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Smaal JA, de Ridder IR, Heshmatollah A, van Zwam WH, Dippel D, Majoie CB, Brown S, Goyal M, Campbell B, Muir KW, Demchuck AM, Davalos A, Jovin TG, Mitchell PJ, White P, Saver JL, Hill MD, Roos YB, van der Lugt A, van Oostenbrugge RJ. Effect of atrial fibrillation on endovascular thrombectomy for acute ischemic stroke. A meta-analysis of individual patient data from six randomised trials: Results from the HERMES collaboration. Eur Stroke J 2020; 5:245-251. [PMID: 33072878 PMCID: PMC7538768 DOI: 10.1177/2396987320923447] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 11/19/2019] [Accepted: 04/03/2020] [Indexed: 12/22/2022] Open
Abstract
Background Atrial fibrillation is an important risk factor for ischemic stroke, and is
associated with an increased risk of poor outcome after ischemic stroke.
Endovascular thrombectomy is safe and effective in acute ischemic stroke
patients with large vessel occlusion of the anterior circulation. This
meta-analysis aims to investigate whether there is an interaction between
atrial fibrillation and treatment effect of endovascular thrombectomy, and
secondarily whether atrial fibrillation is associated with worse outcome in
patients with ischemic stroke due to large vessel occlusion. Methods Individual patient data were from six of the recent randomised clinical
trials (MR CLEAN, EXTEND-IA, REVASCAT, SWIFT PRIME, ESCAPE, PISTE) in which
endovascular thrombectomy plus standard care was compared to standard care
alone. Primary outcome measure was the shift on the modified Rankin scale
(mRS) at 90 days. Secondary outcomes were functional independence (mRS 0–2)
at 90 days, National Institutes of Health Stroke Scale score at 24 h,
symptomatic intracranial hemorrhage and mortality at 90 days. The primary
effect parameter was the adjusted common odds ratio, estimated with ordinal
logistic regression (shift analysis); treatment effect modification of
atrial fibrillation was assessed with a multiplicative interaction term. Results Among 1351 patients, 447 patients had atrial fibrillation, 224 of whom were
treated with endovascular thrombectomy. We found no interaction of atrial
fibrillation with treatment effect of endovascular thrombectomy for both
primary (p-value for interaction: 0.58) and secondary
outcomes. Regardless of treatment allocation, we found no difference in
primary outcome (mRS at 90 days: aOR 1.11 (95% CI 0.89–1.38) and secondary
outcomes between patients with and without atrial fibrillation. Conclusion We found no interaction of atrial fibrillation on treatment effect of
endovascular thrombectomy, and no difference in outcome between large vessel
occlusion stroke patients with and without atrial fibrillation.
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Affiliation(s)
- J A Smaal
- Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - I R de Ridder
- Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - A Heshmatollah
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - W H van Zwam
- Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Dwj Dippel
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - C B Majoie
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands
| | - S Brown
- Altair Biostatistics, St Louis Park, MN, USA
| | - M Goyal
- Department of Radiology, University of Calgary, Foothills Hospital, Calgary, AB, Canada
| | - Bcv Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - K W Muir
- Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, UK
| | - A M Demchuck
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary, AB, Canada
| | - A Davalos
- Department of Neuroscience, University Autònoma de Barcelona, Spain
| | - T G Jovin
- Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - P J Mitchell
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - P White
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - J L Saver
- Department of Neurology, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands
| | - M D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary, AB, Canada
| | - Y B Roos
- Department of Neurology, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands
| | - A van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - R J van Oostenbrugge
- Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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Hilbert A, Ramos LA, van Os HJA, Olabarriaga SD, Tolhuisen ML, Wermer MJH, Barros RS, van der Schaaf I, Dippel D, Roos YBWEM, van Zwam WH, Yoo AJ, Emmer BJ, Lycklama À Nijeholt GJ, Zwinderman AH, Strijkers GJ, Majoie CBLM, Marquering HA. Data-efficient deep learning of radiological image data for outcome prediction after endovascular treatment of patients with acute ischemic stroke. Comput Biol Med 2019; 115:103516. [PMID: 31707199 DOI: 10.1016/j.compbiomed.2019.103516] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 11/15/2022]
Abstract
Treatment selection is becoming increasingly more important in acute ischemic stroke patient care. Clinical variables and radiological image biomarkers (old age, pre-stroke mRS, NIHSS, occlusion location, ASPECTS, among others) have an important role in treatment selection and prognosis. Radiological biomarkers require expert annotation and are subject to inter-observer variability. Recently, Deep Learning has been introduced to reproduce these radiological image biomarkers. Instead of reproducing these biomarkers, in this work, we investigated Deep Learning techniques for building models to directly predict good reperfusion after endovascular treatment (EVT) and good functional outcome using CT angiography images. These models do not require image annotation and are fast to compute. We compare the Deep Learning models to Machine Learning models using traditional radiological image biomarkers. We explored Residual Neural Network (ResNet) architectures, adapted them with Structured Receptive Fields (RFNN) and auto-encoders (AE) for network weight initialization. We further included model visualization techniques to provide insight into the network's decision-making process. We applied the methods on the MR CLEAN Registry dataset with 1301 patients. The Deep Learning models outperformed the models using traditional radiological image biomarkers in three out of four cross-validation folds for functional outcome (average AUC of 0.71) and for all folds for reperfusion (average AUC of 0.65). Model visualization showed that the arteries were relevant features for functional outcome prediction. The best results were obtained for the ResNet models with RFNN. Auto-encoder initialization often improved the results. We concluded that, in our dataset, automated image analysis with Deep Learning methods outperforms radiological image biomarkers for stroke outcome prediction and has the potential to improve treatment selection.
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Affiliation(s)
- A Hilbert
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - L A Ramos
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Clinical Epidemiology and Biostatistics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - H J A van Os
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - S D Olabarriaga
- Department of Clinical Epidemiology and Biostatistics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M L Tolhuisen
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M J H Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - R S Barros
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - I van der Schaaf
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - D Dippel
- Department of Neurology, Erasmus MC - University Medical Center, Rotterdam, the Netherlands
| | - Y B W E M Roos
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - W H van Zwam
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - A J Yoo
- Neurointervention, Texas Stroke Institute, Dallas-Fort Worth, Texas, USA
| | - B J Emmer
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - A H Zwinderman
- Department of Clinical Epidemiology and Biostatistics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - G J Strijkers
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - C B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - H A Marquering
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Sacks D, Baxter B, Campbell BCV, Carpenter JS, Cognard C, Dippel D, Eesa M, Fischer U, Hausegger K, Hirsch JA, Hussain MS, Jansen O, Jayaraman MV, Khalessi AA, Kluck BW, Lavine S, Meyers PM, Ramee S, Rüfenacht DA, Schirmer CM, Vorwerk D. Multisociety Consensus Quality Improvement Revised Consensus Statement for Endovascular Therapy of Acute Ischemic Stroke. AJNR Am J Neuroradiol 2018; 39:E61-E76. [PMID: 29773566 PMCID: PMC7410632 DOI: 10.3174/ajnr.a5638] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- D Sacks
- From the Department of Interventional Radiology (D.S.), The Reading Hospital and Medical Center, West Reading, Pennsylvania
| | - B Baxter
- Department of Radiology (B.B.), Erlanger Medical Center, Chattanooga, Tennessee
| | - B C V Campbell
- Departments of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - J S Carpenter
- Department of Radiology (J.S.C.), West Virginia University, Morgantown, West Virginia
| | - C Cognard
- Department of Diagnostic and Therapeutic Neuroradiology (C.C.), Centre Hospitalier Universitaire de Toulouse, Hôpital Purpan, Toulouse, France
| | - D Dippel
- Department of Neurology (D.D.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M Eesa
- Department of Radiology (M.E.), University of Calgary, Calgary, Alberta, Canada
| | - U Fischer
- Department of Neurology (U.F.), Inselspital-Universitätsspital Bern, Bern, Switzerland
| | - K Hausegger
- Department of Radiology (K.H.), Klagenfurt State Hospital, Klagenfurt am Wörthersee, Austria
| | - J A Hirsch
- Neuroendovascular Program, Department of Radiology (J.A.H.), Massachusetts General Hospital, Boston, Massachusetts
| | - M S Hussain
- Cerebrovascular Center, Neurological Institute (M.S.H.), Cleveland Clinic, Cleveland, Ohio
| | - O Jansen
- Department of Radiology and Neuroradiology (O.J.), Klinik für Radiologie und Neuroradiologie, Kiel, Germany
| | - M V Jayaraman
- Departments of Diagnostic Imaging, Neurology, and Neurosurgery (M.V.J.), Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - A A Khalessi
- Department of Surgery (A.A.K.), University of California San Diego Health, San Diego, California
| | - B W Kluck
- Interventional Cardiology (B.W.K.), Heart Care Group, Allentown, Pennsylvania
| | - S Lavine
- Departments of Neurological Surgery and Radiology (S.L.), Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York
| | - P M Meyers
- Departments of Radiology and Neurological Surgery (P.M.M.), Columbia University College of Physicians and Surgeons, New York, New York
| | - S Ramee
- Interventional Cardiology, Heart and Vascular Institute (S.R.), Ochsner Medical Center, New Orleans, Louisiana
| | - D A Rüfenacht
- Neuroradiology Division (D.A.R.), Swiss Neuro Institute-Clinic Hirslanden, Zürich, Switzerland
| | - C M Schirmer
- Department of Neurosurgery and Neuroscience Center (C.M.S.), Geisinger Health System, Wilkes-Barre, Pennsylvania
| | - D Vorwerk
- Diagnostic and Interventional Radiology Institutes (D.V.), Klinikum Ingolstadt, Ingolstadt, Germany
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de Mos M, Hoorn EJ, Dippel D, van Bommel J. Uremic encephalopathy in critical care: does it exist and does renal replacement therapy improve outcome? Intensive Care Med Exp 2015. [PMCID: PMC4798485 DOI: 10.1186/2197-425x-3-s1-a468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dijkland S, Roozenbeek B, Brouwer P, Lingsma H, Dippel D, Vergouw L, Vergouwen M, Van der Jagt M. Prediction of 60-day case fatality after aneurysmal subarachnoid hemorrhage: external validation of a prediction model. Crit Care 2015. [PMCID: PMC4471511 DOI: 10.1186/cc14547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Majoie C, Berkhemer O, Beumer D, Oostenbrugge RV, Fransen P, Zwam WV, Lugt AVD, Roos Y, Dippel D. E-056 MR CLEAN - Multicentre Randomised Clinical trial of endovascular treatment for acute ischaemic stroke in the Netherlands (NTR1804). J Neurointerv Surg 2013. [DOI: 10.1136/neurintsurg-2013-010870.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hachioui H, Sandt-Koenderman M, Dippel D, Koudstaal P, Visch-Brink E. The ScreeLing: Occurrence of linguistic deficits in acute aphasia post-stroke. J Rehabil Med 2012; 44:429-35. [DOI: 10.2340/16501977-0955] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Van der Worp B, den Hertog H, van Gemert M, Algra A, Dippel D. Paracetamol (Acetaminophen) in stroke trial: results of a randomized, double blind clinical trial. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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