.S., A.v.d.L.), Department of Medical Informatics (E.M.M.S., W.J.N.), Department of Neurology (O.A.B., D.W.J.D.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); and Department of Radiology (W.H.v.Z., O.A.B.), Department of Neurology (R.J.v.O.), and Cardiovascular Research Institute Maastricht (W.H.v.Z., R.J.v.O.), Maastricht University MC, the Netherlands
| | - Charles B L M Majoie
- From the Department of Radiology and Nuclear Medicine (H.C.A., K.M.T, B.G.D., I.G.H.J., A.M.M.B., E.M.M.S., O.A.B., C.B.L.M.M.), Department of Biomedical Engineering and Physics (H.C.A, B.G.D., A.M.M.B., E.M.M.S., H.A.M.), and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology (E.M.M.S., A.v.d.L.), Department of Medical Informatics (E.M.M.S., W.J.N.), Department of Neurology (O.A.B., D.W.J.D.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Robotics and Mechatronics, University of Twente, the Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); and Department of Radiology (W.H.v.Z., O.A.B.), Department of Neurology (R.J.v.O.), and Cardiovascular Research Institute Maastricht (W.H.v.Z., R.J.v.O.), Maastricht University MC, the Netherlands
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Treurniet KM, Yoo AJ, Berkhemer OA, Lingsma HF, Boers AMM, Fransen PSS, Beumer D, van den Berg LA, Sprengers MES, Jenniskens SFM, Lycklama À Nijeholt GJ, van Walderveen MAA, Bot JCJ, Beenen LFM, van den Berg R, van Zwam WH, van der Lugt A, van Oostenbrugge RJ, Dippel DWJ, Roos YBWEM, Marquering HA, Majoie CBLM. Clot Burden Score on Baseline Computerized Tomographic Angiography and Intra-Arterial Treatment Effect in Acute Ischemic Stroke. Stroke 2016; 47:2972-2978. [PMID: 27827328 DOI: 10.1161/strokeaha.116.014565] [Citation(s) in RCA: 41] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/23/2016] [Accepted: 09/19/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE A high clot burden score (CBS) is associated with favorable outcome after intravenous treatment for acute ischemic stroke. The added benefit of intra-arterial treatment might be less in these patients. The aim of this exploratory post hoc analysis was to assess the relation of CBS with neurological improvement and endovascular treatment effect. METHODS For 499 of 500 patients in the MR CLEAN study (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), the CBS was determined. Ordinal logistic regression models with and without main baseline prognostic variables were used to assess the association between CBS (continuous or dichotomized at CBS of 6) and a shift toward better outcome on the modified Rankin Scale. The model without main baseline prognostic variables only included treatment allocation and CBS. Models with and without a multiplicative interaction term of CBS and treatment were compared using the χ2 test to assess treatment effect modification by CBS. RESULTS Higher CBS was associated with a shift toward better outcome on the modified Rankin Scale; adjusted common odds ratio per point CBS was 1.12 (95% confidence interval, 1.04-1.20]. Dichotomized CBS had an adjusted common odds ratio of 1.67 (95% confidence interval, 1.12-2.51). Both effect estimates were slightly attenuated by adding baseline prognostic variables. The addition of the interaction terms did not significantly improve the fit of the models. There was a small and insignificant increase of intra-arterial treatment efficacy in the high CBS group. CONCLUSIONS A higher CBS is associated with improved outcome and may be used as a prognostic marker. We found no evidence that CBS modifies the effect of intra-arterial treatment. CLINICAL TRIAL REGISTRATION URL: http://www.trialregister.nl. Unique identifier: NTR1804. URL: http://www.controlled-trials.com. Unique identifier: ISRCTN10888758.
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Affiliation(s)
- Kilian M Treurniet
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.).
| | - Albert J Yoo
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Olvert A Berkhemer
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Hester F Lingsma
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Anna M M Boers
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Puck S S Fransen
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Debbie Beumer
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Lucie A van den Berg
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Marieke E S Sprengers
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Sjoerd F M Jenniskens
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Geert J Lycklama À Nijeholt
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Marianne A A van Walderveen
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Joseph C J Bot
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Ludo F M Beenen
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - René van den Berg
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Wim H van Zwam
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Aad van der Lugt
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Robert J van Oostenbrugge
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Diederik W J Dippel
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Yvo B W E M Roos
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Henk A Marquering
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
| | - Charles B L M Majoie
- From the Department of Radiology (K.M.T., O.A.B., A.M.M.B., M.E.S.S., L.F.M.B., R.v.d.B., H.A.M., C.B.L.M.M.), Department of Biomedical Engineering and Physics (A.M.M.B., H.A.M.), and Department of Neurology (L.A.v.d.B., Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Department of Radiology, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Department of Public Health (H.F.L.), and Department of Radiology (P.S.S.F., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.), Maastricht University Medical Center, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands (A.M.M.B.); Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (S.F.M.J.); Department of Radiology, MC Haaglanden, The Hague, The Netherlands (G.J.L.À.N.); Department of Radiology, Leiden University Medical Center, The Netherlands (M.A.A.v.W.); and Department of Radiology, VU Medical Center, Amsterdam, The Netherlands (J.C.J.B.)
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Yoo AJ, Berkhemer OA, Fransen PSS, van den Berg LA, Beumer D, Lingsma HF, Schonewille WJ, Sprengers MES, van den Berg R, van Walderveen MAA, Beenen LFM, Wermer MJH, Nijeholt GJLÀ, Boiten J, Jenniskens SFM, Bot JCJ, Boers AMM, Marquering HA, Roos YBWEM, van Oostenbrugge RJ, Dippel DWJ, van der Lugt A, van Zwam WH, Majoie CBLM. Effect of baseline Alberta Stroke Program Early CT Score on safety and efficacy of intra-arterial treatment: a subgroup analysis of a randomised phase 3 trial (MR CLEAN). Lancet Neurol 2016; 15:685-694. [DOI: 10.1016/s1474-4422(16)00124-1] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/22/2016] [Accepted: 03/11/2016] [Indexed: 11/29/2022]
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Boers AMM, Berkhemer OA, Slump CH, van Zwam WH, Roos YBWEM, van der Lugt A, van Oostenbrugge RJ, Yoo AJ, Dippel DWJ, Marquering HA, Majoie CBLM. Topographic distribution of cerebral infarct probability in patients with acute ischemic stroke: mapping of intra-arterial treatment effect. J Neurointerv Surg 2016; 9:431-436. [PMID: 27112775 DOI: 10.1136/neurintsurg-2016-012387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 03/09/2016] [Revised: 04/04/2016] [Accepted: 04/06/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Since proof emerged that IA treatment (IAT) is beneficial for patients with acute ischemic stroke, it has become the standard method of care. Despite these positive results, recovery to functional independence is established in only about one-third of treated patients. The effect of IAT is commonly assessed by functional outcome, whereas its effect on brain tissue salvage is considered a secondary outcome measure (at most). Because patient and treatment selection needs to be improved, understanding the treatment effect on brain tissue salvage is of utmost importance. OBJECTIVE To introduce infarct probability maps to estimate the location and extent of tissue damage based on patient baseline characteristics and treatment type. METHODS Cerebral infarct probability maps were created by combining automatically segmented infarct distributions using follow-up CT images of 281 patients from the MR CLEAN trial. Comparison of infarct probability maps allows visualization and quantification of probable treatment effects. Treatment impact was calculated for 10 Alberta Stroke Program Early CT Score (ASPECTS) and 27 anatomical regions. RESULTS The insular cortex had the highest infarct probability in both control and IAT populations (47.2% and 42.6%, respectively). Comparison showed significant lower infarct probability in 4 ASPECTS and 17 anatomical regions in favor of IAT. Most salvaged tissue was found within the ASPECTS M2 region, which was 8.5% less likely to infarct. CONCLUSIONS Probability maps intuitively visualize the topographic distribution of infarct probability due to treatment, which makes it a promising tool for estimating the effect of treatment.
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Affiliation(s)
- A M M Boers
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.,Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands.,Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - O A Berkhemer
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.,Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - C H Slump
- Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - W H van Zwam
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Y B W E M Roos
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - A van der Lugt
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - R J van Oostenbrugge
- Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - A J Yoo
- Division of Neurointervention, Texas Stroke Institute, Plano, Texas, USA
| | - D W J Dippel
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - H A Marquering
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.,Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - C B L M Majoie
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
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19
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van den Wijngaard IR, Holswilder G, Wermer MJH, Boiten J, Algra A, Dippel DWJ, Dankbaar JW, Velthuis BK, Boers AMM, Majoie CBLM, van Walderveen MAA. Assessment of Collateral Status by Dynamic CT Angiography in Acute MCA Stroke: Timing of Acquisition and Relationship with Final Infarct Volume. AJNR Am J Neuroradiol 2016; 37:1231-6. [PMID: 27032971 DOI: 10.3174/ajnr.a4746] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 01/04/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Dynamic CTA is a promising technique for visualization of collateral filling in patients with acute ischemic stroke. Our aim was to describe collateral filling with dynamic CTA and assess the relationship with infarct volume at follow-up. MATERIALS AND METHODS We selected patients with acute ischemic stroke due to proximal MCA occlusion. Patients underwent NCCT, single-phase CTA, and whole-brain CT perfusion/dynamic CTA within 9 hours after stroke onset. For each patient, a detailed assessment of the extent and velocity of arterial filling was obtained. Poor radiologic outcome was defined as an infarct volume of ≥70 mL. The association between collateral score and follow-up infarct volume was analyzed with Poisson regression. RESULTS Sixty-one patients with a mean age of 67 years were included. For all patients combined, the interval that contained the peak of arterial filling in both hemispheres was between 11 and 21 seconds after ICA contrast entry. Poor collateral status as assessed with dynamic CTA was more strongly associated with infarct volume of ≥70 mL (risk ratio, 1.9; 95% CI, 1.3-2.9) than with single-phase CTA (risk ratio, 1.4; 95% CI, 0.8-2.5). Four subgroups (good-versus-poor and fast-versus-slow collaterals) were analyzed separately; the results showed that compared with good and fast collaterals, a similar risk ratio was found for patients with good-but-slow collaterals (risk ratio, 1.3; 95% CI, 0.7-2.4). CONCLUSIONS Dynamic CTA provides a more detailed assessment of collaterals than single-phase CTA and has a stronger relationship with infarct volume at follow-up. The extent of collateral flow is more important in determining tissue fate than the velocity of collateral filling. The timing of dynamic CTA acquisition in relation to intravenous contrast administration is critical for the optimal assessment of the extent of collaterals.
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Affiliation(s)
- I R van den Wijngaard
- From the Departments of Radiology (I.R.v.d.W., G.H., M.A.A.v.W.) Department of Neurology (I.R.v.d.W., J.B.), Medical Center Haaglanden, the Hague, the Netherlands
| | - G Holswilder
- From the Departments of Radiology (I.R.v.d.W., G.H., M.A.A.v.W.)
| | | | - J Boiten
- Department of Neurology (I.R.v.d.W., J.B.), Medical Center Haaglanden, the Hague, the Netherlands
| | - A Algra
- Clinical Epidemiology (A.A.), Leiden University Medical Center, Leiden, the Netherlands Department of Neurology and Neurosurgery (A.A.), Brain Center Rudolf Magnus
| | - D W J Dippel
- Department of Neurology (D.W.J.D.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - J W Dankbaar
- Department of Radiology (J.W.D., B.K.V.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - B K Velthuis
- Department of Radiology (J.W.D., B.K.V.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - A M M Boers
- Departments of Radiology (A.M.M.B., C.B.L.M.M.) Biomedical Engineering and Physics (A.M.M.B.), Academic Medical Center, Amsterdam, the Netherlands
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20
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Santos EMM, Marquering HA, den Blanken MD, Berkhemer OA, Boers AMM, Yoo AJ, Beenen LF, Treurniet KM, Wismans C, van Noort K, Lingsma HF, Dippel DWJ, van der Lugt A, van Zwam WH, Roos YBWEM, van Oostenbrugge RJ, Niessen WJ, Majoie CB. Thrombus Permeability Is Associated With Improved Functional Outcome and Recanalization in Patients With Ischemic Stroke. Stroke 2016; 47:732-41. [PMID: 26846859 DOI: 10.1161/strokeaha.115.011187] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [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: 09/07/2015] [Accepted: 12/15/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Preclinical studies showed that thrombi can be permeable and may, therefore, allow for residual blood flow in occluded arteries of patients having acute ischemic stroke. This perviousness may increase tissue oxygenation, improve thrombus dissolution, and augment intra-arterial treatment success. We hypothesize that the combination of computed tomographic angiography and noncontrast computed tomography imaging allows measurement of contrast agent penetrating a permeable thrombus, and it is associated with improved outcome. METHODS Thrombus and contralateral artery attenuations in noncontrast computed tomography and computed tomographic angiography images were measured in 184 Multicenter Randomized Clinical trial of Endovascular treatment of acute ischemic stroke in the Netherlands (MR CLEAN) patients with thin-slice images. Two quantitative estimators of the thrombus permeability were introduced: computed tomographic angiography attenuation increase (Δ) and thrombus void fraction (ε). Patients were dichotomized as having a pervious or impervious thrombus and associated with outcome, recanalization, and final infarct volume. RESULTS Patients with Δ≥10.9 HU (n=81 [44%]) and ε≥6.5% (n=77 [42%]) were classified as having a pervious thrombus. These patients were 3.2 (95% confidence interval, 1.7-6.4) times more likely to have a favorable outcome, and 2.5 (95% confidence interval, 1.3-4.8) times more likely to recanalyze, for Δ based classification, and similarly for ε. These odds ratios were independent from intravenous or intra-arterial treatment. Final infarct volume was negatively correlated with both perviousness estimates (correlation coefficient, -0.39 for Δ and -0.40 for ε). CONCLUSIONS This study shows that simultaneous measurement of thrombus attenuation in noncontrast computed tomography and computed tomographic angiography allows for quantification of thrombus perviousness. Thrombus perviousness is strongly associated with improved functional outcome, smaller final infarct volume, and higher recanalization rate.
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Affiliation(s)
- Emilie M M Santos
- From the Departments of Radiology (E.M.M.S., H.A.M., O.A.B., A.M.M.B., L.F.B., K.M.T., C.W., K.N., C.B.M.), Biomedical Engineering and Physics (E.M.M.S., H.A.M., M.D.B., A.M.M.B.), and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (E.M.M.S., A.L., W.J.N.), Medical Informatics (E.M.M.S., W.J.N.), Neurology (O.A.B., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Twente, The Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); Departments of Radiology (W.H.Z.) and Neurology (R.J.O.), and Cardiovascular Research Institute Maastricht (W.H.Z., R.J.O.), Maastricht University MC, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands (W.H.Z.); and Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands (W.J.N.).
| | - Henk A Marquering
- From the Departments of Radiology (E.M.M.S., H.A.M., O.A.B., A.M.M.B., L.F.B., K.M.T., C.W., K.N., C.B.M.), Biomedical Engineering and Physics (E.M.M.S., H.A.M., M.D.B., A.M.M.B.), and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (E.M.M.S., A.L., W.J.N.), Medical Informatics (E.M.M.S., W.J.N.), Neurology (O.A.B., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Twente, The Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); Departments of Radiology (W.H.Z.) and Neurology (R.J.O.), and Cardiovascular Research Institute Maastricht (W.H.Z., R.J.O.), Maastricht University MC, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands (W.H.Z.); and Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands (W.J.N.)
| | - Mark D den Blanken
- From the Departments of Radiology (E.M.M.S., H.A.M., O.A.B., A.M.M.B., L.F.B., K.M.T., C.W., K.N., C.B.M.), Biomedical Engineering and Physics (E.M.M.S., H.A.M., M.D.B., A.M.M.B.), and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (E.M.M.S., A.L., W.J.N.), Medical Informatics (E.M.M.S., W.J.N.), Neurology (O.A.B., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Twente, The Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); Departments of Radiology (W.H.Z.) and Neurology (R.J.O.), and Cardiovascular Research Institute Maastricht (W.H.Z., R.J.O.), Maastricht University MC, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands (W.H.Z.); and Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands (W.J.N.)
| | - Olvert A Berkhemer
- From the Departments of Radiology (E.M.M.S., H.A.M., O.A.B., A.M.M.B., L.F.B., K.M.T., C.W., K.N., C.B.M.), Biomedical Engineering and Physics (E.M.M.S., H.A.M., M.D.B., A.M.M.B.), and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (E.M.M.S., A.L., W.J.N.), Medical Informatics (E.M.M.S., W.J.N.), Neurology (O.A.B., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Twente, The Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); Departments of Radiology (W.H.Z.) and Neurology (R.J.O.), and Cardiovascular Research Institute Maastricht (W.H.Z., R.J.O.), Maastricht University MC, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands (W.H.Z.); and Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands (W.J.N.)
| | - Anna M M Boers
- From the Departments of Radiology (E.M.M.S., H.A.M., O.A.B., A.M.M.B., L.F.B., K.M.T., C.W., K.N., C.B.M.), Biomedical Engineering and Physics (E.M.M.S., H.A.M., M.D.B., A.M.M.B.), and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (E.M.M.S., A.L., W.J.N.), Medical Informatics (E.M.M.S., W.J.N.), Neurology (O.A.B., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Twente, The Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); Departments of Radiology (W.H.Z.) and Neurology (R.J.O.), and Cardiovascular Research Institute Maastricht (W.H.Z., R.J.O.), Maastricht University MC, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands (W.H.Z.); and Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands (W.J.N.)
| | - Albert J Yoo
- From the Departments of Radiology (E.M.M.S., H.A.M., O.A.B., A.M.M.B., L.F.B., K.M.T., C.W., K.N., C.B.M.), Biomedical Engineering and Physics (E.M.M.S., H.A.M., M.D.B., A.M.M.B.), and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (E.M.M.S., A.L., W.J.N.), Medical Informatics (E.M.M.S., W.J.N.), Neurology (O.A.B., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Twente, The Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); Departments of Radiology (W.H.Z.) and Neurology (R.J.O.), and Cardiovascular Research Institute Maastricht (W.H.Z., R.J.O.), Maastricht University MC, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands (W.H.Z.); and Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands (W.J.N.)
| | - Ludo F Beenen
- From the Departments of Radiology (E.M.M.S., H.A.M., O.A.B., A.M.M.B., L.F.B., K.M.T., C.W., K.N., C.B.M.), Biomedical Engineering and Physics (E.M.M.S., H.A.M., M.D.B., A.M.M.B.), and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (E.M.M.S., A.L., W.J.N.), Medical Informatics (E.M.M.S., W.J.N.), Neurology (O.A.B., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Twente, The Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); Departments of Radiology (W.H.Z.) and Neurology (R.J.O.), and Cardiovascular Research Institute Maastricht (W.H.Z., R.J.O.), Maastricht University MC, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands (W.H.Z.); and Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands (W.J.N.)
| | - Kilian M Treurniet
- From the Departments of Radiology (E.M.M.S., H.A.M., O.A.B., A.M.M.B., L.F.B., K.M.T., C.W., K.N., C.B.M.), Biomedical Engineering and Physics (E.M.M.S., H.A.M., M.D.B., A.M.M.B.), and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (E.M.M.S., A.L., W.J.N.), Medical Informatics (E.M.M.S., W.J.N.), Neurology (O.A.B., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Twente, The Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); Departments of Radiology (W.H.Z.) and Neurology (R.J.O.), and Cardiovascular Research Institute Maastricht (W.H.Z., R.J.O.), Maastricht University MC, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands (W.H.Z.); and Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands (W.J.N.)
| | - Carrie Wismans
- From the Departments of Radiology (E.M.M.S., H.A.M., O.A.B., A.M.M.B., L.F.B., K.M.T., C.W., K.N., C.B.M.), Biomedical Engineering and Physics (E.M.M.S., H.A.M., M.D.B., A.M.M.B.), and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (E.M.M.S., A.L., W.J.N.), Medical Informatics (E.M.M.S., W.J.N.), Neurology (O.A.B., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Twente, The Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); Departments of Radiology (W.H.Z.) and Neurology (R.J.O.), and Cardiovascular Research Institute Maastricht (W.H.Z., R.J.O.), Maastricht University MC, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands (W.H.Z.); and Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands (W.J.N.)
| | - Kim van Noort
- From the Departments of Radiology (E.M.M.S., H.A.M., O.A.B., A.M.M.B., L.F.B., K.M.T., C.W., K.N., C.B.M.), Biomedical Engineering and Physics (E.M.M.S., H.A.M., M.D.B., A.M.M.B.), and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (E.M.M.S., A.L., W.J.N.), Medical Informatics (E.M.M.S., W.J.N.), Neurology (O.A.B., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Twente, The Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); Departments of Radiology (W.H.Z.) and Neurology (R.J.O.), and Cardiovascular Research Institute Maastricht (W.H.Z., R.J.O.), Maastricht University MC, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands (W.H.Z.); and Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands (W.J.N.)
| | - Hester F Lingsma
- From the Departments of Radiology (E.M.M.S., H.A.M., O.A.B., A.M.M.B., L.F.B., K.M.T., C.W., K.N., C.B.M.), Biomedical Engineering and Physics (E.M.M.S., H.A.M., M.D.B., A.M.M.B.), and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (E.M.M.S., A.L., W.J.N.), Medical Informatics (E.M.M.S., W.J.N.), Neurology (O.A.B., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Twente, The Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); Departments of Radiology (W.H.Z.) and Neurology (R.J.O.), and Cardiovascular Research Institute Maastricht (W.H.Z., R.J.O.), Maastricht University MC, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands (W.H.Z.); and Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands (W.J.N.)
| | - Diederik W J Dippel
- From the Departments of Radiology (E.M.M.S., H.A.M., O.A.B., A.M.M.B., L.F.B., K.M.T., C.W., K.N., C.B.M.), Biomedical Engineering and Physics (E.M.M.S., H.A.M., M.D.B., A.M.M.B.), and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (E.M.M.S., A.L., W.J.N.), Medical Informatics (E.M.M.S., W.J.N.), Neurology (O.A.B., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Twente, The Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); Departments of Radiology (W.H.Z.) and Neurology (R.J.O.), and Cardiovascular Research Institute Maastricht (W.H.Z., R.J.O.), Maastricht University MC, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands (W.H.Z.); and Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands (W.J.N.)
| | - Aad van der Lugt
- From the Departments of Radiology (E.M.M.S., H.A.M., O.A.B., A.M.M.B., L.F.B., K.M.T., C.W., K.N., C.B.M.), Biomedical Engineering and Physics (E.M.M.S., H.A.M., M.D.B., A.M.M.B.), and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (E.M.M.S., A.L., W.J.N.), Medical Informatics (E.M.M.S., W.J.N.), Neurology (O.A.B., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Twente, The Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); Departments of Radiology (W.H.Z.) and Neurology (R.J.O.), and Cardiovascular Research Institute Maastricht (W.H.Z., R.J.O.), Maastricht University MC, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands (W.H.Z.); and Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands (W.J.N.)
| | - Wim H van Zwam
- From the Departments of Radiology (E.M.M.S., H.A.M., O.A.B., A.M.M.B., L.F.B., K.M.T., C.W., K.N., C.B.M.), Biomedical Engineering and Physics (E.M.M.S., H.A.M., M.D.B., A.M.M.B.), and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (E.M.M.S., A.L., W.J.N.), Medical Informatics (E.M.M.S., W.J.N.), Neurology (O.A.B., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Twente, The Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); Departments of Radiology (W.H.Z.) and Neurology (R.J.O.), and Cardiovascular Research Institute Maastricht (W.H.Z., R.J.O.), Maastricht University MC, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands (W.H.Z.); and Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands (W.J.N.)
| | - Yvo B W E M Roos
- From the Departments of Radiology (E.M.M.S., H.A.M., O.A.B., A.M.M.B., L.F.B., K.M.T., C.W., K.N., C.B.M.), Biomedical Engineering and Physics (E.M.M.S., H.A.M., M.D.B., A.M.M.B.), and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (E.M.M.S., A.L., W.J.N.), Medical Informatics (E.M.M.S., W.J.N.), Neurology (O.A.B., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Twente, The Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); Departments of Radiology (W.H.Z.) and Neurology (R.J.O.), and Cardiovascular Research Institute Maastricht (W.H.Z., R.J.O.), Maastricht University MC, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands (W.H.Z.); and Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands (W.J.N.)
| | - Robert J van Oostenbrugge
- From the Departments of Radiology (E.M.M.S., H.A.M., O.A.B., A.M.M.B., L.F.B., K.M.T., C.W., K.N., C.B.M.), Biomedical Engineering and Physics (E.M.M.S., H.A.M., M.D.B., A.M.M.B.), and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (E.M.M.S., A.L., W.J.N.), Medical Informatics (E.M.M.S., W.J.N.), Neurology (O.A.B., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Twente, The Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); Departments of Radiology (W.H.Z.) and Neurology (R.J.O.), and Cardiovascular Research Institute Maastricht (W.H.Z., R.J.O.), Maastricht University MC, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands (W.H.Z.); and Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands (W.J.N.)
| | - Wiro J Niessen
- From the Departments of Radiology (E.M.M.S., H.A.M., O.A.B., A.M.M.B., L.F.B., K.M.T., C.W., K.N., C.B.M.), Biomedical Engineering and Physics (E.M.M.S., H.A.M., M.D.B., A.M.M.B.), and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (E.M.M.S., A.L., W.J.N.), Medical Informatics (E.M.M.S., W.J.N.), Neurology (O.A.B., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Twente, The Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); Departments of Radiology (W.H.Z.) and Neurology (R.J.O.), and Cardiovascular Research Institute Maastricht (W.H.Z., R.J.O.), Maastricht University MC, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands (W.H.Z.); and Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands (W.J.N.)
| | - Charles B Majoie
- From the Departments of Radiology (E.M.M.S., H.A.M., O.A.B., A.M.M.B., L.F.B., K.M.T., C.W., K.N., C.B.M.), Biomedical Engineering and Physics (E.M.M.S., H.A.M., M.D.B., A.M.M.B.), and Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (E.M.M.S., A.L., W.J.N.), Medical Informatics (E.M.M.S., W.J.N.), Neurology (O.A.B., D.W.J.D.), and Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Robotics and Mechatronics, University of Twente, Twente, The Netherlands (A.M.M.B.); Division of Interventional Neuroradiology, Department of Radiology, Texas Stroke Institute, Plano (A.J.Y.); Departments of Radiology (W.H.Z.) and Neurology (R.J.O.), and Cardiovascular Research Institute Maastricht (W.H.Z., R.J.O.), Maastricht University MC, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands (W.H.Z.); and Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands (W.J.N.)
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