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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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van der Steen W, van der Ende NA, van Kranendonk KR, Chalos V, van Oostenbrugge RJ, van Zwam WH, Roos YB, van Doormaal PJ, van Es AC, Lingsma HF, Majoie CB, van der Lugt A, Dippel DW, Roozenbeek B, Boiten J, Albert Vos J, Jansen IG, Mulder MJ, Goldhoorn RJB, Compagne KC, Kappelhof M, Brouwer J, den Hartog SJ, Emmer BJ, Coutinho JM, Schonewille WJ, Albert Vos J, Wermer MJ, van Walderveen MA, Staals J, 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 PL, van Tuijl J, Peluso JP, Fransen P, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Uyttenboogaart M, Eschgi O, Bokkers RP, Schreuder TH, Heijboer RJ, Keizer K, Yo LS, den Hertog HM, Bulut T, Brouwers PJ, Lycklama GJ, van Walderveen MA, Sprengers ME, Jenniskens SF, van den Berg R, Yoo AJ, Beenen LF, Postma AA, Roosendaal SD, van der Kallen BF, van den Wijngaard IR, Emmer BJ, Martens JM, Yo LS, Vos JA, Bot J, Meijer A, Ghariq E, Bokkers RP, van Proosdij MP, Krietemeijer GM, Peluso JP, Boogaarts HD, Lo R, Dinkelaar W, Auke P, Hammer B, Pegge S, van der Hoorn A, Vinke S, Lycklama à Nijeholt GJ, Boiten J, Vos JA, Hofmeijer J, Martens JM, van der Worp HB, Hofmeijer J, Flach HZ, 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, Geuskens RR, van Straaten T, Ergezen S, Harmsma RR, Muijres D, de Jong A, Berkhemer OA, Boers AM, Huguet J, Groot P, Mens MA, Treurniet KM, Tolhuisen ML, Alves H, Weterings AJ, Kirkels EL, Voogd EJ, Schupp LM, Collette SL, Groot AE, LeCouffe NE, Konduri PR, Prasetya H, Arrarte- Terreros N, Ramos LA, Brown MM, Liebig T, van der Heijden E, Ghannouti N, Fleitour N, Hooijenga I, Puppels C, Pellikaan W, Geerling A, Lindl-Velema A, van Vemde G, de Ridder A, Greebe P, de Bont- Stikkelbroeck J, de Meris J, Haaglanden MC, Janssen K, Licher S, Boodt N, Ros A, Venema E, Slokkers I, Ganpat RJ, Mulder M, Saiedie N, Heshmatollah A, Schipperen S, Vinken S, van Boxtel T, Koets J, Boers M, Santos E, Borst J, Jansen I, Kappelhof M, Lucas M, Geuskens RR, Sales Barros R. Determinants of Symptomatic Intracranial Hemorrhage After Endovascular Stroke Treatment: A Retrospective Cohort Study. Stroke 2022; 53:2818-2827. [PMID: 35674042 PMCID: PMC9389940 DOI: 10.1161/strokeaha.121.036195] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Symptomatic intracranial hemorrhage (sICH) is a serious complication after endovascular treatment for ischemic stroke. We aimed to identify determinants of its occurrence and location.
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Affiliation(s)
- Wouter van der Steen
- Department of Neurology (W.v.d.S., N.A.M.v.d.E., V.C., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine (W.v.d.S., N.A.M.v.d.E., V.C., P.J.v.D., A.v.d.L., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Nadinda A.M. van der Ende
- Department of Neurology (W.v.d.S., N.A.M.v.d.E., V.C., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine (W.v.d.S., N.A.M.v.d.E., V.C., P.J.v.D., A.v.d.L., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Katinka R. van Kranendonk
- Department of Radiology and Nuclear Medicine (K.R.v.K., C.B.L.M.M.), Maastricht University Medical Center, the Netherlands
| | - Vicky Chalos
- Department of Neurology (W.v.d.S., N.A.M.v.d.E., V.C., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine (W.v.d.S., N.A.M.v.d.E., V.C., P.J.v.D., A.v.d.L., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Public Health (V.C., H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Robert J. van Oostenbrugge
- Amsterdam University Medical Center, University of Amsterdam, the Netherlands. Department of Neurology (R.J.v.O.), Maastricht University Medical Center, the Netherlands
| | - Wim H. van Zwam
- Department of Radiology and Nuclear Medicine (W.H.v.Z.), Maastricht University Medical Center, the Netherlands
| | - Yvo B.W.E.M. Roos
- Department of Neurology (Y.B.W.E.M.R.), Maastricht University Medical Center, the Netherlands
| | - Pieter J. van Doormaal
- Department of Radiology and Nuclear Medicine (W.v.d.S., N.A.M.v.d.E., V.C., P.J.v.D., A.v.d.L., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Adriaan C.G.M. van Es
- Department of Radiology, Leiden University Medical Center, the Netherlands (A.C.G.M.v.E.)
| | - Hester F. Lingsma
- Department of Public Health (V.C., H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Charles B.L.M. Majoie
- Department of Radiology and Nuclear Medicine (K.R.v.K., C.B.L.M.M.), Maastricht University Medical Center, the Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine (W.v.d.S., N.A.M.v.d.E., V.C., P.J.v.D., A.v.d.L., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Diederik W.J. Dippel
- Department of Neurology (W.v.d.S., N.A.M.v.d.E., V.C., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Bob Roozenbeek
- Department of Neurology (W.v.d.S., N.A.M.v.d.E., V.C., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine (W.v.d.S., N.A.M.v.d.E., V.C., P.J.v.D., A.v.d.L., B.R.), Erasmus MC University Medical Center, 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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Robba C, van Dijk EJ, van der Jagt M. Acute ischaemic stroke and its challenges for the intensivist. Eur Heart J Acute Cardiovasc Care 2022; 11:258-268. [PMID: 35134852 DOI: 10.1093/ehjacc/zuac004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 06/14/2023]
Abstract
Acute ischaemic stroke (AIS) is responsible for almost 90% of all strokes and is one of the leading causes of death and disability. Acute ischaemic stroke is caused by a critical alteration in focal cerebral blood flow (ischaemia) from a variety of causes, resulting in infarction. The primary cerebral injury due to AIS occurs in the first hours, therefore early reperfusion importantly impacts on patient outcome ('Time is brain' concept). Secondary cerebral damage progressively evolves over the following hours and days due to cerebral oedema, haemorrhagic transformation, and cerebral inflammation. Systemic complications, such as pneumonia, sepsis, and deep venous thrombosis, could also affect outcome. The risk of a recurrent ischaemic stroke is in particular high in the first days, which necessitate particular attention. The role of intensive care unit physicians is therefore to avoid or reduce the risk of secondary damage, especially in the areas where the brain is functionally impaired and 'at risk' of further injury. Therapeutic strategies therefore consist of restoration of blood flow and a bundle of medical, endovascular, and surgical strategies, which-when applied in a timely and consistent manner-can prevent secondary deterioration due to cerebral and systemic complications and recurrent stroke and improve short- and long-term outcomes. A multidisciplinary collaboration between neurosurgeons, interventional radiologists, neurologists, and intensivists is necessary to elaborate the best strategy for the treatment of these patients.
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Affiliation(s)
- Chiara Robba
- Department of Anaesthesia and Intensive Care, Policlinico San Martino, IRCCS for Oncology and Neuroscience, Genova, Italy
- Dipartimento di Scienze Chirurgiche Diagnostiche Integrate, University of Genova, Genova, Italy
| | - Ewoud J van Dijk
- Department of Neurology, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mathieu van der Jagt
- Department of Intensive Care Adults, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
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Linstra KM, van Os HJA, Ruigrok YM, Nederkoorn PJ, van Dijk EJ, Kappelle LJ, Koudstaal PJ, Visser MC, Ferrari MD, MaassenVanDenBrink A, Terwindt GM, Wermer MJH. Sex Differences in Risk Profile, Stroke Cause and Outcome in Ischemic Stroke Patients With and Without Migraine. Front Neurosci 2021; 15:740639. [PMID: 34803586 PMCID: PMC8597840 DOI: 10.3389/fnins.2021.740639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background: An increased risk of stroke in patients with migraine has been primarily found for women. The sex-dependent mechanisms underlying the migraine–stroke association, however, remain unknown. This study aims to explore these sex differences to improve our understanding of pathophysiological mechanisms behind the migraine–stroke association. Methods: We included 2,492 patients with ischemic stroke from the prospective multicenter Dutch Parelsnoer Institute Initiative study, 425 (17%) of whom had a history of migraine. Cardiovascular risk profile, stroke cause (TOAST classification), and outcome [modified Rankin scale (mRS) at 3 months] were compared with both sexes between patients with and without migraine. Results: A history of migraine was not associated with sex differences in the prevalence of conventional cardiovascular risk factors. Women with migraine had an increased risk of stroke at young age (onset < 50 years) compared with women without migraine (RR: 1.7; 95% CI: 1.3–2.3). Men with migraine tended to have more often stroke in the TOAST category other determined etiology (RR: 1.7; 95% CI: 1.0–2.7) in comparison with men without migraine, whereas this increase was not found in women with migraine. Stroke outcome was similar for women with or without migraine (mRS ≥ 3 RR 1.1; 95% CI 0.7–1.5), whereas men seemed to have a higher risk of poor outcome compared with their counterparts without migraine (mRS ≥ 3 RR: 1.5; 95% CI: 1.0–2.1). Conclusion: Our results indicate possible sex differences in the pathophysiology underlying the migraine–stroke association, which are unrelated to conventional cardiovascular risk factors. Further research in larger cohorts is needed to validate these findings.
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Affiliation(s)
- Katie M Linstra
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands.,Division of Pharmacology and Vascular Medicine, Department of Internal Medicine, Erasmus MC, Rotterdam, Netherlands
| | | | - Ynte M Ruigrok
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Ewoud J van Dijk
- Department of Neurology, Radboud University Medical Center, Nijmegen, Netherlands
| | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Peter J Koudstaal
- Department of Neurology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Marieke C Visser
- Department of Neurology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
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van der Ende NAM, Roozenbeek B, Berkhemer OA, Koudstaal PJ, Boiten J, van Dijk EJ, Roos YBWEM, van Oostenbrugge RJ, Majoie CBLM, van Zwam W, Lingsma HF, van der Lugt A, Dippel DWJ. Added Value of a Blinded Outcome Adjudication Committee in an Open-Label Randomized Stroke Trial. Stroke 2021; 53:61-69. [PMID: 34607469 PMCID: PMC8700318 DOI: 10.1161/strokeaha.121.035301] [Citation(s) in RCA: 3] [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] [Indexed: 11/21/2022]
Abstract
Supplemental Digital Content is available in the text. Blinded outcome assessment in trials with prospective randomized open blinded end point design is challenging. Unblinding can result in misclassified outcomes and biased treatment effect estimates. An outcome adjudication committee assures blinded outcome assessment, but the added value for trials with prospective randomized open blinded end point design and subjective outcomes is unknown. We aimed to assess the degree of misclassification of modified Rankin Scale (mRS) scores by a central assessor and its impact on treatment effect estimates in a stroke trial with prospective randomized open blinded end point design.
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Affiliation(s)
- Nadinda A M van der Ende
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands. (N.A.M.v.d.E., B.R., O.A.B., P.J.K., D.W.J.D.).,Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands. (N.A.M.v.d.E., B.R., O.A.B., A.v.d.L.)
| | - Bob Roozenbeek
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands. (N.A.M.v.d.E., B.R., O.A.B., P.J.K., D.W.J.D.).,Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands. (N.A.M.v.d.E., B.R., O.A.B., A.v.d.L.)
| | - Olvert A Berkhemer
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands. (N.A.M.v.d.E., B.R., O.A.B., P.J.K., D.W.J.D.).,Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands. (N.A.M.v.d.E., B.R., O.A.B., A.v.d.L.).,Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, the Netherlands. (O.A.B., C.B.L.M.M.).,Department of Neurology, Amsterdam UMC, University of Amsterdam, the Netherlands. (O.A.B., Y.B.W.E.M.R.)
| | - Peter J Koudstaal
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands. (N.A.M.v.d.E., B.R., O.A.B., P.J.K., D.W.J.D.)
| | - Jelis Boiten
- Department of Neurology, Haaglanden Medical Center, the Hague, the Netherlands (J.B.)
| | - Ewoud J van Dijk
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands (E.J.v.D.)
| | - Yvo B W E M Roos
- Department of Neurology, Amsterdam UMC, University of Amsterdam, the Netherlands. (O.A.B., Y.B.W.E.M.R.)
| | - Robert J van Oostenbrugge
- Department of Neurology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands. (R.J.v.O.)
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, the Netherlands. (O.A.B., C.B.L.M.M.)
| | - Wim van Zwam
- Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands. (W.v.Z.)
| | - Hester F Lingsma
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands. (H.F.L.)
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands. (N.A.M.v.d.E., B.R., O.A.B., A.v.d.L.)
| | - Diederik W J Dippel
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands. (N.A.M.v.d.E., B.R., O.A.B., P.J.K., D.W.J.D.)
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7
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van Leeuwen KG, Meijer FJA, Schalekamp S, Rutten MJCM, van Dijk EJ, van Ginneken B, Govers TM, de Rooij M. Cost-effectiveness of artificial intelligence aided vessel occlusion detection in acute stroke: an early health technology assessment. Insights Imaging 2021; 12:133. [PMID: 34564764 PMCID: PMC8464539 DOI: 10.1186/s13244-021-01077-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022] Open
Abstract
Background Limited evidence is available on the clinical impact of artificial intelligence (AI) in radiology. Early health technology assessment (HTA) is a methodology to assess the potential value of an innovation at an early stage. We use early HTA to evaluate the potential value of AI software in radiology. As a use-case, we evaluate the cost-effectiveness of AI software aiding the detection of intracranial large vessel occlusions (LVO) in stroke in comparison to standard care. We used a Markov based model from a societal perspective of the United Kingdom predominantly using stroke registry data complemented with pooled outcome data from large, randomized trials. Different scenarios were explored by varying missed diagnoses of LVOs, AI costs and AI performance. Other input parameters were varied to demonstrate model robustness. Results were reported in expected incremental costs (IC) and effects (IE) expressed in quality adjusted life years (QALYs). Results Applying the base case assumptions (6% missed diagnoses of LVOs by clinicians, $40 per AI analysis, 50% reduction of missed LVOs by AI), resulted in cost-savings and incremental QALYs over the projected lifetime (IC: − $156, − 0.23%; IE: + 0.01 QALYs, + 0.07%) per suspected ischemic stroke patient. For each yearly cohort of patients in the UK this translates to a total cost saving of $11 million. Conclusions AI tools for LVO detection in emergency care have the potential to improve healthcare outcomes and save costs. We demonstrate how early HTA may be applied for the evaluation of clinically applied AI software for radiology. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-021-01077-4.
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Affiliation(s)
- Kicky G van Leeuwen
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Frederick J A Meijer
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Steven Schalekamp
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Matthieu J C M Rutten
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.,Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Ewoud J van Dijk
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bram van Ginneken
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Tim M Govers
- Department of Operating Rooms, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maarten de Rooij
- Department of Medical Imaging, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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8
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Chu G, Seelig J, Trinks-Roerdink EM, van Alem AP, Alings M, van den Bemt B, Boersma LV, Brouwer MA, Cannegieter SC, Ten Cate H, Kirchhof CJ, Crijns HJ, van Dijk EJ, Elvan A, van Gelder IC, de Groot JR, den Hartog FR, de Jong JS, de Jong S, Klok FA, Lenderink T, Luermans JG, Meeder JG, Pisters R, Polak P, Rienstra M, Smeets F, Tahapary GJ, Theunissen L, Tieleman RG, Trines SA, van der Voort P, Geersing GJ, Rutten FH, Hemels ME, Huisman MV. Design and rationale of DUTCH-AF: a prospective nationwide registry programme and observational study on long-term oral antithrombotic treatment in patients with atrial fibrillation. BMJ Open 2020; 10:e036220. [PMID: 32843516 PMCID: PMC7449286 DOI: 10.1136/bmjopen-2019-036220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Anticoagulation therapy is pivotal in the management of stroke prevention in atrial fibrillation (AF). Prospective registries, containing longitudinal data are lacking with detailed information on anticoagulant therapy, treatment adherence and AF-related adverse events in practice-based patient cohorts, in particular for non-vitamin K oral anticoagulants (NOAC). With the creation of DUTCH-AF, a nationwide longitudinal AF registry, we aim to provide clinical data and answer questions on the (anticoagulant) management over time and of the clinical course of patients with newly diagnosed AF in routine clinical care. Within DUTCH-AF, our current aim is to assess the effect of non-adherence and non-persistence of anticoagulation therapy on clinical adverse events (eg, bleeding and stroke), to determine predictors for such inadequate anticoagulant treatment, and to validate and refine bleeding prediction models. With DUTCH-AF, we provide the basis for a continuing nationwide AF registry, which will facilitate subsequent research, including future registry-based clinical trials. METHODS AND ANALYSIS The DUTCH-AF registry is a nationwide, prospective registry of patients with newly diagnosed 'non-valvular' AF. Patients will be enrolled from primary, secondary and tertiary care practices across the Netherlands. A target of 6000 patients for this initial cohort will be followed for at least 2 years. Data on thromboembolic and bleeding events, changes in antithrombotic therapy and hospital admissions will be registered. Pharmacy-dispensing data will be obtained to calculate parameters of adherence and persistence to anticoagulant treatment, which will be linked to AF-related outcomes such as ischaemic stroke and major bleeding. In a subset of patients, anticoagulation adherence and beliefs about drugs will be assessed by questionnaire. ETHICS AND DISSEMINATION This study protocol was approved as exempt for formal review according to Dutch law by the Medical Ethics Committee of the Leiden University Medical Centre, Leiden, the Netherlands. Results will be disseminated by publications in peer-reviewed journals and presentations at scientific congresses. TRIAL REGISTRATION NUMBER Trial NL7467, NTR7706 (https://www.trialregister.nl/trial/7464).
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Affiliation(s)
- Gordon Chu
- Department of Thrombosis and Hemostasis, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jaap Seelig
- Department of Cardiology, Rijnstate, Arnhem, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Emmy M Trinks-Roerdink
- Department of General Practice, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anouk P van Alem
- Department of Cardiology, Haaglanden Medical Centre, The Hague, The Netherlands
| | - Marco Alings
- Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - Bart van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Lucas Va Boersma
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marc A Brouwer
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Suzanne C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Hugo Ten Cate
- Thrombosis Expert Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Harry Jgm Crijns
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Ewoud J van Dijk
- Deparment of Neurology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Arif Elvan
- Department of Cardiology, Isala Heart Centre, Isala Hospitals, Zwolle, Netherlands
| | - Isabelle C van Gelder
- Department of Cardiology, University Medical Centre Groningen, Groningen, Netherlands
| | - Joris R de Groot
- Department of Cardiology, Heart Centre, Amsterdam University Medical Centre/University of Amsterdam, Amsterdam, Netherlands
| | | | - Jonas Ssg de Jong
- Department of Cardiology, Heart Centre, OLVG, Amsterdam, Netherlands
| | - Sylvie de Jong
- Department of Cardiology, Elkerliek Hospital, Helmond, Netherlands
| | - Frederikus A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Centre, Leiden, The Netherlands
| | - Timo Lenderink
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, Netherlands
| | - Justin G Luermans
- Department of Cardiology, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Joan G Meeder
- Department of Cardiology, VieCuri Medical Centre Noord-Limburg, Venlo, Netherlands
| | - Ron Pisters
- Department of Cardiology, Rijnstate, Arnhem, The Netherlands
| | - Peter Polak
- Department of Cardiology, St. Anna Hospital, Geldrop, Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University Medical Centre Groningen, Groningen, Netherlands
| | - Frans Smeets
- Department of Cardiology, Hospital Bernhoven, Uden, Netherlands
| | | | - Luc Theunissen
- Department of Cardiology, Maxima Medical Centre, Eindhoven, Netherlands
| | | | - Serge A Trines
- Department of Cardiology, Heart-Lung Centre, Leiden University Medical Centre, Leiden, Netherlands
| | | | - Geert-Jan Geersing
- Department of General Practice, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frans H Rutten
- Department of General Practice, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Martin Ew Hemels
- Department of Cardiology, Rijnstate, Arnhem, The Netherlands
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Menno V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Centre, Leiden, The Netherlands
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Compagne KC, Kappelhof M, Goldhoorn RJB, Majoie CB, Roos YB, van Zwam WH, van Oostenbrugge RJ, Boiten J, Lycklama à Nijeholt GJ, den Hertog H, Gerrits D, Sturm EJ, Brouwers PJ, van Walderveen MA, Wermer MJ, Boogaarts HD, van Dijk EJ, van Hasselt BA, Fransen P, de Kort PL, van Tuijl J, Peluso JP, de Bruijn SF, van Dijk LC, Schonewille WJ, Vos JA, Uyttenboogaart M, Bokkers RP, Martens JM, Hofmeijer J, van der Worp B, Lo R, Dippel DW, van der Lugt A. Abstract TMP2: Reduction of Time to Endovascular Treatment and Improved Outcomes After Ischemic Stroke in Routine Clinical Practice: Comparison of the MR CLEAN Registry First and Second Cohorts. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.tmp2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Outcomes after endovascular treatment (EVT) for acute ischemic stroke are highly time dependent, but whether active reduction of time to treatment leads to better outcome has not been demonstrated. We compared data of the two subsequent MR CLEAN Registry cohorts, comprising all patients in the Netherlands who had EVT for acute ischemic stroke from 2014-2017, for a trend in time to treatment and its association with outcome.
Methods:
We compared workflow, successful reperfusion (eTICI 2B-3), NIHSS at 24h, functional outcome (mRS) at 90 days, occurrence of symptomatic intracranial hemorrhage (sICH) and mortality in patients with ischemic stroke and a proximal intracranial occlusion in the anterior circulation included in the second cohort of the Registry (June 2016-November 2017; n = 1779) to those in patients included in the first cohort (March 2014-June 2016; n = 1526) using logistic regression.
Results:
Baseline NIHSS was 16 in both cohorts. Times from onset-to-groin and onset-to-reperfusion were shorter in the second cohort than in the first (185 versus 210 minutes; p<0.01 and 238 versus 270 minutes; p<0.01, respectively) (Figure 1). Successful reperfusion was achieved more often in the second than in the first cohort (72% versus 58%; p<0.01). Rates of sICH and mortality did not differ (5.9% versus 5.7%; p=0.94 and 29% versus 29%; p=0.60). However, follow-up NIHSS was lower (median 10 versus 11; p<0.001) and more patients achieved functional independence at 90 days (42.6% versus 38.9%; p = 0.012) in the second cohort (Figure 1). In a logistic regression model, the difference in good outcome between the two cohorts (aOR 1.27; 95%CI 1.08-1.50) was reduced after additional adjustment for time to reperfusion (aOR 1.15; 95%CI 0.96-1.36) as well as successful reperfusion (aOR 1.16; 95%CI 0.95-1.41).
Discussion:
Our data show that outcomes after EVT in routine clinical practice are improving, likely attributable to improved workflow and experience.
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Affiliation(s)
| | | | | | | | - Yvo B Roos
- Neurology, Amsterdam UMC, UvA, Amsterdam, Netherlands
| | - Wim H van Zwam
- Radiology, Maastricht Univ Med Cntr, Maastricht, Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jo P Peluso
- Elisabeth-TweeSteden Hosp, Tilburg, Netherlands
| | | | | | | | | | | | | | | | | | | | - Rob Lo
- Univ Med Cntr Utrecht, Utrecht, Netherlands
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Dolmans LS, Rutten F, Bartelink MLEL, van Dijk EJ, Nederkoorn PJ, Kappelle J, Hoes AW. Serum biomarkers in patients suspected of transient ischaemic attack in primary care: a diagnostic accuracy study. BMJ Open 2019; 9:e031774. [PMID: 31628130 PMCID: PMC6803126 DOI: 10.1136/bmjopen-2019-031774] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The diagnosis of transient ischaemic attack (TIA) based on symptoms and signs can be challenging and would greatly benefit from a rapid serum biomarker of brain ischaemia. We aimed to quantify the added diagnostic value of serum biomarkers in patients suspected of TIA beyond symptoms and signs. METHODS This is a cross-sectional diagnostic accuracy study with a 6-month follow-up period. Participants were patients suspected of TIA by the general practitioner (GP) in whom a blood sample could be collected within 72 hours from symptom onset. A research nurse visited the participant for the blood sample and a standardised interview. The GP referred participants to the regional TIA service. An expert panel of three neurologists classified cases as TIA, minor stroke or any other diagnosis, based on all available diagnostic information including the GP's and neurologist's correspondence and the follow-up period. We used multivariable logistic regression analyses to quantify the diagnostic accuracy of clinical predictors and the improvement of accuracy by seven biomarkers (NR2, NR2 antibodies, PARK7, NDKA, UFD1, B-FABP and H-FABP). RESULTS 206 patients suspected of TIA participated, of whom 126 (61.2%) were diagnosed with TIA (n=104) or minor stroke (n=22) by the expert panel. The median time from symptom onset to the blood sample collection was 48.0 (IQR 28.3-56.8) hours. None of the seven biomarkers had discriminative value in the diagnosis of TIA, with C-statistics ranging from 0.45 to 0.58. The final multivariable model (C-statistic 0.83 (0.78-0.89)) consisted of eight clinical predictors of TIA/minor stroke: increasing age, a history of coronary artery disease, sudden onset of symptoms, occurrence of symptoms in full intensity, dysarthria, no history of migraine, absence of loss of consciousness and absence of headache. Addition of the individual biomarkers did not further increase the C-statistics. CONCLUSIONS Currently available blood biomarkers have no added diagnostic value in suspected TIA. TRIAL REGISTRATION NUMBER NCT01954329.
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Affiliation(s)
- Louis Servaas Dolmans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frans Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marie-Louise E L Bartelink
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ewoud J van Dijk
- Department of Neurology, Donders Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jaap Kappelle
- Department of Neurology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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11
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Bergkamp MI, Wissink JGJ, van Leijsen EMC, Ghafoorian M, Norris DG, van Dijk EJ, Platel B, Tuladhar AM, de Leeuw FE. Risk of Nursing Home Admission in Cerebral Small Vessel Disease. Stroke 2019; 49:2659-2665. [PMID: 30355195 DOI: 10.1161/strokeaha.118.021993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background and Purpose- Since cerebral small vessel disease (SVD) is associated with cognitive and motor impairment and both might ultimately lead to nursing home admission, our objective was to investigate the association of SVD markers with nursing home admission. Methods- The RUN DMC study (Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort) is a prospective cohort of 503 independent living individuals with SVD. Date of nursing home admission was retrieved from the Dutch municipal personal records database. Risk of nursing home admission was calculated using a competing risk analysis, with mortality as a competing risk. Results- During follow-up (median 8.7 years, interquartile range 8.5-8.9), 31 participants moved to a nursing home. Before nursing home admission, 19 participants were diagnosed with dementia, 6 with parkinsonism, and 10 with stroke. Participants with the lowest white matter volume had an 8-year risk of nursing home admission of 13.3% (95% CI, 8.6-18.9), which was significantly different from participants with middle or highest white matter volume (respectively, 4.8% [95% CI, 2.3-8.8] and 0%; P<0.001). After adjusting for baseline age and living condition, the association of white matter volume and total brain volume with nursing home admission was significant, with, respectively, hazard ratios of 0.88 [95% CI, 0.84-0.95] ( P value 0.025) and 0.92 [95% CI, 0.85-0.98] ( P<0.001) per 10 mL. The association of white matter hyperintensities and lacunes with nursing home admission was not significant. Conclusions- This study demonstrates that in SVD patients, independent from age and living condition, a lower white matter volume and a lower total brain volume is associated with an increased risk of nursing home admission. Nursing home admission is a relevant outcome in SVD research since it might be able to combine both cognitive and functional consequences of SVD in 1 outcome.
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Affiliation(s)
- Mayra I Bergkamp
- From the Department of Neurology, Centre for Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour (M.I.B., J.G.J.W., E.M.C.v.L., E.J.v.D., A.M.T., F.-E.d.L.), Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Joost G J Wissink
- From the Department of Neurology, Centre for Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour (M.I.B., J.G.J.W., E.M.C.v.L., E.J.v.D., A.M.T., F.-E.d.L.), Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Esther M C van Leijsen
- From the Department of Neurology, Centre for Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour (M.I.B., J.G.J.W., E.M.C.v.L., E.J.v.D., A.M.T., F.-E.d.L.), Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Mohsen Ghafoorian
- Department of Radiology and Nuclear Medicine, Diagnostic Image Analysis Group (M.G., B.P.), Radboud University Medical Centre, Nijmegen, the Netherlands.,Institute for Computing and Information Sciences, (M.G.), Radboud University, Nijmegen, the Netherlands
| | - David G Norris
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour (D.G.N.), Radboud University, Nijmegen, the Netherlands.,Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Germany (D.G.N.)
| | - Ewoud J van Dijk
- From the Department of Neurology, Centre for Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour (M.I.B., J.G.J.W., E.M.C.v.L., E.J.v.D., A.M.T., F.-E.d.L.), Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Bram Platel
- Department of Radiology and Nuclear Medicine, Diagnostic Image Analysis Group (M.G., B.P.), Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Anil M Tuladhar
- From the Department of Neurology, Centre for Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour (M.I.B., J.G.J.W., E.M.C.v.L., E.J.v.D., A.M.T., F.-E.d.L.), Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Frank-Erik de Leeuw
- From the Department of Neurology, Centre for Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour (M.I.B., J.G.J.W., E.M.C.v.L., E.J.v.D., A.M.T., F.-E.d.L.), Radboud University Medical Centre, Nijmegen, the Netherlands
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12
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Dolmans LS, Lebedeva ER, Veluponnar D, van Dijk EJ, Nederkoorn PJ, Hoes AW, Rutten FH, Olesen J, Kappelle LJ. Diagnostic Accuracy of the Explicit Diagnostic Criteria for Transient Ischemic Attack: A Validation Study. Stroke 2019; 50:2080-2085. [PMID: 31693449 PMCID: PMC6661246 DOI: 10.1161/strokeaha.119.025626] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— The clinical diagnosis of a transient ischemic attack (TIA) can be difficult. Evidence-based criteria hardly exist. We evaluated if the recently proposed Explicit Diagnostic Criteria for TIA (EDCT), an easy to perform clinical tool focusing on type, duration, and mode of onset of clinical features, would facilitate the clinical diagnosis of TIA. Methods— We used data from patients suspected of a TIA by a general practitioner and referred to a TIA service in the region of Utrecht, the Netherlands, who participated in the MIND-TIA (Markers in the Diagnosis of TIA) study. Information about the clinical features was collected with a standardized questionnaire within 72 hours after onset. A panel of 3 experienced neurologists ultimately determined the definite diagnosis based on all available diagnostic information including a 6-month follow-up period. Two researchers scored the EDCT. Sensitivity, specificity, and predictive values of the EDCT were assessed using the panel diagnosis as reference. A secondary analysis was performed with modified subcriteria of the EDCT. Results— Of the 206 patients, 126 (61%) had a TIA (n=104) or minor stroke (n=22), and 80 (39%) an alternative diagnosis. Most common alternative diagnoses were migraine with aura (n=24; 30.0%), stress related or somatoform symptoms (n=16; 20.0%), and syncope (n=9; 11.3%). The original EDCT had a sensitivity of 98.4% (95% CI, 94.4–99.8) and a specificity of 61.3% (49.7–71.9). Negative and positive predictive values were 96.1% (86.0–99.0) and 80.0% (75.2–84.1), respectively. The modified EDCT showed a higher specificity of 73.8% (62.7–83.0) with the same sensitivity and a similar negative predictive value of 96.7%, but a higher positive predictive value of 85.5% (80.3–89.5). Conclusions— The EDCT has excellent sensitivity and negative predictive value and could be a valuable diagnostic tool for the diagnosis of TIA.
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Affiliation(s)
- L Servaas Dolmans
- From the Julius Center for Health Sciences and Primary Care (L.S.D., D.V., A.W.H., F.H.R.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Elena R Lebedeva
- Department of Neurology, Ural State Medical University, Yekaterinburg, Russia (E.R.L.).,International Headache Center 'Europe-Asia', Yekaterinburg, Russia (E.R.L., J.O.)
| | - Dinusha Veluponnar
- From the Julius Center for Health Sciences and Primary Care (L.S.D., D.V., A.W.H., F.H.R.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Ewoud J van Dijk
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands (E.J.v.D.)
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam UMC, University of Amsterdam, the Netherlands (P.J.N.)
| | - Arno W Hoes
- From the Julius Center for Health Sciences and Primary Care (L.S.D., D.V., A.W.H., F.H.R.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Frans H Rutten
- From the Julius Center for Health Sciences and Primary Care (L.S.D., D.V., A.W.H., F.H.R.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Jes Olesen
- International Headache Center 'Europe-Asia', Yekaterinburg, Russia (E.R.L., J.O.).,Department of Neurology, Danish Headache Center, Rigshospitalet Glostrup, University of Copenhagen, Denmark (J.O.)
| | - L Jaap Kappelle
- Department of Neurology (L.J.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
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Becks MJ, Manniesing R, Vister J, Pegge SA, Steens SC, van Dijk EJ, Prokop M, Meijer FJ. Brain CT perfusion improves intracranial vessel occlusion detection on CT angiography. J Neuroradiol 2019; 46:124-129. [DOI: 10.1016/j.neurad.2018.03.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/18/2018] [Accepted: 03/10/2018] [Indexed: 10/17/2022]
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Volovici V, van Dijk EJ, van der Lugt A, Koudstaal PJ, Vincent AJ. A Modified Encephalo-Duro-Synangiosis Technique Induced Neovascularization in Symptomatic Atherosclerotic Carotid Artery Occlusion: A Phase I trial. World Neurosurg 2019; 124:e176-e181. [PMID: 30615994 DOI: 10.1016/j.wneu.2018.12.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/16/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To the best of our knowledge, the present study is the first to assess the safety and feasibility of a modified encephalo-galeo-duro-synangiosis operation in patients with atherosclerotic carotid artery occlusion. METHODS Eight patients who had experienced new ipsilateral cerebrovascular events after the diagnosis of carotid artery occlusion were recruited. To facilitate extracranial-to-intracranial collateralization, 5 or 6 burr holes were made, and the dura mater and arachnoid were opened. The patients were closely monitored for complications and underwent conventional angiography, magnetic resonance imaging, and perfusion-weighted magnetic resonance imaging at baseline and 1 year of follow-up. After 10 years, the patients who were still alive were interviewed and assessed for functional outcomes and neurological status. RESULTS No surgery-related adverse events were observed, apart from temporary headache and subcutaneous effusion. Four of six patients had developed an extracranial-to-intracranial collateral blood vessels on angiography, and these patients had no incident ischemic events during the follow-up period. During the long-term follow-up period (10 years), 3 patients had died. Of those living, 4 of the 5 patients reported total resolution of the symptoms, with no incident ischemic events. One patient still experienced disability from an ischemic stroke that occurred as a result of the 1-year follow-up angiography. CONCLUSIONS Encephalo-duro-galeo-synangiosis for symptomatic carotid occlusion seems to be safe and feasible and might be able to induce extracranial-to-intracranial collaterals in patients with carotid artery occlusion. Further studies are needed to define the optimal therapeutic window and yield of burr hole surgery in the treatment of symptomatic carotid occlusive disease as an adjuvant to extracranial-intracranial bypass.
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Affiliation(s)
- Victor Volovici
- Department of Neurosurgery, Erasmus University Medical Center, Rotterdam and International Stroke Center, Erasmus, The Netherlands; Department of Public Health, Erasmus University Medical Center, Rotterdam and International Stroke Center, Erasmus, The Netherlands.
| | - Ewoud J van Dijk
- Department of Neurology, Erasmus University Medical Center, Rotterdam and International Stroke Center, Erasmus, The Netherlands; Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Aad van der Lugt
- Department of Radiology, Erasmus University Medical Center, Rotterdam and International Stroke Center, Erasmus, The Netherlands
| | - Peter J Koudstaal
- Department of Public Health, Erasmus University Medical Center, Rotterdam and International Stroke Center, Erasmus, The Netherlands
| | - Arnaud J Vincent
- Department of Neurosurgery, Erasmus University Medical Center, Rotterdam and International Stroke Center, Erasmus, The Netherlands
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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, Lintia-Gaultier A, Wahlgren N, Pouclet-Courtemanche H, Rouaud T, Rouaud Jaffrenou V, Schunck A, Sevin-Allouet M, Toulgoat F, Wiertlewski S, Gauvrit JY, Ronziere T, Cahagne V, van der Heijden E, Ferre JC, Pinel JF, Raoult H, Mas JL, Meder JF, Al Najjar-Carpentier AA, Birchenall J, Bodiguel E, Calvet D, Domigo V, Ghannouti N, Godon-Hardy S, Guiraud V, Lamy C, Majhadi L, Morin L, Naggara O, Trystram D, Turc G, Berge J, Sibon I, Fleitour N, Menegon P, Barreau X, Rouanet F, Debruxelles S, Kazadi A, Renou P, Fleury O, Pasco-Papon A, Dubas F, Caroff J, Hooijenga I, Godard Ducceschi S, Hamon MA, Lecluse A, Marc G, Giroud M, Ricolfi F, Bejot Y, Chavent A, Gentil A, Kazemi A, Puppels C, Osseby GV, Voguet C, Mahagne MH, Sedat J, Chau Y, Suissa L, Lachaud S, Houdart E, Stapf C, Buffon Porcher F, Pellikaan W, Chabriat H, Guedin P, Herve D, Jouvent E, Mawet J, Saint-Maurice JP, Schneble HM, Turjman F, Nighoghossian N, Berhoune NN, Geerling A, Bouhour F, Cho TH, Derex L, Felix S, Gervais-Bernard H, Gory B, Manera L, Mechtouff L, Ritzenthaler T, Riva R, Lindl-Velema A, Salaris Silvio F, Tilikete C, Blanc R, Obadia M, Bartolini MB, Gueguen A, Piotin M, Pistocchi S, Redjem H, Drouineau J, van Vemde G, Neau JP, Godeneche G, Lamy M, Marsac E, Velasco S, Clavelou P, Chabert E, Bourgois N, Cornut-Chauvinc C, Ferrier A, de Ridder A, Gabrillargues J, Jean B, Marques AR, Vitello N, Detante O, Barbieux M, Boubagra K, Favre Wiki I, Garambois K, Tahon F, Greebe P, Ashok V, Voguet C, Coskun O, Guedin P, Rodesch G, Lapergue B, Bourdain F, Evrard S, Graveleau P, Decroix JP, de Bont-Stikkelbroeck J, Wang A, Sellal F, Ahle G, Carelli G, Dugay MH, Gaultier C, Lebedinsky AP, Lita L, Musacchio RM, Renglewicz-Destuynder C, de Meris J, Tournade A, Vuillemet F, Montoro FM, Mounayer C, Faugeras F, Gimenez L, Labach C, Lautrette G, Denier C, Saliou G, Janssen K, Chassin O, Dussaule C, Melki E, Ozanne A, Puccinelli F, Sachet M, Sarov M, Bonneville JF, Moulin T, Biondi A, Struijk W, De Bustos Medeiros E, Vuillier F, Courtheoux P, Viader F, Apoil-Brissard M, Bataille M, Bonnet AL, Cogez J, Kazemi A, Touze E, Licher S, Leclerc X, Leys D, Aggour M, Aguettaz P, Bodenant M, Cordonnier C, Deplanque D, Girot M, Henon H, Kalsoum E, Boodt N, Lucas C, Pruvo JP, Zuniga P, Bonafé A, Arquizan C, Costalat V, Machi P, Mourand I, Riquelme C, Bounolleau P, Ros A, Arteaga C, Faivre A, Bintner M, Tournebize P, Charlin C, Darcel F, Gauthier-Lasalarie P, Jeremenko M, Mouton S, Zerlauth JB, Venema E, Lamy C, Hervé D, Hassan H, Gaston A, Barral FG, Garnier P, Beaujeux R, Wolff V, Herbreteau D, Debiais S, Slokkers I, Murray A, Ford G, Muir KW, White P, Brown MM, Clifton A, Freeman J, Ford I, Markus H, Wardlaw J, Ganpat RJ, Lees KR, Molyneux A, Robinson T, Lewis S, Norrie J, Robertson F, Perry R, Dixit A, Cloud G, Clifton A, Mulder M, Madigan J, Roffe C, Nayak S, Lobotesis K, Smith C, Herwadkar A, Kandasamy N, Goddard T, Bamford J, Subramanian G, Saiedie N, Lenthall R, Littleton E, Lamin S, Storey K, Ghatala R, Banaras A, Aeron-Thomas J, Hazel B, Maguire H, Veraque E, Heshmatollah A, Harrison L, Keshvara R, Cunningham J, Schipperen S, Vinken S, van Boxtel T, Koets J, Boers M, Santos E, Borst J, Jansen I, Kappelhof M, Lucas M, Geuskens R, Barros RS, Dobbe R, Csizmadia M, Hill MD, Goyal M, Demchuk AM, Menon BK, Eesa M, Ryckborst KJ, Wright MR, Kamal NR, Andersen L, Randhawa PA, Stewart T, Patil S, Minhas P, Almekhlafi M, Mishra S, Clement F, Sajobi T, Shuaib A, Montanera WJ, Roy D, Silver FL, Jovin TG, Frei DF, Sapkota B, Rempel JL, Thornton J, Williams D, Tampieri D, Poppe AY, Dowlatshahi D, Wong JH, Mitha AP, Subramaniam S, Hull G, Lowerison MW, Sajobi T, Salluzzi M, Wright MR, Maxwell M, Lacusta S, Drupals E, Armitage K, Barber PA, Smith EE, Morrish WF, Coutts SB, Derdeyn C, Demaerschalk B, Yavagal D, Martin R, Brant R, Yu Y, Willinsky RA, Montanera WJ, Weill A, Kenney C, Aram H, Stewart T, Stys PK, Watson TW, Klein G, Pearson D, Couillard P, Trivedi A, Singh D, Klourfeld E, Imoukhuede O, Nikneshan D, Blayney S, Reddy R, Choi P, Horton M, Musuka T, Dubuc V, Field TS, Desai J, Adatia S, Alseraya A, Nambiar V, van Dijk R, Wong JH, Mitha AP, Morrish WF, Eesa M, Newcommon NJ, Shuaib A, Schwindt B, Butcher KS, Jeerakathil T, Buck B, Khan K, Naik SS, Emery DJ, Owen RJ, Kotylak TB, Ashforth RA, Yeo TA, McNally D, Siddiqui M, Saqqur M, Hussain D, Kalashyan H, Manosalva A, Kate M, Gioia L, Hasan S, Mohammad A, Muratoglu M, Williams D, Thornton J, Cullen A, Brennan P, O'Hare A, Looby S, Hyland D, Duff S, McCusker M, Hallinan B, Lee S, McCormack J, Moore A, O'Connor M, Donegan C, Brewer L, Martin A, Murphy S, O'Rourke K, Smyth S, Kelly P, Lynch T, Daly T, O'Brien P, O'Driscoll A, Martin M, Daly T, Collins R, Coughlan T, McCabe D, Murphy S, O'Neill D, Mulroy M, Lynch O, Walsh T, O'Donnell M, Galvin T, Harbison J, McElwaine P, Mulpeter K, McLoughlin C, Reardon M, Harkin E, Dolan E, Watts M, Cunningham N, Fallon C, Gallagher S, Cotter P, Crowe M, Doyle R, Noone I, Lapierre M, Coté VA, Lanthier S, Odier C, Durocher A, Raymond J, Weill A, Daneault N, Deschaintre Y, Jankowitz B, Baxendell L, Massaro L, Jackson-Graves C, Decesare S, Porter P, Armbruster K, Adams A, Billigan J, Oakley J, Ducruet A, Jadhav A, Giurgiutiu DV, Aghaebrahim A, Reddy V, Hammer M, Starr M, Totoraitis V, Wechsler L, Streib S, Rangaraju S, Campbell D, Rocha M, Gulati D, Silver FL, Krings T, Kalman L, Cayley A, Williams J, Stewart T, Wiegner R, Casaubon LK, Jaigobin C, del Campo JM, Elamin E, Schaafsma JD, Willinsky RA, Agid R, Farb R, ter Brugge K, Sapkoda BL, Baxter BW, Barton K, Knox A, Porter A, Sirelkhatim A, Devlin T, Dellinger C, Pitiyanuvath N, Patterson J, Nichols J, Quarfordt S, Calvert J, Hawk H, Fanale C, Frei DF, Bitner A, Novak A, Huddle D, Bellon R, Loy D, Wagner J, Chang I, Lampe E, Spencer B, Pratt R, Bartt R, Shine S, Dooley G, Nguyen T, Whaley M, McCarthy K, Teitelbaum J, Tampieri D, Poon W, Campbell N, Cortes M, Dowlatshahi D, Lum C, Shamloul R, Robert S, Stotts G, Shamy M, Steffenhagen N, Blacquiere D, Hogan M, AlHazzaa M, Basir G, Lesiuk H, Iancu D, Santos M, Choe H, Weisman DC, Jonczak K, Blue-Schaller A, Shah Q, MacKenzie L, Klein B, Kulandaivel K, Kozak O, Gzesh DJ, Harris LJ, Khoury JS, Mandzia J, Pelz D, Crann S, Fleming L, Hesser K, Beauchamp B, Amato-Marzialli B, Boulton M, Lopez-Ojeda P, Sharma M, Lownie S, Chan R, Swartz R, Howard P, Golob D, Gladstone D, Boyle K, Boulos M, Hopyan J, Yang V, Da Costa L, Holmstedt CA, Turk AS, Navarro R, Jauch E, Ozark S, Turner R, Phillips S, Shankar J, Jarrett J, Gubitz G, Maloney W, Vandorpe R, Schmidt M, Heidenreich J, Hunter G, Kelly M, Whelan R, Peeling L, Burns PA, Hunter A, Wiggam I, Kerr E, Watt M, Fulton A, Gordon P, Rennie I, Flynn P, Smyth G, O'Leary S, Gentile N, Linares G, McNelis P, Erkmen K, Katz P, Azizi A, Weaver M, Jungreis C, Faro S, Shah P, Reimer H, Kalugdan V, Saposnik G, Bharatha A, Li Y, Kostyrko P, Santos M, Marotta T, Montanera W, Sarma D, Selchen D, Spears J, Heo JH, Jeong K, Kim DJ, Kim BM, Kim YD, Song D, Lee KJ, Yoo J, Bang OY, Rho S, Lee J, Jeon P, Kim KH, Cha J, Kim SJ, Ryoo S, Lee MJ, Sohn SI, Kim CH, Ryu HG, Hong JH, Chang HW, Lee CY, Rha J, Davis SM, Donnan GA, Campbell BCV, Mitchell PJ, Churilov L, Yan B, Dowling R, Yassi N, Oxley TJ, Wu TY, Silver G, McDonald A, McCoy R, Kleinig TJ, Scroop R, Dewey HM, Simpson M, Brooks M, Coulton B, Krause M, Harrington TJ, Steinfort B, Faulder K, Priglinger M, Day S, Phan T, Chong W, Holt M, Chandra RV, Ma H, Young D, Wong K, Wijeratne T, Tu H, Mackay E, Celestino S, Bladin CF, Loh PS, Gilligan A, Ross Z, Coote S, Frost T, Parsons MW, Miteff F, Levi CR, Ang T, Spratt N, Kaauwai L, Badve M, Rice H, de Villiers L, Barber PA, McGuinness B, Hope A, Moriarty M, Bennett P, Wong A, Coulthard A, Lee A, Jannes J, Field D, Sharma G, Salinas S, Cowley E, Snow B, Kolbe J, Stark R, King J, Macdonnell R, Attia J, D'Este C, Saver JL, Goyal M, Diener HC, Levy EI, Bonafé A, Mendes Pereira V, Jahan R, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, von Kummer R, Smith W, Turjman F, Hamilton S, Chiacchierini R, Amar A, Sanossian N, Loh Y, Devlin T, Baxter B, Hawk H, Sapkota B, Quarfordt S, Sirelkhatim A, Dellinger C, Barton K, Reddy VK, Ducruet A, Jadhav A, Horev A, Giurgiutiu DV, Totoraitis V, Hammer M, Jankowitz B, Wechsler L, Rocha M, Gulati D, Campbell D, Star M, Baxendell L, Oakley J, Siddiqui A, Hopkins LN, Snyder K, Sawyer R, Hall S, Costalat V, Riquelme C, Machi P, Omer E, Arquizan C, Mourand I, Charif M, Ayrignac X, Menjot de Champfleur N, Leboucq N, Gascou G, Moynier M, du Mesnil de Rochemont R, Singer O, Berkefeld J, Foerch C, Lorenz M, Pfeilschifer W, Hattingen E, Wagner M, You SJ, Lescher S, Braun H, Dehkharghani S, Belagaje SR, Anderson A, Lima A, Obideen M, Haussen D, Dharia R, Frankel M, Patel V, Owada K, Saad A, Amerson L, Horn C, Doppelheuer S, Schindler K, Lopes DK, Chen M, Moftakhar R, Anton C, Smreczak M, Carpenter JS, Boo S, Rai A, Roberts T, Tarabishy A, Gutmann L, Brooks C, Brick J, Domico J, Reimann G, Hinrichs K, Becker M, Heiss E, Selle C, Witteler A, Al-Boutros S, Danch MJ, Ranft A, Rohde S, Burg K, Weimar C, Zegarac V, Hartmann C, Schlamann M, Göricke S, Ringlestein A, Wanke I, Mönninghoff C, Dietzold M, Budzik R, Davis T, Eubank G, Hicks WJ, Pema P, Vora N, Mejilla J, Taylor M, Clark W, Rontal A, Fields J, Peterson B, Nesbit G, Lutsep H, Bozorgchami H, Priest R, Ologuntoye O, Barnwell S, Dogan A, Herrick K, Takahasi C, Beadell N, Brown B, Jamieson S, Hussain MS, Russman A, Hui F, Wisco D, Uchino K, Khawaja Z, Katzan I, Toth G, Cheng-Ching E, Bain M, Man S, Farrag A, George P, John S, Shankar L, Drofa A, Dahlgren R, Bauer A, Itreat A, Taqui A, Cerejo R, Richmond A, Ringleb P, Bendszus M, Möhlenbruch M, Reiff T, Amiri H, Purrucker J, Herweh C, Pham M, Menn O, Ludwig I, Acosta I, Villar C, Morgan W, Sombutmai C, Hellinger F, Allen E, Bellew M, Gandhi R, Bonwit E, Aly J, Ecker RD, Seder D, Morris J, Skaletsky M, Belden J, Baker C, Connolly LS, Papanagiotou P, Roth C, Kastrup A, Politi M, Brunner F, Alexandrou M, Merdivan H, Ramsey C, Given II C, Renfrow S, Deshmukh V, Sasadeusz K, Vincent F, Thiesing JT, Putnam J, Bhatt A, Kansara A, Caceves D, Lowenkopf T, Yanase L, Zurasky J, Dancer S, Freeman B, Scheibe-Mirek T, Robison J, Rontal A, Roll J, Clark D, Rodriguez M, Fitzsimmons BFM, Zaidat O, Lynch JR, Lazzaro M, Larson T, Padmore L, Das E, Farrow-Schmidt A, Hassan A, Tekle W, Cate C, Jansen O, Cnyrim C, Wodarg F, Wiese C, Binder A, Riedel C, Rohr A, Lang N, Laufs H, Krieter S, Remonda L, Diepers M, Añon J, Nedeltchev K, Kahles T, Biethahn S, Lindner M, Chang V, Gächter C, Esperon C, Guglielmetti M, Arenillas Lara JF, Martínez Galdámez M, Calleja Sanz AI, Cortijo Garcia E, Garcia Bermejo P, Perez S, Mulero Carrillo P, Crespo Vallejo E, Ruiz Piñero M, Lopez Mesonero L, Reyes Muñoz FJ, Brekenfeld C, Buhk JH, Krützelmann A, Thomalla G, Cheng B, Beck C, Hoppe J, Goebell E, Holst B, Grzyska U, Wortmann G, Starkman S, Duckwiler G, Jahan R, Rao N, Sheth S, Ng K, Noorian A, Szeder V, Nour M, McManus M, Huang J, Tarpley J, Tateshima S, Gonzalez N, Ali L, Liebeskind D, Hinman J, Calderon-Arnulphi M, Liang C, Guzy J, Koch S, DeSousa K, Gordon-Perue G, Haussen D, Elhammady M, Peterson E, Pandey V, Dharmadhikari S, Khandelwal P, Malik A, Pafford R, Gonzalez P, Ramdas K, Andersen G, Damgaard D, Von Weitzel-Mudersbach P, Simonsen C, Ruiz de Morales Ayudarte N, Poulsen M, Sørensen L, Karabegovich S, Hjørringgaard M, Hjort N, Harbo T, Sørensen K, Deshaies E, Padalino D, Swarnkar A, Latorre JG, Elnour E, El-Zammar Z, Villwock M, Farid H, Balgude A, Cross L, Hansen K, Holtmannspötter M, Kondziella D, Hoejgaard J, Taudorf S, Soendergaard H, Wagner A, Cronquist M, Stavngaard T, Cortsen M, Krarup LH, Hyldal T, Haring HP, Guggenberger S, Hamberger M, Trenkler J, Sonnberger M, Nussbaumer K, Dominger C, Bach E, Jagadeesan BD, Taylor R, Kim J, Shea K, Tummala R, Zacharatos H, Sandhu D, Ezzeddine M, Grande A, Hildebrandt D, Miller K, Scherber J, Hendrickson A, Jumaa M, Zaidi S, Hendrickson T, Snyder V, Killer-Oberpfalzer M, Mutzenbach J, Weymayr F, Broussalis E, Stadler K, Jedlitschka A, Malek A, Mueller-Kronast N, Beck P, Martin C, Summers D, Day J, Bettinger I, Holloway W, Olds K, Arkin S, Akhtar N, Boutwell C, Crandall S, Schwartzman M, Weinstein C, Brion B, Prothmann S, Kleine J, Kreiser K, Boeckh-Behrens T, Poppert H, Wunderlich S, Koch ML, Biberacher V, Huberle A, Gora-Stahlberg G, Knier B, Meindl T, Utpadel-Fischler D. Imaging features and safety and efficacy of endovascular stroke treatment: a meta-analysis of individual patient-level data. Lancet Neurol 2018; 17:895-904. [DOI: 10.1016/s1474-4422(18)30242-4] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/29/2022]
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van Alebeek ME, Arntz RM, Ekker MS, Synhaeve NE, Maaijwee NAMM, Schoonderwaldt H, van der Vlugt MJ, van Dijk EJ, Rutten-Jacobs LCA, de Leeuw FE. Risk factors and mechanisms of stroke in young adults: The FUTURE study. J Cereb Blood Flow Metab 2018; 38:1631-1641. [PMID: 28534705 PMCID: PMC6120122 DOI: 10.1177/0271678x17707138] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/17/2017] [Indexed: 11/16/2022]
Abstract
Incidence of ischemic stroke and transient ischemic attack in young adults is rising. However, etiology remains unknown in 30-40% of these patients when current classification systems designed for the elderly are used. Our aim was to identify risk factors according to a pediatric approach, which might lead to both better identification of risk factors and provide a stepping stone for the understanding of disease mechanism, particularly in patients currently classified as "unknown etiology". Risk factors of 656 young stroke patients (aged 18-50) of the FUTURE study were categorized according to the "International Pediatric Stroke Study" (IPSS), with stratification on gender, age and stroke of "unknown etiology". Categorization of risk factors into ≥1 IPSS category was possible in 94% of young stroke patients. Chronic systemic conditions were more present in patients aged <35 compared to patients ≥35 (32.6% vs. 15.6%, p < 0.05). Among 226 patients classified as "stroke of unknown etiology" using TOAST, we found risk factors in 199 patients (88%) with the IPSS approach. We identified multiple risk factors linked to other mechanisms of stroke in the young than in the elderly . This can be a valuable starting point to develop an etiologic classification system specifically designed for young stroke patients.
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Affiliation(s)
- Mayte E van Alebeek
- Department of Neurology, Center for
Neuroscience, Radboudumc, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, The Netherlands
| | - Renate M Arntz
- Department of Neurology, Center for
Neuroscience, Radboudumc, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, The Netherlands
| | - Merel S Ekker
- Department of Neurology, Center for
Neuroscience, Radboudumc, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, The Netherlands
| | - Nathalie E Synhaeve
- Department of Neurology, Elisabeth
Tweesteden Hospital, PO Box 90151, 5000, LC Tilburg, the Netherlands
| | - Noortje AMM Maaijwee
- Center for Neurology and
Neurorehabilitation, Luzern State Hospital, Luzern, Switzerland
| | - Hennie Schoonderwaldt
- Department of Neurology, Center for
Neuroscience, Radboudumc, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, The Netherlands
| | | | - Ewoud J van Dijk
- Department of Neurology, Center for
Neuroscience, Radboudumc, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, The Netherlands
| | | | - Frank-Erik de Leeuw
- Department of Neurology, Center for
Neuroscience, Radboudumc, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, The Netherlands
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Schellekens MMI, van Alebeek ME, Arntz RM, Synhaeve NE, Maaijwee NAMM, Schoonderwaldt HC, van der Vlugt MJ, van Dijk EJ, Rutten-Jacobs LCA, de Leeuw FE. Prothrombotic factors do not increase the risk of recurrent ischemic events after cryptogenic stroke at young age: the FUTURE study. J Thromb Thrombolysis 2018; 45:504-511. [PMID: 29480382 PMCID: PMC5889776 DOI: 10.1007/s11239-018-1631-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The role of hypercoagulable states and preceding infections in the etiology of young stroke and their role in developing recurrent ischemic events remains unclear. Our aim is to determine the prevalence of these conditions in patients with cryptogenic stroke at young age and to assess the long-term risk of recurrent ischemic events in patients with and without a hypercoagulable state or a recent pre-stroke infection with Borrelia or Syphilis. PATIENTS AND METHODS We prospectively included patients with a first-ever transient ischemic attack or ischemic stroke, aged 18-50, admitted to our hospital between 1995 and 2010. A retrospective analysis was conducted of prothrombotic factors and preceding infections. Outcome was recurrent ischemic events. RESULTS Prevalence of prothrombotic factors did not significantly differ between patients with a cryptogenic stroke and with an identified cause (24/120 (20.0%) and 32/174 (18.4%) respectively). In patients with a cryptogenic stroke the long-term risk [mean follow-up of 8.9 years (SD 4.6)] of any recurrent ischemic event or recurrent cerebral ischemia did not significantly differ between patients with and without a hypercoagulable state or a recent infection. In patients with a cryptogenic stroke 15-years cumulative risk of any recurrent ischemic event was 24 and 23% in patients with and without any prothrombotic factor respectively. CONCLUSIONS The prevalence of prothrombotic factors and preceding infections did not significantly differ between stroke patients with a cryptogenic versus an identified cause of stroke and neither is significantly associated with an increased risk of recurrent ischemic events after cryptogenic stroke.
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Affiliation(s)
- Mijntje M I Schellekens
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, RadboudUMC, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Mayte E van Alebeek
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, RadboudUMC, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Renate M Arntz
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, RadboudUMC, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Nathalie E Synhaeve
- Department of Neurology, Elisabeth Tweesteden Hospital, PO Box 90151, 5000 LC, Tilburg, The Netherlands
| | - Noortje A M M Maaijwee
- Center for Neurology and Neurorehabilitation, Luzern State Hospital, Spitalstrasse 31, 6000, Luzern 16, Switzerland
| | - Hennie C Schoonderwaldt
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, RadboudUMC, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | | | - Ewoud J van Dijk
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, RadboudUMC, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | | | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, RadboudUMC, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
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van Alebeek ME, de Vrijer M, Arntz RM, Maaijwee NA, Synhaeve NE, Schoonderwaldt H, van der Vlugt MJ, van Dijk EJ, de Heus R, Rutten-Jacobs LC, de Leeuw FE. Increased Risk of Pregnancy Complications After Stroke. Stroke 2018; 49:877-883. [DOI: 10.1161/strokeaha.117.019904] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/02/2018] [Accepted: 01/29/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Mayte E. van Alebeek
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Myrthe de Vrijer
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Renate M. Arntz
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Noortje A.M.M. Maaijwee
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Nathalie E. Synhaeve
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Hennie Schoonderwaldt
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Maureen J. van der Vlugt
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Ewoud J. van Dijk
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Roel de Heus
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Loes C.A. Rutten-Jacobs
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Frank-Erik de Leeuw
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
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van Leijsen EMC, Kuiperij HB, Kersten I, Bergkamp MI, van Uden IWM, Vanderstichele H, Stoops E, Claassen JAHR, van Dijk EJ, de Leeuw FE, Verbeek MM. Plasma Aβ (Amyloid-β) Levels and Severity and Progression of Small Vessel Disease. Stroke 2018. [PMID: 29540613 DOI: 10.1161/strokeaha.117.019810] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND PURPOSE Cerebral small vessel disease (SVD) is a frequent pathology in aging and contributor to the development of dementia. Plasma Aβ (amyloid β) levels may be useful as early biomarker, but the role of plasma Aβ in SVD remains to be elucidated. We investigated the association of plasma Aβ levels with severity and progression of SVD markers. METHODS We studied 487 participants from the RUN DMC study (Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Imaging Cohort) of whom 258 participants underwent 3 MRI assessments during 9 years. We determined baseline plasma Aβ38, Aβ40, and Aβ42 levels using ELISAs. We longitudinally assessed volume of white matter hyperintensities semiautomatically and manually rated lacunes and microbleeds. We analyzed associations between plasma Aβ and SVD markers by ANCOVA adjusted for age, sex, and hypertension. RESULTS Cross-sectionally, plasma Aβ40 levels were elevated in participants with microbleeds (mean, 205.4 versus 186.4 pg/mL; P<0.01) and lacunes (mean, 194.8 versus 181.2 pg/mL; P<0.05). Both Aβ38 and Aβ40 were elevated in participants with severe white matter hyperintensities (Aβ38, 25.3 versus 22.7 pg/mL; P<0.01; Aβ40, 201.8 versus 183.3 pg/mL; P<0.05). Longitudinally, plasma Aβ40 levels were elevated in participants with white matter hyperintensity progression (mean, 194.6 versus 182.9 pg/mL; P<0.05). Both Aβ38 and Aβ40 were elevated in participants with incident lacunes (Aβ38, 24.5 versus 22.5 pg/mL; P<0.05; Aβ40, 194.9 versus 181.2 pg/mL; P<0.01) and Aβ42 in participants with incident microbleeds (62.8 versus 60.4 pg/mL; P<0.05). CONCLUSIONS Plasma Aβ levels are associated with both presence and progression of SVD markers, suggesting that Aβ pathology might contribute to the development and progression of SVD. Plasma Aβ levels might thereby serve as inexpensive and noninvasive measure for identifying individuals with increased risk for progression of SVD.
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Affiliation(s)
- Esther M C van Leijsen
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - H Bea Kuiperij
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Iris Kersten
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Mayra I Bergkamp
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Ingeborg W M van Uden
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Hugo Vanderstichele
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Erik Stoops
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Jurgen A H R Claassen
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Ewoud J van Dijk
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Frank-Erik de Leeuw
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.)
| | - Marcel M Verbeek
- From the Department of Neurology (E.M.C.v.L., H.B.K., I.K., M.I.B., I.W.M.v.U., E.J.v.D., F.-E.d.L., M.M.V.), Department of Laboratory Medicine (H.B.K., I.K., M.M.V.), and Department of Geriatric Medicine (J.A.H.R.C.), Donders Institute for Brain, Cognition and Behaviour, Donders Center for Medical Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands; and ADx NeuroSciences, Ghent, Belgium (H.V., E.S.).
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Campbell BCV, van Zwam WH, Goyal M, Menon BK, Dippel DWJ, Demchuk AM, Bracard S, White P, Dávalos A, Majoie CBLM, van der Lugt A, Ford GA, de la Ossa NP, Kelly M, Bourcier R, Donnan GA, Roos YBWEM, Bang OY, Nogueira RG, Devlin TG, van den Berg LA, Clarençon F, Burns P, Carpenter J, Berkhemer OA, Yavagal DR, Pereira VM, Ducrocq X, Dixit A, Quesada H, Epstein J, Davis SM, Jansen O, Rubiera M, Urra X, Micard E, Lingsma HF, Naggara O, Brown S, Guillemin F, Muir KW, van Oostenbrugge RJ, Saver JL, Jovin TG, Hill MD, Mitchell PJ, Berkhemer OA, Fransen PSS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJH, van Walderveen MAA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle J, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van Rooij WJJ, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach Z, Marquering HA, Sprengers ME, Jenniskens SF, Beenen LF, van den Berg R, Koudstaal PJ, van Zwam WH, Roos YB, van der Lugt A, van Oostenbrugge RJ, Wakhloo A, Moonis M, Henninger N, Goddeau R, Massari F, Minaeian A, Lozano JD, Ramzan M, Stout C, Patel A, Majoie CB, Tunguturi A, Onteddu S, Carandang R, Howk M, Ribó M, Sanjuan E, Rubiera M, Pagola J, Flores A, Muchada M, Dippel DW, Meler P, Huerga E, Gelabert S, Coscojuela P, Tomasello A, Rodriguez D, Santamarina E, Maisterra O, Boned S, Seró L, Brown MM, Rovira A, Molina CA, Millán M, Muñoz L, Pérez de la Ossa N, Gomis M, Dorado L, López-Cancio E, Palomeras E, Munuera J, Liebig T, García Bermejo P, Remollo S, Castaño C, García-Sort R, Cuadras P, Puyalto P, Hernández-Pérez M, Jiménez M, Martínez-Piñeiro A, Lucente G, Stijnen T, Dávalos A, Chamorro A, Urra X, Obach V, Cervera A, Amaro S, Llull L, Codas J, Balasa M, Navarro J, Andersson T, Ariño H, Aceituno A, Rudilosso S, Renu A, Macho JM, San Roman L, Blasco J, López A, Macías N, Cardona P, Mattle H, Quesada H, Rubio F, Cano L, Lara B, de Miquel MA, Aja L, Serena J, Cobo E, Albers GW, Lees KR, Wahlgren N, Arenillas J, Roberts R, Minhas P, Al-Ajlan F, Salluzzi M, Zimmel L, Patel S, Eesa M, Martí-Fàbregas J, Jankowitz B, van der Heijden E, Serena J, Salvat-Plana M, López-Cancio E, Bracard S, Ducrocq X, Anxionnat R, Baillot PA, Barbier C, Derelle AL, Lacour JC, Ghannouti N, Richard S, Samson Y, Sourour N, Baronnet-Chauvet F, Clarencon F, Crozier S, Deltour S, Di Maria F, Le Bouc R, Leger A, Fleitour N, Mutlu G, Rosso C, Szatmary Z, Yger M, Zavanone C, Bakchine S, Pierot L, Caucheteux N, Estrade L, Kadziolka K, Hooijenga I, Leautaud A, Renkes C, Serre I, Desal H, Guillon B, Boutoleau-Bretonniere C, Daumas-Duport B, De Gaalon S, Derkinderen P, Evain S, Puppels C, Herisson F, Laplaud DA, Lebouvier T, Lintia-Gaultier A, Pouclet-Courtemanche H, Rouaud T, Rouaud Jaffrenou V, Schunck A, Sevin-Allouet M, Toulgoat F, Pellikaan W, Wiertlewski S, Gauvrit JY, Ronziere T, Cahagne V, Ferre JC, Pinel JF, Raoult H, Mas JL, Meder JF, Al Najjar-Carpentier AA, Geerling A, Birchenall J, Bodiguel E, Calvet D, Domigo V, Godon-Hardy S, Guiraud V, Lamy C, Majhadi L, Morin L, Naggara O, Lindl-Velema A, Trystram D, Turc G, Berge J, Sibon I, Menegon P, Barreau X, Rouanet F, Debruxelles S, Kazadi A, Renou P, van Vemde G, Fleury O, Pasco-Papon A, Dubas F, Caroff J, Godard Ducceschi S, Hamon MA, Lecluse A, Marc G, Giroud M, Ricolfi F, de Ridder A, Bejot Y, Chavent A, Gentil A, Kazemi A, Osseby GV, Voguet C, Mahagne MH, Sedat J, Chau Y, Suissa L, Greebe P, Lachaud S, Houdart E, Stapf C, Buffon Porcher F, Chabriat H, Guedin P, Herve D, Jouvent E, Mawet J, Saint-Maurice JP, de Bont-Stikkelbroeck J, Schneble HM, Turjman F, Nighoghossian N, Berhoune NN, Bouhour F, Cho TH, Derex L, Felix S, Gervais-Bernard H, Gory B, de Meris J, Manera L, Mechtouff L, Ritzenthaler T, Riva R, Salaris Silvio F, 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Leclerc X, Leys D, Aggour M, Aguettaz P, Bodenant M, Cordonnier C, Mulder M, Deplanque D, Girot M, Henon H, Kalsoum E, Lucas C, Pruvo JP, Zuniga P, Bonafé A, Arquizan C, Costalat V, Saiedie N, Machi P, Mourand I, Riquelme C, Bounolleau P, Arteaga C, Faivre A, Bintner M, Tournebize P, Charlin C, Darcel F, Heshmatollah A, Gauthier-Lasalarie P, Jeremenko M, Mouton S, Zerlauth JB, Lamy C, Hervé D, Hassan H, Gaston A, Barral FG, Garnier P, Schipperen S, Beaujeux R, Wolff V, Herbreteau D, Debiais S, Murray A, Ford G, Muir KW, White P, Brown MM, Clifton A, Vinken S, Freeman J, Ford I, Markus H, Wardlaw J, Lees KR, Molyneux A, Robinson T, Lewis S, Norrie J, Robertson F, van Boxtel T, Perry R, Dixit A, Cloud G, Clifton A, Madigan J, Roffe C, Nayak S, Lobotesis K, Smith C, Herwadkar A, Koets J, Kandasamy N, Goddard T, Bamford J, Subramanian G, Lenthall R, Littleton E, Lamin S, Storey K, Ghatala R, Banaras A, Boers M, Aeron-Thomas J, Hazel B, Maguire H, Veraque E, Harrison L, Keshvara R, Cunningham J, Santos E, Borst J, Jansen I, Kappelhof M, Lucas M, Geuskens R, Barros RS, Dobbe R, Csizmadia M, Hill MD, Goyal M, Demchuk AM, Menon BK, Eesa M, Ryckborst KJ, Wright MR, Kamal NR, Andersen L, Randhawa PA, Stewart T, Patil S, Minhas P, Almekhlafi M, Mishra S, Clement F, Sajobi T, Shuaib A, Montanera WJ, Roy D, Silver FL, Jovin TG, Frei DF, Sapkota B, Rempel JL, Thornton J, Williams D, Tampieri D, Poppe AY, Dowlatshahi D, Wong JH, Mitha AP, Subramaniam S, Hull G, Lowerison MW, Sajobi T, Salluzzi M, Wright MR, Maxwell M, Lacusta S, Drupals E, Armitage K, Barber PA, Smith EE, Morrish WF, Coutts SB, Derdeyn C, Demaerschalk B, Yavagal D, Martin R, Brant R, Yu Y, Willinsky RA, Montanera WJ, Weill A, Kenney C, Aram H, Stewart T, Stys PK, Watson TW, Klein G, Pearson D, Couillard P, Trivedi A, Singh D, Klourfeld E, Imoukhuede O, Nikneshan D, Blayney S, Reddy R, Choi P, Horton M, Musuka T, Dubuc V, Field TS, Desai J, Adatia S, Alseraya A, Nambiar V, van Dijk R, Wong JH, Mitha AP, Morrish WF, Eesa M, Newcommon NJ, Shuaib A, Schwindt B, Butcher KS, Jeerakathil T, Buck B, Khan K, Naik SS, Emery DJ, Owen RJ, Kotylak TB, Ashforth RA, Yeo TA, McNally D, Siddiqui M, Saqqur M, Hussain D, Kalashyan H, Manosalva A, Kate M, Gioia L, Hasan S, Mohammad A, Muratoglu M, Williams D, Thornton J, Cullen A, Brennan P, O'Hare A, Looby S, Hyland D, Duff S, McCusker M, Hallinan B, Lee S, McCormack J, Moore A, O'Connor M, Donegan C, Brewer L, Martin A, Murphy S, O'Rourke K, Smyth S, Kelly P, Lynch T, Daly T, O'Brien P, O'Driscoll A, Martin M, Daly T, Collins R, Coughlan T, McCabe D, Murphy S, O'Neill D, Mulroy M, Lynch O, Walsh T, O'Donnell M, Galvin T, Harbison J, McElwaine P, Mulpeter K, McLoughlin C, Reardon M, Harkin E, Dolan E, Watts M, Cunningham N, Fallon C, Gallagher S, Cotter P, Crowe M, Doyle R, Noone I, Lapierre M, Coté VA, Lanthier S, Odier C, Durocher A, Raymond J, Weill A, Daneault N, Deschaintre Y, Jankowitz B, Baxendell L, Massaro L, Jackson-Graves C, Decesare S, Porter P, Armbruster K, Adams A, Billigan J, Oakley J, Ducruet A, Jadhav A, Giurgiutiu DV, Aghaebrahim A, Reddy V, Hammer M, Starr M, Totoraitis V, Wechsler L, Streib S, Rangaraju S, Campbell D, Rocha M, Gulati D, Silver FL, Krings T, Kalman L, Cayley A, Williams J, Stewart T, Wiegner R, Casaubon LK, Jaigobin C, del Campo JM, Elamin E, Schaafsma JD, Willinsky RA, Agid R, Farb R, ter Brugge K, Sapkoda BL, Baxter BW, Barton K, Knox A, Porter A, Sirelkhatim A, Devlin T, Dellinger C, Pitiyanuvath N, Patterson J, Nichols J, Quarfordt S, Calvert J, Hawk H, Fanale C, Frei DF, Bitner A, Novak A, Huddle D, Bellon R, Loy D, Wagner J, Chang I, Lampe E, Spencer B, Pratt R, Bartt R, Shine S, Dooley G, Nguyen T, Whaley M, McCarthy K, Teitelbaum J, Tampieri D, Poon W, Campbell N, Cortes M, Dowlatshahi D, Lum C, Shamloul R, Robert S, Stotts G, Shamy M, Steffenhagen N, Blacquiere D, Hogan M, AlHazzaa M, Basir G, Lesiuk H, Iancu D, Santos M, Choe H, Weisman DC, Jonczak K, Blue-Schaller A, Shah Q, MacKenzie L, Klein B, Kulandaivel K, Kozak O, Gzesh DJ, Harris LJ, Khoury JS, Mandzia J, Pelz D, Crann S, Fleming L, Hesser K, Beauchamp B, Amato-Marzialli B, Boulton M, Lopez- Ojeda P, Sharma M, Lownie S, Chan R, Swartz R, Howard P, Golob D, Gladstone D, Boyle K, Boulos M, Hopyan J, Yang V, Da Costa L, Holmstedt CA, Turk AS, Navarro R, Jauch E, Ozark S, Turner R, Phillips S, Shankar J, Jarrett J, Gubitz G, Maloney W, Vandorpe R, Schmidt M, Heidenreich J, Hunter G, Kelly M, Whelan R, Peeling L, Burns PA, Hunter A, Wiggam I, Kerr E, Watt M, Fulton A, Gordon P, Rennie I, Flynn P, Smyth G, O'Leary S, Gentile N, Linares G, McNelis P, Erkmen K, Katz P, Azizi A, Weaver M, Jungreis C, Faro S, Shah P, Reimer H, Kalugdan V, Saposnik G, Bharatha A, Li Y, Kostyrko P, Santos M, Marotta T, Montanera W, Sarma D, Selchen D, Spears J, Heo JH, Jeong K, Kim DJ, Kim BM, Kim YD, Song D, Lee KJ, Yoo J, Bang OY, Rho S, Lee J, Jeon P, Kim KH, Cha J, Kim SJ, Ryoo S, Lee MJ, Sohn SI, Kim CH, Ryu HG, Hong JH, Chang HW, Lee CY, Rha J, Davis SM, Donnan GA, Campbell BCV, Mitchell PJ, Churilov L, Yan B, Dowling R, Yassi N, Oxley TJ, Wu TY, Silver G, McDonald A, McCoy R, Kleinig TJ, Scroop R, Dewey HM, Simpson M, Brooks M, Coulton B, Krause M, Harrington TJ, Steinfort B, Faulder K, Priglinger M, Day S, Phan T, Chong W, Holt M, Chandra RV, Ma H, Young D, Wong K, Wijeratne T, Tu H, Mackay E, Celestino S, Bladin CF, Loh PS, Gilligan A, Ross Z, Coote S, Frost T, Parsons MW, Miteff F, Levi CR, Ang T, Spratt N, Kaauwai L, Badve M, Rice H, de Villiers L, Barber PA, McGuinness B, Hope A, Moriarty M, Bennett P, Wong A, Coulthard A, Lee A, Jannes J, Field D, Sharma G, Salinas S, Cowley E, Snow B, Kolbe J, Stark R, King J, Macdonnell R, Attia J, D'Este C, Saver JL, Goyal M, Diener HC, Levy EI, Bonafé A, Mendes Pereira V, Jahan R, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, von Kummer R, Smith W, Turjman F, Hamilton S, Chiacchierini R, Amar A, Sanossian N, Loh Y, Devlin T, Baxter B, Hawk H, Sapkota B, Quarfordt S, Sirelkhatim A, Dellinger C, Barton K, Reddy VK, Ducruet A, Jadhav A, Horev A, Giurgiutiu DV, Totoraitis V, Hammer M, Jankowitz B, Wechsler L, Rocha M, Gulati D, Campbell D, Star M, Baxendell L, Oakley J, Siddiqui A, Hopkins LN, Snyder K, Sawyer R, Hall S, Costalat V, Riquelme C, Machi P, Omer E, Arquizan C, Mourand I, Charif M, Ayrignac X, Menjot de Champfleur N, Leboucq N, Gascou G, Moynier M, du Mesnil de Rochemont R, Singer O, Berkefeld J, Foerch C, Lorenz M, Pfeilschifer W, Hattingen E, Wagner M, You SJ, Lescher S, Braun H, Dehkharghani S, Belagaje SR, Anderson A, Lima A, Obideen M, Haussen D, Dharia R, Frankel M, Patel V, Owada K, Saad A, Amerson L, Horn C, Doppelheuer S, Schindler K, Lopes DK, Chen M, Moftakhar R, Anton C, Smreczak M, Carpenter JS, Boo S, Rai A, Roberts T, Tarabishy A, Gutmann L, Brooks C, Brick J, Domico J, Reimann G, Hinrichs K, Becker M, Heiss E, Selle C, Witteler A, Al-Boutros S, Danch MJ, Ranft A, Rohde S, Burg K, Weimar C, Zegarac V, Hartmann C, Schlamann M, Göricke S, Ringlestein A, Wanke I, Mönninghoff C, Dietzold M, Budzik R, Davis T, Eubank G, Hicks WJ, Pema P, Vora N, Mejilla J, Taylor M, Clark W, Rontal A, Fields J, Peterson B, Nesbit G, Lutsep H, Bozorgchami H, Priest R, Ologuntoye O, Barnwell S, Dogan A, Herrick K, Takahasi C, Beadell N, Brown B, Jamieson S, Hussain MS, Russman A, Hui F, Wisco D, Uchino K, Khawaja Z, Katzan I, Toth G, Cheng-Ching E, Bain M, Man S, Farrag A, George P, John S, Shankar L, Drofa A, Dahlgren R, Bauer A, Itreat A, Taqui A, Cerejo R, Richmond A, Ringleb P, Bendszus M, Möhlenbruch M, Reiff T, Amiri H, Purrucker J, Herweh C, Pham M, Menn O, Ludwig I, Acosta I, Villar C, Morgan W, Sombutmai C, Hellinger F, Allen E, Bellew M, Gandhi R, Bonwit E, Aly J, Ecker RD, Seder D, Morris J, Skaletsky M, Belden J, Baker C, Connolly LS, Papanagiotou P, Roth C, Kastrup A, Politi M, Brunner F, Alexandrou M, Merdivan H, Ramsey C, Given II C, Renfrow S, Deshmukh V, Sasadeusz K, Vincent F, Thiesing JT, Putnam J, Bhatt A, Kansara A, Caceves D, Lowenkopf T, Yanase L, Zurasky J, Dancer S, Freeman B, Scheibe-Mirek T, Robison J, Rontal A, Roll J, Clark D, Rodriguez M, Fitzsimmons BFM, Zaidat O, Lynch JR, Lazzaro M, Larson T, Padmore L, Das E, Farrow-Schmidt A, Hassan A, Tekle W, Cate C, Jansen O, Cnyrim C, Wodarg F, Wiese C, Binder A, Riedel C, Rohr A, Lang N, Laufs H, Krieter S, Remonda L, Diepers M, Añon J, Nedeltchev K, Kahles T, Biethahn S, Lindner M, Chang V, Gächter C, Esperon C, Guglielmetti M, Arenillas Lara JF, Martínez Galdámez M, Calleja Sanz AI, Cortijo Garcia E, Garcia Bermejo P, Perez S, Mulero Carrillo P, Crespo Vallejo E, Ruiz Piñero M, Lopez Mesonero L, Reyes Muñoz FJ, Brekenfeld C, Buhk JH, Krützelmann A, Thomalla G, Cheng B, Beck C, Hoppe J, Goebell E, Holst B, Grzyska U, Wortmann G, Starkman S, Duckwiler G, Jahan R, Rao N, Sheth S, Ng K, Noorian A, Szeder V, Nour M, McManus M, Huang J, Tarpley J, Tateshima S, Gonzalez N, Ali L, Liebeskind D, Hinman J, Calderon-Arnulphi M, Liang C, Guzy J, Koch S, DeSousa K, Gordon-Perue G, Haussen D, Elhammady M, Peterson E, Pandey V, Dharmadhikari S, Khandelwal P, Malik A, Pafford R, Gonzalez P, Ramdas K, Andersen G, Damgaard D, Von Weitzel-Mudersbach P, Simonsen C, Ruiz de Morales Ayudarte N, Poulsen M, Sørensen L, Karabegovich S, Hjørringgaard M, Hjort N, Harbo T, Sørensen K, Deshaies E, Padalino D, Swarnkar A, Latorre JG, Elnour E, El-Zammar Z, Villwock M, Farid H, Balgude A, Cross L, Hansen K, Holtmannspötter M, Kondziella D, Hoejgaard J, Taudorf S, Soendergaard H, Wagner A, Cronquist M, Stavngaard T, Cortsen M, Krarup LH, Hyldal T, Haring HP, Guggenberger S, Hamberger M, Trenkler J, Sonnberger M, Nussbaumer K, Dominger C, Bach E, Jagadeesan BD, Taylor R, Kim J, Shea K, Tummala R, Zacharatos H, Sandhu D, Ezzeddine M, Grande A, Hildebrandt D, Miller K, Scherber J, Hendrickson A, Jumaa M, Zaidi S, Hendrickson T, Snyder V, Killer-Oberpfalzer M, Mutzenbach J, Weymayr F, Broussalis E, Stadler K, Jedlitschka A, Malek A, Mueller-Kronast N, Beck P, Martin C, Summers D, Day J, Bettinger I, Holloway W, Olds K, Arkin S, Akhtar N, Boutwell C, Crandall S, Schwartzman M, Weinstein C, Brion B, Prothmann S, Kleine J, Kreiser K, Boeckh-Behrens T, Poppert H, Wunderlich S, Koch ML, Biberacher V, Huberle A, Gora-Stahlberg G, Knier B, Meindl T, Utpadel-Fischler D, Zech M, Kowarik M, Seifert C, Schwaiger B, Puri A, Hou S. Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data. Lancet Neurol 2018; 17:47-53. [DOI: 10.1016/s1474-4422(17)30407-6] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/05/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
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Meijs M, Patel A, van de Leemput SC, Prokop M, van Dijk EJ, de Leeuw FE, Meijer FJA, van Ginneken B, Manniesing R. Robust Segmentation of the Full Cerebral Vasculature in 4D CT of Suspected Stroke Patients. Sci Rep 2017; 7:15622. [PMID: 29142240 PMCID: PMC5688074 DOI: 10.1038/s41598-017-15617-w] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 10/31/2017] [Indexed: 11/13/2022] Open
Abstract
A robust method is presented for the segmentation of the full cerebral vasculature in 4-dimensional (4D) computed tomography (CT). The method consists of candidate vessel selection, feature extraction, random forest classification and postprocessing. Image features include among others the weighted temporal variance image and parameters, including entropy, of an intensity histogram in a local region at different scales. These histogram parameters revealed to be a strong feature in the detection of vessels regardless of shape and size. The method was trained and tested on a large database of 264 patients with suspicion of acute ischemia who underwent 4D CT in our hospital in the period January 2014 to December 2015. Five subvolumes representing different regions of the cerebral vasculature were annotated in each image in the training set by medical assistants. The evaluation was done on 242 patients. A total of 16 (<8%) patients showed severe under or over segmentation and were reported as failures. One out of five subvolumes was randomly annotated in 159 patients and was used for quantitative evaluation. Quantitative evaluation showed a Dice coefficient of 0.91 ± 0.07 and a modified Hausdorff distance of 0.23 ± 0.22 mm. Therefore, robust vessel segmentation in 4D CT is feasible with good accuracy.
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Affiliation(s)
- Midas Meijs
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525GA, Nijmegen, The Netherlands.
| | - Ajay Patel
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525GA, Nijmegen, The Netherlands
| | - Sil C van de Leemput
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525GA, Nijmegen, The Netherlands
| | - Mathias Prokop
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525GA, Nijmegen, The Netherlands
| | - Ewoud J van Dijk
- Department of Neurology, Radboud University Medical Center, Geert Grooteplein 10, 6525GA, Nijmegen, The Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Radboud University Medical Center, Geert Grooteplein 10, 6525GA, Nijmegen, The Netherlands
| | - Frederick J A Meijer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525GA, Nijmegen, The Netherlands
| | - Bram van Ginneken
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525GA, Nijmegen, The Netherlands
| | - Rashindra Manniesing
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525GA, Nijmegen, The Netherlands
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van Rooij FG, Kessels RPC, Richard E, De Leeuw FE, van Dijk EJ. Cognitive Impairment in Transient Ischemic Attack Patients: A Systematic Review. Cerebrovasc Dis 2017; 42:1-9. [PMID: 26886189 DOI: 10.1159/000444282] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/05/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although by definition a transient ischemic attack (TIA) lasts less than 24 h, many patients experience cognitive complaints beyond focal symptom resolution. However, their prevalence, causes and profile are unclear. We therefore performed a systematic review on cognitive impairment after TIA. SUMMARY Medline and Embase were searched for relevant studies. Risk of bias was assessed, and data synthesis was performed according to the severity of cognitive impairment. Thirteen studies were included, with considerable heterogeneity concerning methods and timing of cognitive testing. Confounding, detection bias and attrition were the main causes of a high risk of bias in several studies. The prevalence of post-TIA mild cognitive impairment ranged from 29 to 68%. Severe cognitive impairment was found in 8-22% of patients. Studies using a cognitive screening instrument and those performed shortly after TIA or several years later, reported the highest frequencies of impairment. Patients evaluated with a screening tool were substantially older than those who underwent a full neuropsychological assessment (weighted mean age difference 10.9 years). Based on limited data, the post-TIA cognitive profile showed prominent executive function deficits. Insufficient data refrained us from drawing conclusions on causality. The few studies that reported neuroimaging results found a minor correlation with cognitive impairment. KEY MESSAGES Mild cognitive impairment is present in more than a third of the TIA patients and has a profile comparable with vascular cognitive impairment. Reported rates of post-TIA cognitive impairment are highly variable and higher frequencies are found with cognitive screening tools. Considerable heterogeneity and insufficient data limit further conclusions about potential causative factors.
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Affiliation(s)
- Frank G van Rooij
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
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23
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van Leijsen EMC, van Uden IWM, Ghafoorian M, Bergkamp MI, Lohner V, Kooijmans ECM, van der Holst HM, Tuladhar AM, Norris DG, van Dijk EJ, Rutten-Jacobs LCA, Platel B, Klijn CJM, de Leeuw FE. Nonlinear temporal dynamics of cerebral small vessel disease: The RUN DMC study. Neurology 2017; 89:1569-1577. [PMID: 28878046 PMCID: PMC5634663 DOI: 10.1212/wnl.0000000000004490] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 07/10/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the temporal dynamics of cerebral small vessel disease (SVD) by 3 consecutive assessments over a period of 9 years, distinguishing progression from regression. METHODS Changes in SVD markers of 276 participants of the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Imaging Cohort (RUN DMC) cohort were assessed at 3 time points over 9 years. We assessed white matter hyperintensities (WMH) volume by semiautomatic segmentation and rated lacunes and microbleeds manually. We categorized baseline WMH severity as mild, moderate, or severe according to the modified Fazekas scale. We performed mixed-effects regression analysis including a quadratic term for increasing age. RESULTS Mean WMH progression over 9 years was 4.7 mL (0.54 mL/y; interquartile range 0.95-5.5 mL), 20.3% of patients had incident lacunes (2.3%/y), and 18.9% had incident microbleeds (2.2%/y). WMH volume declined in 9.4% of the participants during the first follow-up interval, but only for 1 participant (0.4%) throughout the whole follow-up. Lacunes disappeared in 3.6% and microbleeds in 5.7% of the participants. WMH progression accelerated over time: including a quadratic term for increasing age during follow-up significantly improved the model (p < 0.001). SVD progression was predominantly seen in participants with moderate to severe WMH at baseline compared to those with mild WMH (odds ratio [OR] 35.5, 95% confidence interval [CI] 15.8-80.0, p < 0.001 for WMH progression; OR 5.7, 95% CI 2.8-11.2, p < 0.001 for incident lacunes; and OR 2.9, 95% CI 1.4-5.9, p = 0.003 for incident microbleeds). CONCLUSIONS SVD progression is nonlinear, accelerating over time, and a highly dynamic process, with progression interrupted by reduction in some, in a population that on average shows progression.
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Affiliation(s)
- Esther M C van Leijsen
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany
| | - Ingeborg W M van Uden
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany
| | - Mohsen Ghafoorian
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany
| | - Mayra I Bergkamp
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany
| | - Valerie Lohner
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany
| | - Eline C M Kooijmans
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany
| | - Helena M van der Holst
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany
| | - Anil M Tuladhar
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany
| | - David G Norris
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany
| | - Ewoud J van Dijk
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany
| | - Loes C A Rutten-Jacobs
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany
| | - Bram Platel
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany
| | - Catharina J M Klijn
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany
| | - Frank-Erik de Leeuw
- From the Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroscience, Department of Neurology (E.M.C.v.L., I.W.M.v.U., M.I.B., V.L., E.C.M.K., H.M.v.d.H., A.M.T., E.J.v.D., C.J.M.K., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Centre; Institute for Computing and Information Sciences (M.G.) and Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging (D.G.N.), Radboud University, Nijmegen, the Netherlands; Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK; and Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), University of Duisburg-Essen, Essen, Germany.
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24
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Mulder MJ, Ergezen S, Lingsma HF, Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lycklama à Nijeholt G, Emmer BJ, van der Worp HB, Nederkoorn PJ, Roos YB, van Oostenbrugge RJ, van Zwam WH, Majoie CB, van der Lugt A, Dippel DW, Schonewille WJ, Vos JA, Wermer MJ, van Walderveen MA, Staals J, Hofmeijer J, van Oostayen JA, Boiten J, Brouwer PA, de Bruijn SF, van Dijk LC, Kappelle LJ, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van den Berg JS, van Rooij WJJ, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, van Walderveen MA, Bot JC, Marquering HA, Beenen LF, Sprengers ME, Jenniskens SF, van den Berg R, Yoo AJ, Koudstaal PJ, Boiten J, van Dijk EJ, Wermer MJ, Flach HZ, Steyerberg EW. Baseline Blood Pressure Effect on the Benefit and Safety of Intra-Arterial Treatment in MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands). Stroke 2017; 48:1869-1876. [DOI: 10.1161/strokeaha.116.016225] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 02/23/2017] [Accepted: 03/01/2017] [Indexed: 12/21/2022]
Abstract
Background and Purpose—
High blood pressure (BP) is associated with poor outcome and the occurrence of symptomatic intracranial hemorrhage in acute ischemic stroke. Whether BP influences the benefit or safety of intra-arterial treatment (IAT) is not known. We aimed to assess the relation of BP with functional outcome, occurrence of symptomatic intracranial hemorrhage and effect of IAT.
Methods—
This is a post hoc analysis of the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands). BP was measured at baseline, before IAT or stroke unit admission. We estimated the association of baseline BP with the score on the modified Rankin Scale at 90 days and safety parameters with ordinal and logistic regression analysis. Effect of BP on the effect of IAT was tested with multiplicative interaction terms.
Results—
Systolic BP (SBP) had the best correlation with functional outcome. This correlation was U-shaped; both low and high baseline SBP were associated with poor functional outcome. Higher SBP was associated with symptomatic intracranial hemorrhage (adjusted odds ratio, 1.25 for every 10 mm Hg higher SBP [95% confidence interval, 1.09–1.44]). Between SBP and IAT, there was no interaction for functional outcome, symptomatic intracranial hemorrhage, or other safety parameters; the absolute benefit of IAT was evident for the whole SBP range. The same was found for diastolic BP.
Conclusions—
BP does not affect the benefit or safety of IAT in patients with acute ischemic stroke caused by proximal intracranial vessel occlusion. Our data provide no arguments to withhold or delay IAT based on BP.
Clinical Trial Registration—
URL:
http://www.isrctn.com
. Unique identifier: ISRCTN10888758.
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Affiliation(s)
- Maxim J.H.L. Mulder
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Saliha Ergezen
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Hester F. Lingsma
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Olvert A. Berkhemer
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Puck S.S. Fransen
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Debbie Beumer
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Lucie A. van den Berg
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Geert Lycklama à Nijeholt
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Bart J. Emmer
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - H. Bart van der Worp
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Paul J. Nederkoorn
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Yvo B.W.E.M. Roos
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Robert J. van Oostenbrugge
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Wim H. van Zwam
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Charles B.L.M. Majoie
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Aad van der Lugt
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | - Diederik W.J. Dippel
- From the Department of Neurology, (M.J.H.L.M., S.E., O.A.B., P.S.S.F., D.W.J.D.), Department of Radiology (M.J.H.L.M., B.J.E., A.v.d.L.), and Department of Public Health (H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology (L.A.v.d.B., P.J.N., Y.B.W.E.M.R.) and Department of Radiology (O.A.B., C.B.L.M.M.), Academic Medical Center, Amsterdam, the Netherlands; Department of Neurology (D.B., R.J.v.O.) and Department of Radiology (O.A.B., W.H.v.Z.),
| | | | - Jan Albert Vos
- Radiology, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | | | | | - Julie Staals
- Department of Neurology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), the Netherlands
| | | | | | - Jelis Boiten
- Neurology, MC Haaglanden, the Hague, the Netherlands
| | | | | | | | - L. Jaap Kappelle
- Department of Neurology, University Medical Center Utrecht, the Netherlands
| | - Rob H. Lo
- Radiology, University Medical Center Utrecht, the Netherlands
| | - Ewoud J. van Dijk
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joost de Vries
- Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Paul L.M. de Kort
- Department of Neurology, Sint Elisabeth Hospital, Tilburg, the Netherlands
| | | | | | | | - Leo A.M. Aerden
- Department of Neurology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | | | - Marieke C. Visser
- Department of Neurology, VU Medical Center, Amsterdam, the Netherlands
| | | | - Patrick C. Vroomen
- Department of Neurology, University Medical Center Groningen, the Netherlands
| | - Omid Eshghi
- Radiology, University Medical Center Groningen, the Netherlands
| | | | | | - Koos Keizer
- Department of Neurology, Catharina Hospital, Eindhoven, the Netherlands
| | | | | | - Dick G. Gerrits
- Radiology, Medical Spectrum Twente, Enschede, the Netherlands)
| | | | - Giorgos B. Karas
- Radiology, Sint Lucas Andreas Hospital, Amsterdam, the Netherlands
| | | | | | - Henk A. Marquering
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands
| | - Ludo F. Beenen
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | | | | | - René van den Berg
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Peter J. Koudstaal
- Department of Neurology, Erasmus MC University Medical Center, the Netherlands
| | - Jelis Boiten
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherland
| | - Ewoud J. van Dijk
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | - Ewout W. Steyerberg
- Public Health, Erasmus MC University Medical Center, the Netherlands; Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands
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25
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Hauer AJ, Ruigrok YM, Algra A, van Dijk EJ, Koudstaal PJ, Luijckx GJ, Nederkoorn PJ, van Oostenbrugge RJ, Visser MC, Wermer MJ, Kappelle LJ, Klijn CJM. Age-Specific Vascular Risk Factor Profiles According to Stroke Subtype. J Am Heart Assoc 2017; 6:JAHA.116.005090. [PMID: 28483775 PMCID: PMC5524074 DOI: 10.1161/jaha.116.005090] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Ischemic and hemorrhagic stroke are increasingly recognized as heterogeneous diseases with distinct subtypes and etiologies. Information on variation in distribution of vascular risk factors according to age in stroke subtypes is limited. We investigated the prevalence of vascular risk factors in stroke subtypes in relation to age. METHODS AND RESULTS We studied a prospective multicenter university hospital-based cohort of 4033 patients. For patients with ischemic stroke caused by large artery atherosclerosis, small vessel disease, or cardioembolism and for patients with spontaneous intracerebral hemorrhage or aneurysmal subarachnoid hemorrhage, we calculated prevalences of vascular risk factors in 4 age groups: <55, 55 to 65, 65 to 75, and ≥75 years, and mean differences with 95% CIs in relation to the reference age group. Patients aged <55 years were significantly more often of non-white origin (in particular in spontaneous intracerebral hemorrhage and aneurysmal subarachnoid hemorrhage patients) and most often smoked (most prominent for aneurysmal subarachnoid hemorrhage patients). Patients aged <55 years with ischemic stroke caused by large artery atherosclerosis or small vessel disease more often had hypertension, hyperlipidemia, and diabetes mellitus than patients with ischemic stroke of cardiac origin. Overall, the frequency of hypertension, hyperlipidemia, and diabetes mellitus increased with age among all stroke subtypes, whereas smoking decreased with age. Regardless of age, accumulation of potentially modifiable risk factors was most pronounced in patients with ischemic stroke caused by large artery atherosclerosis or small vessel disease. CONCLUSIONS The prevalence of common cardiovascular risk factors shows different age-specific patterns among various stroke subtypes. Recognition of these patterns may guide tailored stroke prevention efforts aimed at specific risk groups.
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Affiliation(s)
- Allard J Hauer
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ynte M Ruigrok
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ale Algra
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ewoud J van Dijk
- Department of Neurology, Donders Institute of Brain Behaviour & Cognition, Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter J Koudstaal
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gert-Jan Luijckx
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Marieke C Visser
- Department of Neurology, VU Medical Center, Amsterdam, The Netherlands
| | - Marieke J Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Catharina J M Klijn
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands .,Department of Neurology, Donders Institute of Brain Behaviour & Cognition, Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
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26
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Patel A, van Ginneken B, Meijer FJ, van Dijk EJ, Prokop M, Manniesing R. Robust cranial cavity segmentation in CT and CT perfusion images of trauma and suspected stroke patients. Med Image Anal 2017; 36:216-228. [DOI: 10.1016/j.media.2016.12.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 12/06/2016] [Accepted: 12/08/2016] [Indexed: 11/28/2022]
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27
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Arntz RM, van Alebeek ME, Synhaeve NE, van Pamelen J, Maaijwee NA, Schoonderwaldt H, van der Vlugt MJ, van Dijk EJ, Rutten-Jacobs LC, de Leeuw FE. The very long-term risk and predictors of recurrent ischaemic events after a stroke at a young age: The FUTURE study. Eur Stroke J 2016; 1:337-345. [PMID: 31008296 DOI: 10.1177/2396987316673440] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 08/02/2016] [Accepted: 09/16/2016] [Indexed: 11/15/2022] Open
Abstract
Introduction Patients who suffer a stroke at a young age, remain at a substantial risk of developing recurrent vascular events and information on very long-term prognosis and its risk factors is indispensable. Our aim is to investigate this very long-term risk and associated risk factors up to 35 years after stroke. Patients and methods Prospective cohort study among 656 patients with a first-ever ischaemic stroke or transient ischaemic stroke (TIA), aged 18-50, who visited our hospital (1980-2010). Outcomes assessed at follow-up (2014-2015) included TIA or ischaemic stroke and other arterial events, whichever occurred first. Kaplan-Meier analysis quantified cumulative risks. A prediction model was constructed to assess risk factors independently associated with any ischaemic event using Cox proportional hazard analyses followed by bootstrap validation procedure to avoid overestimation. Results Mean follow-up was 12.4 (SD 8.2) years (8105 person-years). Twenty-five years cumulative risk was 45.4% (95%CI: 39.4-51.5) for any ischaemic event, 30.1% (95%CI: 24.8-35.4) for cerebral ischaemia and 27.0% (95%CI: 21.1-33.0) for other arterial events. Risk factors retained in the prediction model were smoking (HR 1.35, 95%CI: 1.04-1.74), poor kidney function (HR 2.10, 95%CI: 1.32-3.35), history of peripheral arterial disease (HR 2.10, 95%CI: 1.08-3.76) and cardiac disease (HR 1.84, 95%CI: 1.06-3.18) (C-statistic 0.59 (95%CI: 0.55-0.64)). Discussion and conclusion Young stroke patients remain at a substantial risk for recurrent events; almost 1 of 2 develops a recurrent ischaemic event and 1 of 3 develops a recurrent stroke or TIA during 25 years of follow-up. Risk factors independently associated with recurrent events were poor kidney function, smoking, history of peripheral arterial disease and cardiac disease.
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Affiliation(s)
- Renate M Arntz
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands
| | - Mayte E van Alebeek
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands
| | - Nathalie E Synhaeve
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands.,Department of Neurology, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - Jeske van Pamelen
- Department of Neurology, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - Noortje Amm Maaijwee
- Centre for Neurology and Neurorehabilitation, State Hospital, Luzern, Switzerland
| | - Hennie Schoonderwaldt
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands
| | | | - Ewoud J van Dijk
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands
| | | | - Frank-Erik de Leeuw
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands
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28
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van der Holst HM, van Uden IWM, de Laat KF, van Leijsen EMC, van Norden AGW, Norris DG, van Dijk EJ, Tuladhar AM, de Leeuw FE. Baseline Cerebral Small Vessel Disease Is Not Associated with Gait Decline After Five Years. Mov Disord Clin Pract 2016; 4:374-382. [PMID: 30838274 DOI: 10.1002/mdc3.12435] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/22/2016] [Accepted: 08/10/2016] [Indexed: 11/07/2022] Open
Abstract
Background Cerebral small vessel disease (SVD) is cross-sectionally associated with gait disturbances, however, the relation between baseline SVD and gait decline over time is uncertain. Furthermore, diffusion tensor imaging (DTI) studies on gait decline are currently lacking. Objective To investigate the association between baseline imaging SVD markers and gait decline. Methods In 2006, 310 participants from the RUN DMC cohort, a prospective cohort with older adults aged 50-85 years with SVD, were included. Gait variables were assessed using a computerized walkway during baseline and follow-up. Linear and logistic regression analyses were used to investigate the relation between imaging measures and gait decline and incident gait impairment (speed ≤ 1.0 m/s). Tract-based spatial statistics (TBSS) was used to identify possible differences in DTI measures of white matter tracts between participants with and without incident gait impairment. Results Mean age was 63.3 years (SD: 8.4) and mean follow-up duration 5.4 years (SD: 0.2). No significant associations between imaging measures and gait decline were found. TBSS analysis revealed no significant differences in DTI measures between participants with and without incident gait impairment after additional adjustment for SVD. In sub-analyses, a high total WMH volume (OR: 2.8 for highest quartile, 95% CI: 1.1-7.1) and high infratentorial WMH volume (OR: 1.8 per SD increase, 95% CI: 1.1-2.9) were associated with an increased 5-year risk of gait impairment, although this was not significant after correction for multiple testing. Conclusion Baseline imaging SVD markers were not associated with gait decline or incident gait impairment after 5 years. Future studies should investigate if SVD progression is related to gait deterioration.
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Affiliation(s)
- Helena M van der Holst
- Department of Neurology Radboud University Medical Center Donders Institute for Brain, Cognition and Behaviour Centre for Neuroscience Reinier Postlaan 4 Nijmegen 6500HB The Netherlands
| | - Ingeborg W M van Uden
- Department of Neurology Radboud University Medical Center Donders Institute for Brain, Cognition and Behaviour Centre for Neuroscience Reinier Postlaan 4 Nijmegen 6500HB The Netherlands
| | - Karlijn F de Laat
- Department of Neurology HagaZiekenhuis Den Haag Leyyweg 275 Den Haag 2545 CH The Netherlands
| | - Esther M C van Leijsen
- Department of Neurology Radboud University Medical Center Donders Institute for Brain, Cognition and Behaviour Centre for Neuroscience Reinier Postlaan 4 Nijmegen 6500HB The Netherlands
| | - Anouk G W van Norden
- Department of Neurology Amphia ziekenhuis Breda Molengracht 21 Breda 4818 CK The Netherlands
| | - David G Norris
- Donders Institute for Brain, Cognition and Behaviour Centre for Cognitive Neuroimaging Radboud University Nijmegen The Netherlands.,Erwin L. Hahn Institute for Magnetic Resonance Imaging UNESCO-Weltkulturerbe Zollverein Leitstand Kokerei Zollverein Arendahls Wiese 199 Essen D-45141 Germany.,MIRA Institute for Biomedical Technology and Technical Medicine University of Twente Enschede 7500 AE The Netherlands
| | - Ewoud J van Dijk
- Department of Neurology Radboud University Medical Center Donders Institute for Brain, Cognition and Behaviour Centre for Neuroscience Reinier Postlaan 4 Nijmegen 6500HB The Netherlands
| | - Anil M Tuladhar
- Department of Neurology Radboud University Medical Center Donders Institute for Brain, Cognition and Behaviour Centre for Neuroscience Reinier Postlaan 4 Nijmegen 6500HB The Netherlands.,Donders Institute for Brain, Cognition and Behaviour Centre for Cognitive Neuroimaging Radboud University Nijmegen The Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology Radboud University Medical Center Donders Institute for Brain, Cognition and Behaviour Centre for Neuroscience Reinier Postlaan 4 Nijmegen 6500HB The Netherlands
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29
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Schaapsmeerders P, Tuladhar AM, Arntz RM, Franssen S, Maaijwee NA, Rutten-Jacobs LC, Schoonderwaldt HC, Dorresteijn LD, van Dijk EJ, Kessels RP, de Leeuw FE. Remote Lower White Matter Integrity Increases the Risk of Long-Term Cognitive Impairment After Ischemic Stroke in Young Adults. Stroke 2016; 47:2517-25. [DOI: 10.1161/strokeaha.116.014356] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 08/05/2016] [Indexed: 12/16/2022]
Abstract
Background and Purpose—
Poststroke cognitive impairment occurs frequently in young patients with ischemic stroke (18 through 50 years of age). Accumulating data suggest that stroke is associated with lower white matter integrity remote from the stroke impact area, which might explain why some patients have good long-term cognitive outcome and others do not. Given the life expectancy of decades in young patients, we therefore investigated remote white matter in relation to long-term cognitive function.
Methods—
We included all consecutive first-ever ischemic stroke patients, left/right hemisphere, without recurrent stroke or transient ischemic attack during follow-up, aged 18 through 50 years, admitted to our university medical center between 1980 and 2010. One hundred seventeen patients underwent magnetic resonance imaging scanning including a T1-weighted scan, a diffusion tensor imaging scan, and completed a neuropsychological assessment. Patients were compared with a matched stroke-free control group (age, sex, and education matched). Cognitive impairment was defined as >1.5 SD below the mean cognitive index score of controls and no cognitive impairment as ≤1 SD. Tract-Based Spatial Statistics was used to assess the white matter integrity (fractional anisotropy and mean diffusivity).
Results—
About 11 years after ischemic stroke, lower remote white matter integrity was associated with a worse long-term cognitive performance. A lower remote white matter integrity, even in the contralesional hemisphere, was observed in cognitively impaired patients (n=25) compared with cognitively unimpaired patients (n=71).
Conclusions—
These findings indicate that although stroke has an acute onset, it might have long lasting effects on remote white matter integrity and thereby increases the risk of long-term cognitive impairment.
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Affiliation(s)
- Pauline Schaapsmeerders
- From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Anil M. Tuladhar
- From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Renate M. Arntz
- From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Sieske Franssen
- From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Noortje A.M. Maaijwee
- From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Loes C.A. Rutten-Jacobs
- From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Hennie C. Schoonderwaldt
- From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Lucille D.A. Dorresteijn
- From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Ewoud J. van Dijk
- From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Roy P.C. Kessels
- From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Frank-Erik de Leeuw
- From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
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van der Holst HM, van Uden IWM, Tuladhar AM, de Laat KF, van Norden AGW, Norris DG, van Dijk EJ, Rutten-Jacobs LC, de Leeuw FE. Factors Associated With 8-Year Mortality in Older Patients With Cerebral Small Vessel Disease: The Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort (RUN DMC) Study. JAMA Neurol 2016; 73:402-9. [PMID: 26831360 DOI: 10.1001/jamaneurol.2015.4560] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Gait and cognition have been related to mortality in population-based studies. This association is possibly mediated by cerebral small vessel disease (SVD), which has been associated with mortality as well. It is unknown which factors can predict mortality in individuals with SVD. Identification of high-risk patients may provide insight into factors that reflect their vital health status. OBJECTIVES To assess mortality in patients with cerebral SVD and identify potential clinical and/or imaging factors associated with mortality. DESIGN, SETTING, AND PARTICIPANTS A prospective, single-center cohort study was conducted. The present investigation is embedded in the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort (RUN DMC) study. Between January 17, 2006, and February 27, 2007, all participants underwent a cognitive and motor assessment and cerebral magnetic resonance imaging (MRI) including a diffusion tensor imaging sequence to assess microstructural integrity of the white matter. Participants were followed up until their death or November 24, 2014. Participants included 503 older adults with SVD noted on brain imaging. Data analysis was performed from November 26, 2014, to February 2, 2015. MAIN OUTCOMES AND MEASURES Eight-year all-cause mortality. RESULTS Of 503 participants (mean [SD] age, 65.7 [8.8] years; range, 50-85 years; 284 [56.5%] were male), 80 individuals (15.9%) died during a mean (SD) follow-up of 7.8 (1.5) years. In the final analysis, 494 (98.2%) were included, of whom 78 (15.8%) died. Gait speed, cognitive index, conventional MRI markers of SVD (white matter hyperintensity volume, brain volume, and lacunes), and diffusion measures of the white matter were associated with an 8-year risk of mortality independent of age, sex, and vascular risk factors. The prediction of mortality was determined using Cox proportional hazards models with backward stepwise selection and including age, sex, vascular risk factors, gait speed, cognitive index, MRI, and diffusion measures. Results are reported as hazard ratios (HRs) (95% CI). Older age (1.05 per 1-year increase [1.01-1.08]), lower gait speed (1.15 per 0.1-m/s slower gait [1.06-1.24]), lower gray matter volume (0.72 per 1-SD increase [0.55-0.95]), and greater global mean diffusivity of the white matter (1.51 per 1-SD increase [1.19-1.92]) were identified as the main factors associated with mortality. Cognitive index and other conventional SVD markers were not retained in the prediction model. CONCLUSIONS AND RELEVANCE Gait, cognition, and imaging markers of SVD are associated with 8-year risk of mortality. In the prediction of mortality, an older age, lower gait speed, lower gray matter volume, and greater global mean diffusivity of white matter at baseline best predicted mortality in our population. Further research is needed to investigate the reproducibility of this prediction model and to elucidate the association between the factors identified and mortality.
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Affiliation(s)
- Helena M van der Holst
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Department of Neurology, Nijmegen, the Netherlands
| | - Ingeborg W M van Uden
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Department of Neurology, Nijmegen, the Netherlands
| | - Anil M Tuladhar
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Department of Neurology, Nijmegen, the Netherlands2Radboud University, Donders Institute for Brain, Cognition and Behaviour, Center for Cogni
| | - Karlijn F de Laat
- HagaZiekenhuis Den Haag, Department of Neurology, Den Haag, the Netherlands
| | | | - David G Norris
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging, Nijmegen, the Netherlands5Erwin L. Hahn Institute for Magnetic Resonance Imaging, UNESCO-Weltkulturerbe Zollverein, Essen, Germany6MIRA Institute
| | - Ewoud J van Dijk
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Department of Neurology, Nijmegen, the Netherlands
| | - Loes C Rutten-Jacobs
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, England
| | - Frank-Erik de Leeuw
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Department of Neurology, Nijmegen, the Netherlands
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31
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van Uden IW, van der Holst HM, van Leijsen EM, Tuladhar AM, van Norden AG, de Laat KF, Claassen JA, van Dijk EJ, Kessels RP, Richard E, Tendolkar I, de Leeuw FE. Late-onset depressive symptoms increase the risk of dementia in small vessel disease. Neurology 2016; 87:1102-9. [DOI: 10.1212/wnl.0000000000003089] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 05/30/2016] [Indexed: 11/15/2022] Open
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Arntz RM, van den Broek SMA, van Uden IWM, Ghafoorian M, Platel B, Rutten-Jacobs LCA, Maaijwee NAM, Schaapsmeerders P, Schoonderwaldt HC, van Dijk EJ, de Leeuw FE. Accelerated development of cerebral small vessel disease in young stroke patients. Neurology 2016; 87:1212-9. [PMID: 27521431 PMCID: PMC5035980 DOI: 10.1212/wnl.0000000000003123] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 06/08/2016] [Indexed: 01/30/2023] Open
Abstract
Objective: To study the long-term prevalence of small vessel disease after young stroke and to compare this to healthy controls. Methods: This prospective cohort study comprises 337 patients with an ischemic stroke or TIA, aged 18–50 years, without a history of TIA or stroke. In addition, 90 age- and sex-matched controls were included. At follow-up, lacunes, microbleeds, and white matter hyperintensity (WMH) volume were assessed using MRI. To investigate the relation between risk factors and small vessel disease, logistic and linear regression were used. Results: After mean follow-up of 9.9 (SD 8.1) years, 337 patients were included (227 with an ischemic stroke and 110 with a TIA). Mean age of patients was 49.8 years (SD 10.3) and 45.4% were men; for controls, mean age was 49.4 years (SD 11.9) and 45.6% were men. Compared with controls, patients more often had at least 1 lacune (24.0% vs 4.5%, p < 0.0001). In addition, they had a higher WMH volume (median 1.5 mL [interquartile range (IQR) 0.5–3.7] vs 0.4 mL [IQR 0.0–1.0], p < 0.001). Compared with controls, patients had the same volume WMHs on average 10–20 years earlier. In the patient group, age at stroke (β = 0.03, 95% confidence interval [CI] 0.02–0.04) hypertension (β = 0.22, 95% CI 0.04–0.39), and smoking (β = 0.18, 95% CI 0.01–0.34) at baseline were associated with WMH volume. Conclusions: Patients with a young stroke have a higher burden of small vessel disease than controls adjusted for confounders. Cerebral aging seems accelerated by 10–20 years in these patients, which may suggest an increased vulnerability to vascular risk factors.
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Affiliation(s)
- Renate M Arntz
- From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK
| | - Steffen M A van den Broek
- From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK
| | - Inge W M van Uden
- From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK
| | - Mohsen Ghafoorian
- From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK
| | - Bram Platel
- From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK
| | - Loes C A Rutten-Jacobs
- From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK
| | - Noortje A M Maaijwee
- From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK
| | - Pauline Schaapsmeerders
- From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK
| | - Hennie C Schoonderwaldt
- From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK
| | - Ewoud J van Dijk
- From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK
| | - Frank-Erik de Leeuw
- From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK.
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Berkhemer OA, Jansen IG, Beumer D, Fransen PS, van den Berg LA, Yoo AJ, Lingsma HF, Sprengers ME, Jenniskens SF, Lycklama à Nijeholt GJ, van Walderveen MA, van den Berg R, Bot JC, Beenen LF, Boers AM, Slump CH, Roos YB, van Oostenbrugge RJ, Dippel DW, van der Lugt A, van Zwam WH, Marquering HA, Majoie CB, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJ, Staals J, Hofmeijer J, van Oostayen JA, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle LJ, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van den Berg JS, van Hassel BA, Aerden LA, Dallinga RJ, Visser MC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Koudstaal PJ, Flach HZ, Steyerberg EW, Brown MM, Liebig T, Stijnen T. Collateral Status on Baseline Computed Tomographic Angiography and Intra-Arterial Treatment Effect in Patients With Proximal Anterior Circulation Stroke. Stroke 2016; 47:768-76. [PMID: 26903582 DOI: 10.1161/strokeaha.115.011788] [Citation(s) in RCA: 197] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 12/10/2015] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Recent randomized trials have proven the benefit of intra-arterial treatment (IAT) with retrievable stents in acute ischemic stroke. Patients with poor or absent collaterals (preexistent anastomoses to maintain blood flow in case of a primary vessel occlusion) may gain less clinical benefit from IAT. In this post hoc analysis, we aimed to assess whether the effect of IAT was modified by collateral status on baseline computed tomographic angiography in the Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN).
Methods—
MR CLEAN was a multicenter, randomized trial of IAT versus no IAT. Primary outcome was the modified Rankin Scale at 90 days. The primary effect parameter was the adjusted common odds ratio for a shift in direction of a better outcome on the modified Rankin Scale. Collaterals were graded from 0 (absent) to 3 (good). We used multivariable ordinal logistic regression analysis with interaction terms to estimate treatment effect modification by collateral status.
Results—
We found a significant modification of treatment effect by collaterals (
P
=0.038). The strongest benefit (adjusted common odds ratio 3.2 [95% confidence intervals 1.7–6.2]) was found in patients with good collaterals (grade 3). The adjusted common odds ratio was 1.6 [95% confidence intervals 1.0–2.7] for moderate collaterals (grade 2), 1.2 [95% confidence intervals 0.7–2.3] for poor collaterals (grade 1), and 1.0 [95% confidence intervals 0.1–8.7] for patients with absent collaterals (grade 0).
Conclusions—
In MR CLEAN, baseline computed tomographic angiography collateral status modified the treatment effect. The benefit of IAT was greatest in patients with good collaterals on baseline computed tomographic angiography. Treatment benefit appeared less and may be absent in patients with absent or poor collaterals.
Clinical Trial Registration—
URL:
http://www.trialregister.nl
and
http://www.controlled-trials.com
. Unique identifier: (NTR)1804 and ISRCTN10888758, respectively.
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Affiliation(s)
- Olvert A. Berkhemer
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Ivo G.H. Jansen
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Debbie Beumer
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Puck S.S. Fransen
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Lucie A. van den Berg
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Albert J. Yoo
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Hester F. Lingsma
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Marieke E.S. Sprengers
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Sjoerd F.M. Jenniskens
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Geert J. Lycklama à Nijeholt
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Marianne A.A. van Walderveen
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - René van den Berg
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Joseph C.J. Bot
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Ludo F.M. Beenen
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Anna M.M. Boers
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Cornelis H. Slump
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Yvo B.W.E.M. Roos
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Robert J. van Oostenbrugge
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Diederik W.J. Dippel
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Aad van der Lugt
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Wim H. van Zwam
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Henk A. Marquering
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
| | - Charles B.L.M. Majoie
- From the Departments of Radiology (O.A.B., I.G.H.J., M.E.S.S., R.v.d.B., L.F.M.B., A.M.M.B., C.B.L.M.M.), Neurology (L.A.v.d.B., Y.B.W.E.M.R.), and Biomedical Engineering and Physics (A.M.M.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Radiology (P.S.S.F., A.v.d.L.), and Public Health (H.F.L.), Erasmus MC University Medical Center Rotterdam, The Netherlands; Departments of Neurology (D.B., R.J.v.O.), and Radiology (W.H.v.Z.),
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Fransen PSS, Berkhemer OA, Lingsma HF, Beumer D, van den Berg LA, Yoo AJ, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJH, van Walderveen MAA, Staals J, Hofmeijer J, van Oostayen JA, Lycklama À Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle LJ, Lo RH, van Dijk EJ, de Vries J, de Kort PLM, van den Berg JSP, van Hasselt BAAM, Aerden LAM, Dallinga RJ, Visser MC, Bot JCJ, Vroomen PC, Eshghi O, Schreuder THCML, Heijboer RJJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach HZ, Marquering HA, Sprengers MES, Jenniskens SFM, Beenen LFM, van den Berg R, Koudstaal PJ, van Zwam WH, Roos YBWEM, van Oostenbrugge RJ, Majoie CBLM, van der Lugt A, Dippel DWJ. Time to Reperfusion and Treatment Effect for Acute Ischemic Stroke: A Randomized Clinical Trial. JAMA Neurol 2015; 73:190-6. [PMID: 26716735 DOI: 10.1001/jamaneurol.2015.3886] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Intra-arterial treatment (IAT) for acute ischemic stroke caused by intracranial arterial occlusion leads to improved functional outcome in patients treated within 6 hours after onset. The influence of treatment delay on treatment effect is not yet known. OBJECTIVE To evaluate the influence of time from stroke onset to the start of treatment and from stroke onset to reperfusion on the effect of IAT. DESIGN, SETTING, AND PARTICIPANTS The Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) was a multicenter, randomized clinical open-label trial of IAT vs no IAT in 500 patients. The time to the start of treatment was defined as the time from onset of symptoms to groin puncture (TOG). The time from onset of treatment to reperfusion (TOR) was defined as the time to reopening the vessel occlusion or the end of the procedure in cases for which reperfusion was not achieved. Data were collected from December 3, 2010, to June 3, 2014, and analyzed (intention to treat) from July 1, 2014, to September 19, 2015. MAIN OUTCOMES AND MEASURES Main outcome was the modified Rankin Scale (mRS) score for functional outcome (range, 0 [no symptoms] to 6 [death]). Multiple ordinal logistic regression analysis estimated the effect of treatment and tested for the interaction of time to randomization, TOG, and TOR with treatment. The effect of treatment as a risk difference on reaching independence (mRS score, 0-2) was computed as a function of TOG and TOR. Calculations were adjusted for age, National Institutes of Health Stroke Scale score, previous stroke, atrial fibrillation, diabetes mellitus, and intracranial arterial terminus occlusion. RESULTS Among 500 patients (58% male; median age, 67 years), the median TOG was 260 (interquartile range [IQR], 210-311) minutes; median TOR, 340 (IQR, 274-395) minutes. An interaction between TOR and treatment (P = .04) existed, but not between TOG and treatment (P = .26). The adjusted risk difference (95% CI) was 25.9% (8.3%-44.4%) when reperfusion was reached at 3 hours, 18.8% (6.6%-32.6%) at 4 hours, and 6.7% (0.4%-14.5%) at 6 hours. CONCLUSION AND RELEVANCE For every hour of reperfusion delay, the initially large benefit of IAT decreases; the absolute risk difference for a good outcome is reduced by 6% per hour of delay. Patients with acute ischemic stroke require immediate diagnostic workup and IAT in case of intracranial arterial vessel occlusion. TRIAL REGISTRATION trialregister.nl Identifier: NTR1804.
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Affiliation(s)
- Puck S S Fransen
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands2Department of Radiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Olvert A Berkhemer
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands3Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Hester F Lingsma
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Debbie Beumer
- Department of Neurology, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | | | | | | | - Jan Albert Vos
- Department of Radiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands
| | - Marieke J H Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Julie Staals
- Department of Neurology, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | | | | | | | - Jelis Boiten
- Department of Neurology, Medisch Centrum Haaglanden, the Hague, the Netherlands
| | - Patrick A Brouwer
- Department of Radiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Bart J Emmer
- Department of Radiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Lukas C van Dijk
- Department of Radiology, Haga Hospital, the Hague, the Netherlands
| | - L Jaap Kappelle
- Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rob H Lo
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ewoud J van Dijk
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joost de Vries
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Paul L M de Kort
- Department of Neurology, St Elisabeth Hospital, Tilburg, the Netherlands
| | | | | | - Leo A M Aerden
- Department of Neurology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - René J Dallinga
- Department of Radiology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - Marieke C Visser
- Department of Neurology, VU Medical Center, Amsterdam, the Netherlands
| | - Joseph C J Bot
- Department of Radiology, VU Medical Center, Amsterdam, the Netherlands
| | - Patrick C Vroomen
- Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands
| | - Omid Eshghi
- Department of Radiology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Roel J J Heijboer
- Department of Radiology, Atrium Medical Center, Heerlen, the Netherlands
| | - Koos Keizer
- Department of Neurology, Catharina Hospital, Eindhoven, the Netherlands
| | | | | | - Dick G Gerrits
- Department of Radiology, Medical Spectrum Twente, Enschede, the Netherlands
| | | | - Giorgos B Karas
- Department of Radiology, St Lucas Andreas Hospital, Amsterdam, the Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - H Zwenneke Flach
- Department of Neurology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - Henk A Marquering
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands39Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Sjoerd F M Jenniskens
- Department of Radiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ludo F M Beenen
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - René van den Berg
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Peter J Koudstaal
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Wim H van Zwam
- Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Yvo B W E M Roos
- Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands
| | - Robert J van Oostenbrugge
- Department of Neurology, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | | | - Aad van der Lugt
- Department of Radiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Diederik W J Dippel
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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van Rooij FG, Vermeer SE, Góraj BM, Koudstaal PJ, Richard E, de Leeuw FE, van Dijk EJ. Diffusion-weighted imaging in transient neurological attacks. Ann Neurol 2015; 78:1005-10. [DOI: 10.1002/ana.24539] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/18/2015] [Accepted: 10/03/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Frank G. van Rooij
- Department of Neurology; Center for Neuroscience, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center; Nijmegen the Netherlands
| | - Sarah E. Vermeer
- Department of Neurology; Rijnstate Hospital; Arnhem the Netherlands
| | - Bozena M. Góraj
- Department of Radiology; Radboud University Medical Center; Nijmegen the Netherlands
- Department of Diagnostic Imaging; Medical Center of Postgraduate Education; Warsaw Poland
| | - Peter J. Koudstaal
- Department of Neurology; Erasmus Medical Center; Rotterdam the Netherlands
| | - Edo Richard
- Department of Neurology; Center for Neuroscience, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center; Nijmegen the Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology; Center for Neuroscience, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center; Nijmegen the Netherlands
| | - Ewoud J. van Dijk
- Department of Neurology; Center for Neuroscience, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center; Nijmegen the Netherlands
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36
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Borst J, Berkhemer OA, Roos YB, van Bavel E, van Zwam WH, van Oostenbrugge RJ, van Walderveen MA, Lingsma HF, van der Lugt A, Dippel DW, Yoo AJ, Marquering HA, Majoie CB, Fransen PS, Beumer D, van den Berg LA, Schonewille WJ, Vos JA, Nederkoorn PJ, Wermer MJ, Staals J, Hofmeijer J, van Oostayen JA, Lycklama à Nijeholt GJ, Boiten J, Brouwer PA, Emmer BJ, de Bruijn SF, van Dijk LC, Kappelle LJ, Lo RH, van Dijk EJ, de Vries J, de Kort PL, van den Berg JS, van Hasselt BA, Aerden LA, Dallinga RJ, Visser MC, Bot JC, Vroomen PC, Eshghi O, Schreuder TH, Heijboer RJ, Keizer K, Tielbeek AV, den Hertog HM, Gerrits DG, van den Berg-Vos RM, Karas GB, Steyerberg EW, Flach HZ, Sprengers ME, Jenniskens SF, Beenen LF, van den Berg R, Koudstaal PJ, Brown MM, Liebig T, Stijnen T, Andersson T, Mattle H, Wahlgren N, van der Heijden E, Ghannouti N, Fleitour N, Hooijenga I, Puppels C, Pellikaan W, Geerling A, Lindl-Velema A, van Vemde G, de Ridder A, Greebe P, de Bont-Stikkelbroeck J, de Meris J, Janssen K, Struijk W, Simons T, Messchendorp G, van der Minne F, Bongenaar H, Licher S, Boodt N, Ros A, Venema E, Slokkers I, Ganpat RJ, Mulder M, Saiedie N, Heshmatollah A, Schipperen S, Vinken S, van Boxtel T, Koets J, Boers M, Santos E, Jansen I, Kappelhof M, Lucas M, Geuskens R, Barros RS, Dobbe R, Csizmadia M. Value of Computed Tomographic Perfusion–Based Patient Selection for Intra-Arterial Acute Ischemic Stroke Treatment. Stroke 2015; 46:3375-82. [DOI: 10.1161/strokeaha.115.010564] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/09/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Jordi Borst
- From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of
| | - Olvert A. Berkhemer
- From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of
| | - Yvo B.W.E.M. Roos
- From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of
| | - Ed van Bavel
- From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of
| | - Wim H. van Zwam
- From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of
| | - Robert J. van Oostenbrugge
- From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of
| | - Marianne A.A. van Walderveen
- From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of
| | - Hester F. Lingsma
- From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of
| | - Aad van der Lugt
- From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of
| | - Diederik W.J. Dippel
- From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of
| | - Albert J. Yoo
- From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of
| | - Henk A. Marquering
- From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of
| | - Charles B.L.M. Majoie
- From the Departments of Radiology (J.B., O.A.B., H.A.M., C.B.L.M.M.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (E.v.B., H.A.M.), Academic Medical Center, Amsterdam, The Netherlands; Departments of Radiology (W.H.v.Z.) and Neurology (R.J.v.O.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (M.A.A.v.W.); Departments of
| | - Puck S.S. Fransen
- Departments of Neurology and Radiology, Erasmus MC University Medical Center Rotterdam, The Netherlands
| | - Debbie Beumer
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, The Netherlands and Department of Neurology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands
| | | | | | - Jan Albert Vos
- Department of Radiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Paul J. Nederkoorn
- Department of Neurology, Academic Medical Center Amsterdam, The Netherlands
| | | | - Julie Staals
- Department of Neurology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands
| | | | | | | | - Jelis Boiten
- Department of Neurology, MC Haaglanden, the Hague, The Netherlands
| | - Patrick A. Brouwer
- Department of Radiology, Erasmus MC University Medical Center Rotterdam, The Netherlands
| | - Bart J. Emmer
- Department of Radiology, Erasmus MC University Medical Center Rotterdam, The Netherlands
| | | | | | - L. Jaap Kappelle
- Department of Neurology, University Medical Center Utrecht, The Netherlands
| | - Rob H. Lo
- Department of Radiology, University Medical Center Utrecht, The Netherlands
| | - Ewoud J. van Dijk
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joost de Vries
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul L.M. de Kort
- Department of Neurology, Sint Elisabeth Hospital, Tilburg, The Netherlands
| | | | | | - Leo A.M. Aerden
- Department of Neurology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - René J. Dallinga
- Department of Radiology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Marieke C. Visser
- Department of Neurology, VU Medical Center, Amsterdam, The Netherlands
| | - Joseph C.J. Bot
- Department of Radiology, VU Medical Center, Amsterdam, The Netherlands
| | - Patrick C. Vroomen
- Department of Neurology, University Medical Center Groningen, The Netherlands
| | - Omid Eshghi
- Department of Radiology, University Medical Center Groningen, The Netherlands
| | | | - Roel J.J. Heijboer
- Department of Radiology, Atrium Medical Center, Heerlen, The Netherlands
| | - Koos Keizer
- Department of Neurology, Catharina Hospital, Eindhoven, The Netherlands
| | | | | | - Dick G. Gerrits
- Department of Radiology, Medical Spectrum Twente, Enschede, The Netherlands
| | | | - Giorgos B. Karas
- Department of Radiology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - Ewout W. Steyerberg
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, The Netherlands
| | - H. Zwenneke Flach
- Department of Neurology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | | | | | - Ludo F.M. Beenen
- Department of Radiology, Academic Medical Center Amsterdam, The Netherlands
| | - René van den Berg
- Department of Radiology, Academic Medical Center Amsterdam, The Netherlands
| | - Peter J. Koudstaal
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, The Netherlands
| | | | | | - Theo Stijnen
- Leiden University Medical Center, Leiden, the Netherlands
| | - Tommy Andersson
- Neuro Interventionist, Karolinska Univeristy Hospital, Stockholm, Sweden
| | | | | | | | | | | | | | | | | | - Annet Geerling
- Radboud University Nijmegen Medical Center, the Netherlands
| | | | | | | | - Paut Greebe
- University Medical Center Utrecht, the Netherlands
| | | | | | | | | | | | | | | | | | - Silvan Licher
- Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Nikki Boodt
- Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Adriaan Ros
- Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Esmee Venema
- Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Ilse Slokkers
- Erasmus MC University Medical Center Rotterdam, the Netherlands
| | | | - Maxim Mulder
- Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Nawid Saiedie
- Erasmus MC University Medical Center Rotterdam, the Netherlands
| | | | | | - Stefan Vinken
- Erasmus MC University Medical Center Rotterdam, the Netherlands
| | | | - Jeroen Koets
- Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Merel Boers
- Academic Medical Center Amsterdam, the Netherlands
| | | | - Ivo Jansen
- Academic Medical Center Amsterdam, the Netherlands
| | | | - Marit Lucas
- Academic Medical Center Amsterdam, the Netherlands
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van Uden IW, van der Holst HM, Tuladhar AM, van Norden AG, de Laat KF, Rutten-Jacobs LC, Norris DG, Claassen JA, van Dijk EJ, Kessels RP, de Leeuw FE. White Matter and Hippocampal Volume Predict the Risk of Dementia in Patients with Cerebral Small Vessel Disease: The RUN DMC Study. J Alzheimers Dis 2015; 49:863-73. [DOI: 10.3233/jad-150573] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Ingeborg W.M. van Uden
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, Nijmegen, The Netherlands
| | - Helena M. van der Holst
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, Nijmegen, The Netherlands
| | - Anil M. Tuladhar
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, Nijmegen, The Netherlands
| | | | | | - Loes C.A. Rutten-Jacobs
- University of Cambridge, Department of Clinical Neurosciences, Neurology Unit, Cambridge, UK
| | - David G. Norris
- Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Essen, Germany
| | - Jurgen A.H.R. Claassen
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Department of Geriatrics, Nijmegen, The Netherlands
| | - Ewoud J. van Dijk
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, Nijmegen, The Netherlands
| | - Roy P.C. Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Department of Medical Psychology, Nijmegen, The Netherlands
| | - Frank-Erik de Leeuw
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, Nijmegen, The Netherlands
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van Seeters T, Biessels GJ, Kappelle LJ, van der Schaaf IC, Dankbaar JW, Horsch AD, Niesten JM, Luitse MJ, Majoie CB, Vos JA, Schonewille WJ, van Walderveen MA, Wermer MJ, Duijm LE, Keizer K, Bot JC, Visser MC, van der Lugt A, Dippel DW, Kesselring FO, Hofmeijer J, Lycklama à Nijeholt GJ, Boiten J, van Rooij WJ, de Kort PL, Roos YB, van Dijk EJ, Pleiter CC, Mali WP, van der Graaf Y, Velthuis BK. The Prognostic Value of CT Angiography and CT Perfusion in Acute Ischemic Stroke. Cerebrovasc Dis 2015; 40:258-69. [DOI: 10.1159/000441088] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 09/09/2015] [Indexed: 11/19/2022] Open
Abstract
Background: CT angiography (CTA) and CT perfusion (CTP) are important diagnostic tools in acute ischemic stroke. We investigated the prognostic value of CTA and CTP for clinical outcome and determined whether they have additional prognostic value over patient characteristics and non-contrast CT (NCCT). Methods: We included 1,374 patients with suspected acute ischemic stroke in the prospective multicenter Dutch acute stroke study. Sixty percent of the cohort was used for deriving the predictors and the remaining 40% for validating them. We calculated the predictive values of CTA and CTP predictors for poor clinical outcome (modified Rankin Scale score 3-6). Associations between CTA and CTP predictors and poor clinical outcome were assessed with odds ratios (OR). Multivariable logistic regression models were developed based on patient characteristics and NCCT predictors, and subsequently CTA and CTP predictors were added. The increase in area under the curve (AUC) value was determined to assess the additional prognostic value of CTA and CTP. Model validation was performed by assessing discrimination and calibration. Results: Poor outcome occurred in 501 patients (36.5%). Each of the evaluated CTA measures strongly predicted outcome in univariable analyses: the positive predictive value (PPV) was 59% for Alberta Stroke Program Early CT Score (ASPECTS) ≤7 on CTA source images (OR 3.3; 95% CI 2.3-4.8), 63% for presence of a proximal intracranial occlusion (OR 5.1; 95% CI 3.7-7.1), 66% for poor leptomeningeal collaterals (OR 4.3; 95% CI 2.8-6.6), and 58% for a >70% carotid or vertebrobasilar stenosis/occlusion (OR 3.2; 95% CI 2.2-4.6). The same applied to the CTP measures, as the PPVs were 65% for ASPECTS ≤7 on cerebral blood volume maps (OR 5.1; 95% CI 3.7-7.2) and 53% for ASPECTS ≤7 on mean transit time maps (OR 3.9; 95% CI 2.9-5.3). The prognostic model based on patient characteristics and NCCT measures was highly predictive for poor clinical outcome (AUC 0.84; 95% CI 0.81-0.86). Adding CTA and CTP predictors to this model did not improve the predictive value (AUC 0.85; 95% CI 0.83-0.88). In the validation cohort, the AUC values were 0.78 (95% CI 0.73-0.82) and 0.79 (95% CI 0.75-0.83), respectively. Calibration of the models was satisfactory. Conclusions: In patients with suspected acute ischemic stroke, admission CTA and CTP parameters are strong predictors of poor outcome and can be used to predict long-term clinical outcome. In multivariable prediction models, however, their additional prognostic value over patient characteristics and NCCT is limited in an unselected stroke population.
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Schaapsmeerders P, Tuladhar AM, Maaijwee NAM, Rutten-Jacobs LCA, Arntz RM, Schoonderwaldt HC, Dorresteijn LDA, van Dijk EJ, Kessels RPC, de Leeuw FE. Lower Ipsilateral Hippocampal Integrity after Ischemic Stroke in Young Adults: A Long-Term Follow-Up Study. PLoS One 2015; 10:e0139772. [PMID: 26462115 PMCID: PMC4603678 DOI: 10.1371/journal.pone.0139772] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 09/17/2015] [Indexed: 11/18/2022] Open
Abstract
Background and purpose Memory impairment after stroke is poorly understood as stroke rarely occurs in the hippocampus. Previous studies have observed smaller ipsilateral hippocampal volumes after stroke compared with controls. Possibly, these findings on macroscopic level are not the first occurrence of structural damage and are preceded by microscopic changes that may already be associated with a worse memory function. We therefore examined the relationship between hippocampal integrity, volume, and memory performance long after first-ever ischemic stroke in young adults. Methods We included all consecutive first-ever ischemic stroke patients, without hippocampal strokes or recurrent stroke/TIA, aged 18–50 years, admitted to our academic hospital between 1980 and 2010. One hundred and forty-six patients underwent T1 MPRAGE, DTI scanning and completed the Rey Auditory Verbal Learning Test and were compared with 84 stroke-free controls. After manual correction of hippocampal automatic segmentation, we calculated mean hippocampal fractional anisotropy (FA) and diffusivity (MD). Results On average 10 years after ischemic stroke, lesion volume was associated with lower ipsilateral hippocampal integrity (p<0.05), independent of hippocampal volume. In patients with a normal ipsilateral hippocampal volume (volume is less than or equal to 1.5 SD below the mean volume of controls) significant differences in ipsilateral hippocampal MD were observed (p<0.0001). However, patients with a normal hippocampal volume and high hippocampal MD did not show a worse memory performance compared with patients with a normal volume and low hippocampal MD (p>0.05). Conclusions Patients with average ipsilateral hippocampal volume could already have lower ipsilateral hippocampal integrity, although at present with no attendant worse memory performance compared with patients with high hippocampal integrity. Longitudinal studies are needed to investigate whether a low hippocampal integrity after stroke might lead to exacerbated memory decline with increasing age.
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Affiliation(s)
- Pauline Schaapsmeerders
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - Anil M. Tuladhar
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - Noortje A. M. Maaijwee
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | | | - Renate M. Arntz
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - Hennie C. Schoonderwaldt
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | | | - Ewoud J. van Dijk
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - Roy P. C. Kessels
- Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience and Centre for Cognition, Radboud University Nijmegen, Nijmegen, the Netherlands
- Department of Medical Psychology, Radboud university medical centre, Nijmegen, the Netherlands
| | - Frank-Erik de Leeuw
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
- * E-mail:
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40
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van der Holst HM, van Uden IWM, Tuladhar AM, de Laat KF, van Norden AGW, Norris DG, van Dijk EJ, Esselink RAJ, Platel B, de Leeuw FE. Cerebral small vessel disease and incident parkinsonism: The RUN DMC study. Neurology 2015; 85:1569-77. [PMID: 26446068 DOI: 10.1212/wnl.0000000000002082] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 06/12/2015] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To investigate the relation between baseline cerebral small vessel disease (SVD) and the risk of incident parkinsonism using different MRI and diffusion tensor imaging (DTI) measures. METHODS In the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort (RUN DMC) study, a prospective cohort study, 503 elderly participants with SVD and without parkinsonism were included in 2006. During follow-up (2011-2012), parkinsonism was diagnosed according to UK Brain Bank criteria. Cox regression analysis was used to investigate the association between baseline imaging measures and incident all-cause parkinsonism and vascular parkinsonism (VP). Tract-based spatial statistics analysis was used to identify differences in baseline DTI measures of white matter (WM) tracts between participants with VP and without parkinsonism. RESULTS Follow-up was available from 501 participants (mean age 65.6 years; mean follow-up duration 5.2 years). Parkinsonism developed in 20 participants; 15 were diagnosed with VP. The 5-year risk of (any) parkinsonism was increased for those with a high white matter hyperintensity (WMH) volume (hazard ratio [HR] 1.8 per SD increase, 95% confidence interval [CI] 1.3-2.4) and a high number of lacunes (HR 1.4 per number increase, 95% CI 1.1-1.8) at baseline. For VP, this risk was also increased by the presence of microbleeds (HR 5.7, 95% CI 1.9-16.8) and a low gray matter volume (HR 0.4 per SD increase, 95% CI 0.2-0.8). Lower fractional anisotropy values in bifrontal WM tracts involved in movement control were observed in participants with VP compared to participants without parkinsonism. CONCLUSIONS SVD at baseline, especially a high WMH volume and a high number of lacunes, is associated with incident parkinsonism. Our findings favor a role of SVD in the etiology of parkinsonism.
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Affiliation(s)
- Helena M van der Holst
- From the Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Department of Neurology (H.M.v.d.H., I.W.M.v.U., A.M.T., E.J.v.D., R.A.J.E., F.-E.d.L.), and Radboud University, Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging (A.M.T., D.G.N.), Nijmegen, the Netherlands; Department of Neurology (K.F.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), UNESCO-Weltkulturerbe Zollverein, Leitstand Kokerei Zollverein, Essen, Germany; MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands; and Department of Radiology and Nuclear Medicine (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Inge W M van Uden
- From the Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Department of Neurology (H.M.v.d.H., I.W.M.v.U., A.M.T., E.J.v.D., R.A.J.E., F.-E.d.L.), and Radboud University, Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging (A.M.T., D.G.N.), Nijmegen, the Netherlands; Department of Neurology (K.F.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), UNESCO-Weltkulturerbe Zollverein, Leitstand Kokerei Zollverein, Essen, Germany; MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands; and Department of Radiology and Nuclear Medicine (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anil M Tuladhar
- From the Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Department of Neurology (H.M.v.d.H., I.W.M.v.U., A.M.T., E.J.v.D., R.A.J.E., F.-E.d.L.), and Radboud University, Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging (A.M.T., D.G.N.), Nijmegen, the Netherlands; Department of Neurology (K.F.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), UNESCO-Weltkulturerbe Zollverein, Leitstand Kokerei Zollverein, Essen, Germany; MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands; and Department of Radiology and Nuclear Medicine (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Karlijn F de Laat
- From the Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Department of Neurology (H.M.v.d.H., I.W.M.v.U., A.M.T., E.J.v.D., R.A.J.E., F.-E.d.L.), and Radboud University, Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging (A.M.T., D.G.N.), Nijmegen, the Netherlands; Department of Neurology (K.F.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), UNESCO-Weltkulturerbe Zollverein, Leitstand Kokerei Zollverein, Essen, Germany; MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands; and Department of Radiology and Nuclear Medicine (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anouk G W van Norden
- From the Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Department of Neurology (H.M.v.d.H., I.W.M.v.U., A.M.T., E.J.v.D., R.A.J.E., F.-E.d.L.), and Radboud University, Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging (A.M.T., D.G.N.), Nijmegen, the Netherlands; Department of Neurology (K.F.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), UNESCO-Weltkulturerbe Zollverein, Leitstand Kokerei Zollverein, Essen, Germany; MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands; and Department of Radiology and Nuclear Medicine (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - David G Norris
- From the Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Department of Neurology (H.M.v.d.H., I.W.M.v.U., A.M.T., E.J.v.D., R.A.J.E., F.-E.d.L.), and Radboud University, Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging (A.M.T., D.G.N.), Nijmegen, the Netherlands; Department of Neurology (K.F.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), UNESCO-Weltkulturerbe Zollverein, Leitstand Kokerei Zollverein, Essen, Germany; MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands; and Department of Radiology and Nuclear Medicine (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ewoud J van Dijk
- From the Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Department of Neurology (H.M.v.d.H., I.W.M.v.U., A.M.T., E.J.v.D., R.A.J.E., F.-E.d.L.), and Radboud University, Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging (A.M.T., D.G.N.), Nijmegen, the Netherlands; Department of Neurology (K.F.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), UNESCO-Weltkulturerbe Zollverein, Leitstand Kokerei Zollverein, Essen, Germany; MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands; and Department of Radiology and Nuclear Medicine (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rianne A J Esselink
- From the Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Department of Neurology (H.M.v.d.H., I.W.M.v.U., A.M.T., E.J.v.D., R.A.J.E., F.-E.d.L.), and Radboud University, Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging (A.M.T., D.G.N.), Nijmegen, the Netherlands; Department of Neurology (K.F.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), UNESCO-Weltkulturerbe Zollverein, Leitstand Kokerei Zollverein, Essen, Germany; MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands; and Department of Radiology and Nuclear Medicine (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bram Platel
- From the Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Department of Neurology (H.M.v.d.H., I.W.M.v.U., A.M.T., E.J.v.D., R.A.J.E., F.-E.d.L.), and Radboud University, Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging (A.M.T., D.G.N.), Nijmegen, the Netherlands; Department of Neurology (K.F.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), UNESCO-Weltkulturerbe Zollverein, Leitstand Kokerei Zollverein, Essen, Germany; MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands; and Department of Radiology and Nuclear Medicine (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frank-Erik de Leeuw
- From the Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, Department of Neurology (H.M.v.d.H., I.W.M.v.U., A.M.T., E.J.v.D., R.A.J.E., F.-E.d.L.), and Radboud University, Donders Institute for Brain, Cognition and Behaviour, Center for Cognitive Neuroimaging (A.M.T., D.G.N.), Nijmegen, the Netherlands; Department of Neurology (K.F.d.L.), HagaZiekenhuis Den Haag, the Netherlands; Department of Neurology (A.G.W.v.N.), Amphia Ziekenhuis Breda, the Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging (D.G.N.), UNESCO-Weltkulturerbe Zollverein, Leitstand Kokerei Zollverein, Essen, Germany; MIRA Institute for Biomedical Technology and Technical Medicine (D.G.N.), University of Twente, Enschede, the Netherlands; and Department of Radiology and Nuclear Medicine (B.P.), Radboud University Medical Center, Nijmegen, the Netherlands.
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Maaijwee NAMM, Arntz RM, Rutten-Jacobs LCA, Schaapsmeerders P, Schoonderwaldt HC, van Dijk EJ, de Leeuw FE. Post-stroke fatigue and its association with poor functional outcome after stroke in young adults. J Neurol Neurosurg Psychiatry 2015; 86:1120-6. [PMID: 25362090 DOI: 10.1136/jnnp-2014-308784] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 10/10/2014] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Post-stroke fatigue negatively influences short-term functional outcome in older stroke survivors. In young adults, in the midst of their active working and family life, this influence may even be more pronounced. However, there are only few studies on this topic in young patients with stroke. Therefore, we investigated the long-term prevalence of post-stroke fatigue in patients with a young transient ischaemic attack (TIA) or ischaemic stroke and its association with functional outcome. METHODS This study is part of a large cohort study among 511 stroke survivors with a first-ever TIA or ischaemic stroke, aged 18-50 years. After a mean follow-up of 9.8 (SD 8.4) years, we assessed the presence of fatigue with the fatigue subscale of the Checklist Individual Strength questionnaire and functional outcome. Prevalence of fatigue between young patients with stroke and 147 stroke-free sex-matched and age-matched controls was compared. OR's for poor functional outcome on modified Rankin Score (mRS>2) and Instrumental Activities of Daily Living (IADL<8) and cognitive performance were calculated using logistic regression analysis. RESULTS Of the young patients with stroke, 41% experienced symptoms of fatigue, versus 18.4% in controls (p 0.0005). Fatigue was associated with a poor functional outcome, as assessed by the mRS (OR 4.0 (95% CI 1.6 to 9.6), IADL (OR 2.2 (95% CI 1.1 to 4.6), and impairment in speed of information processing (OR 2.2 (95% CI 1.3 to 3.9). CONCLUSIONS Fatigue was very common in young stroke survivors and was associated with a poor functional outcome, even after almost a decade of follow-up.
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Affiliation(s)
- Noortje A M M Maaijwee
- Department of Neurology, Radboud University Nijmegen Medical Centre, The Netherlands, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
| | - Renate M Arntz
- Department of Neurology, Radboud University Nijmegen Medical Centre, The Netherlands, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
| | | | - Pauline Schaapsmeerders
- Department of Neurology, Radboud University Nijmegen Medical Centre, The Netherlands, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
| | - Henny C Schoonderwaldt
- Department of Neurology, Radboud University Nijmegen Medical Centre, The Netherlands, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
| | - Ewoud J van Dijk
- Department of Neurology, Radboud University Nijmegen Medical Centre, The Netherlands, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Radboud University Nijmegen Medical Centre, The Netherlands, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
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Wilbers J, Kappelle AC, Versteeg L, Tuladhar AM, Steens SCA, Meijer FJA, Boogerd W, Dorresteijn LD, Kaanders JH, Kessels RPC, van Dijk EJ. Cognitive function, depression, fatigue and quality of life among long-term survivors of head and neck cancer. Neurooncol Pract 2015; 2:144-150. [PMID: 31386076 DOI: 10.1093/nop/npv012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 01/20/2015] [Indexed: 11/12/2022] Open
Abstract
Background Long-term cancer treatment complications become more prevalent as survival improves. Little is known about the psychological complications in long-term survivors of head and neck cancer (HNC). We investigated cognitive functioning and its relation with depression, fatigue, cognitive complaints, and brain lesions on MRI. Methods This study is part of a multicentre, prospective cohort study of 65 patients treated for HNC. A comprehensive neuropsychological assessment was combined with validated questionnaires on subjective memory complaints, depression, and fatigue after a median of 7 years follow-up. Results were compared with age- and education-adjusted normative data. Further, we evaluated cerebral white matter hyperintensities (WMH), brain volume, and infarctions on MRI. Results HNC patients had worse cognitive performance in two of the five assessed cognitive domains: episodic memory (z = -0.48, P = .003) and speed of information processing (z = -0.47, P < 0.001). Patients with fatigue performed worse than patients without fatigue on verbal fluency (mean difference in z-score 0.52, P = .02) and speed of information processing (0.49, P = .04). Patients with subjective memory complaints had a worse episodic memory performance (mean difference in z-score -0.96; P = .02). Patients with cerebral infarction(s) on MRI performed worse on fluency (mean difference in z-score 0.74, P = .005). A lower cognitive performance was not associated with depression, WMH or brain volume. Conclusion Long-term HNC survivors showed worse cognitive functioning 7 years after treatment. Cognitive function was associated with subjective complaints and fatigue, but not with depressive symptoms. Cerebral infarctions on MRI were correlated with cognitive function, whereas WMH, and brain volume were not.
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Affiliation(s)
- Joyce Wilbers
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen PO Box 9101, 6500 HB Nijmegen, the Netherlands (J.W., A.C.K., A.M.T., E.J.v.D.); Department of Medical Psychology, Radboud University Medical Center and Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, 6500 HE, the Netherlands (L.V., R.P.C.K.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands (S.C.A.S., F.J.A.M.); Department of Neurology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, PO Box 90203, 1006 BE Amsterdam, the Netherlands (W.B.); Department of Neurology, Medisch Spectrum Twente, PO Box 50000, 7500 KA Enschede, the Netherlands (L.D.D.); Department of Radiation Oncology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (J.H.K.)
| | - Arnoud C Kappelle
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen PO Box 9101, 6500 HB Nijmegen, the Netherlands (J.W., A.C.K., A.M.T., E.J.v.D.); Department of Medical Psychology, Radboud University Medical Center and Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, 6500 HE, the Netherlands (L.V., R.P.C.K.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands (S.C.A.S., F.J.A.M.); Department of Neurology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, PO Box 90203, 1006 BE Amsterdam, the Netherlands (W.B.); Department of Neurology, Medisch Spectrum Twente, PO Box 50000, 7500 KA Enschede, the Netherlands (L.D.D.); Department of Radiation Oncology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (J.H.K.)
| | - Laura Versteeg
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen PO Box 9101, 6500 HB Nijmegen, the Netherlands (J.W., A.C.K., A.M.T., E.J.v.D.); Department of Medical Psychology, Radboud University Medical Center and Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, 6500 HE, the Netherlands (L.V., R.P.C.K.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands (S.C.A.S., F.J.A.M.); Department of Neurology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, PO Box 90203, 1006 BE Amsterdam, the Netherlands (W.B.); Department of Neurology, Medisch Spectrum Twente, PO Box 50000, 7500 KA Enschede, the Netherlands (L.D.D.); Department of Radiation Oncology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (J.H.K.)
| | - Anil M Tuladhar
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen PO Box 9101, 6500 HB Nijmegen, the Netherlands (J.W., A.C.K., A.M.T., E.J.v.D.); Department of Medical Psychology, Radboud University Medical Center and Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, 6500 HE, the Netherlands (L.V., R.P.C.K.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands (S.C.A.S., F.J.A.M.); Department of Neurology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, PO Box 90203, 1006 BE Amsterdam, the Netherlands (W.B.); Department of Neurology, Medisch Spectrum Twente, PO Box 50000, 7500 KA Enschede, the Netherlands (L.D.D.); Department of Radiation Oncology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (J.H.K.)
| | - Stefan C A Steens
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen PO Box 9101, 6500 HB Nijmegen, the Netherlands (J.W., A.C.K., A.M.T., E.J.v.D.); Department of Medical Psychology, Radboud University Medical Center and Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, 6500 HE, the Netherlands (L.V., R.P.C.K.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands (S.C.A.S., F.J.A.M.); Department of Neurology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, PO Box 90203, 1006 BE Amsterdam, the Netherlands (W.B.); Department of Neurology, Medisch Spectrum Twente, PO Box 50000, 7500 KA Enschede, the Netherlands (L.D.D.); Department of Radiation Oncology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (J.H.K.)
| | - Frederick J A Meijer
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen PO Box 9101, 6500 HB Nijmegen, the Netherlands (J.W., A.C.K., A.M.T., E.J.v.D.); Department of Medical Psychology, Radboud University Medical Center and Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, 6500 HE, the Netherlands (L.V., R.P.C.K.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands (S.C.A.S., F.J.A.M.); Department of Neurology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, PO Box 90203, 1006 BE Amsterdam, the Netherlands (W.B.); Department of Neurology, Medisch Spectrum Twente, PO Box 50000, 7500 KA Enschede, the Netherlands (L.D.D.); Department of Radiation Oncology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (J.H.K.)
| | - Willem Boogerd
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen PO Box 9101, 6500 HB Nijmegen, the Netherlands (J.W., A.C.K., A.M.T., E.J.v.D.); Department of Medical Psychology, Radboud University Medical Center and Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, 6500 HE, the Netherlands (L.V., R.P.C.K.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands (S.C.A.S., F.J.A.M.); Department of Neurology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, PO Box 90203, 1006 BE Amsterdam, the Netherlands (W.B.); Department of Neurology, Medisch Spectrum Twente, PO Box 50000, 7500 KA Enschede, the Netherlands (L.D.D.); Department of Radiation Oncology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (J.H.K.)
| | - Lucille D Dorresteijn
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen PO Box 9101, 6500 HB Nijmegen, the Netherlands (J.W., A.C.K., A.M.T., E.J.v.D.); Department of Medical Psychology, Radboud University Medical Center and Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, 6500 HE, the Netherlands (L.V., R.P.C.K.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands (S.C.A.S., F.J.A.M.); Department of Neurology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, PO Box 90203, 1006 BE Amsterdam, the Netherlands (W.B.); Department of Neurology, Medisch Spectrum Twente, PO Box 50000, 7500 KA Enschede, the Netherlands (L.D.D.); Department of Radiation Oncology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (J.H.K.)
| | - Johannes H Kaanders
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen PO Box 9101, 6500 HB Nijmegen, the Netherlands (J.W., A.C.K., A.M.T., E.J.v.D.); Department of Medical Psychology, Radboud University Medical Center and Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, 6500 HE, the Netherlands (L.V., R.P.C.K.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands (S.C.A.S., F.J.A.M.); Department of Neurology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, PO Box 90203, 1006 BE Amsterdam, the Netherlands (W.B.); Department of Neurology, Medisch Spectrum Twente, PO Box 50000, 7500 KA Enschede, the Netherlands (L.D.D.); Department of Radiation Oncology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (J.H.K.)
| | - Roy P C Kessels
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen PO Box 9101, 6500 HB Nijmegen, the Netherlands (J.W., A.C.K., A.M.T., E.J.v.D.); Department of Medical Psychology, Radboud University Medical Center and Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, 6500 HE, the Netherlands (L.V., R.P.C.K.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands (S.C.A.S., F.J.A.M.); Department of Neurology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, PO Box 90203, 1006 BE Amsterdam, the Netherlands (W.B.); Department of Neurology, Medisch Spectrum Twente, PO Box 50000, 7500 KA Enschede, the Netherlands (L.D.D.); Department of Radiation Oncology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (J.H.K.)
| | - Ewoud J van Dijk
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen PO Box 9101, 6500 HB Nijmegen, the Netherlands (J.W., A.C.K., A.M.T., E.J.v.D.); Department of Medical Psychology, Radboud University Medical Center and Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, 6500 HE, the Netherlands (L.V., R.P.C.K.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands (S.C.A.S., F.J.A.M.); Department of Neurology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, PO Box 90203, 1006 BE Amsterdam, the Netherlands (W.B.); Department of Neurology, Medisch Spectrum Twente, PO Box 50000, 7500 KA Enschede, the Netherlands (L.D.D.); Department of Radiation Oncology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands (J.H.K.)
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Synhaeve NE, Schaapsmeerders P, Arntz RM, Maaijwee NA, Rutten-Jacobs LC, Schoonderwaldt HC, Dorresteijn LD, de Kort PL, van Dijk EJ, Kessels RP, de Leeuw FE. Cognitive performance and poor long-term functional outcome after young stroke. Neurology 2015; 85:776-82. [DOI: 10.1212/wnl.0000000000001882] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 05/04/2015] [Indexed: 01/24/2023] Open
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Arntz RM, Rutten-Jacobs LCA, Maaijwee NAM, Schoonderwaldt HC, Dorresteijn LDA, van Dijk EJ, de Leeuw FE. Poststroke Epilepsy Is Associated With a High Mortality After a Stroke at Young Age: Follow-Up of Transient Ischemic Attack and Stroke Patients and Unelucidated Risk Factor Evaluation Study. Stroke 2015; 46:2309-11. [PMID: 26138118 DOI: 10.1161/strokeaha.115.010115] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [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: 05/19/2015] [Accepted: 05/22/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Poststroke epilepsy is a common complication after a young stroke. We investigated the association between poststroke epilepsy and mortality. METHODS We performed a prospective cohort study among 631 patients with a first-ever transient ischemic attack or ischemic stroke, aged 18 to 50 years. Survival analysis and Cox proportional hazard analysis were used to estimate cumulative mortality and hazard ratios for patients with and without epilepsy. RESULTS After mean follow-up of 12.5 years (SD 8.6), 76 (12.0%) developed poststroke epilepsy. Case fatality was 27.4% for patients with poststroke epilepsy and 2.1% for those without. Poststroke epilepsy was associated with 30-day mortality (hazard ratio, 4.8; 95% confidence interval, 1.7-14.0) and long-term mortality (hazard ratio, 1.8; 95% confidence interval, 1.2-2.9). CONCLUSIONS Epilepsy is a common problem after a young stroke and is associated with an increased short-term and long-term mortality.
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Affiliation(s)
- Renate M Arntz
- From the Department of Neurology and Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands (R.M.A., L.C.A.R.-J., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Neurology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurolog, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Loes C A Rutten-Jacobs
- From the Department of Neurology and Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands (R.M.A., L.C.A.R.-J., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Neurology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurolog, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Noortje A M Maaijwee
- From the Department of Neurology and Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands (R.M.A., L.C.A.R.-J., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Neurology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurolog, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Hennie C Schoonderwaldt
- From the Department of Neurology and Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands (R.M.A., L.C.A.R.-J., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Neurology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurolog, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Lucille D A Dorresteijn
- From the Department of Neurology and Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands (R.M.A., L.C.A.R.-J., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Neurology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurolog, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Ewoud J van Dijk
- From the Department of Neurology and Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands (R.M.A., L.C.A.R.-J., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Neurology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurolog, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Frank-Erik de Leeuw
- From the Department of Neurology and Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands (R.M.A., L.C.A.R.-J., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Neurology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurolog, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.).
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van Uden IWM, Tuladhar AM, de Laat KF, van Norden AGW, Norris DG, van Dijk EJ, Tendolkar I, de Leeuw FE. White matter integrity and depressive symptoms in cerebral small vessel disease: The RUN DMC study. Am J Geriatr Psychiatry 2015; 23:525-35. [PMID: 25151438 DOI: 10.1016/j.jagp.2014.07.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 07/01/2014] [Accepted: 07/12/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Depressive symptoms are common in elderly with cerebral small vessel disease (SVD). As not every individual with SVD experiences depressive symptoms, other factors might play a role. We therefore investigated the white matter (WM) integrity of the white matter tracts in elderly with depressive symptoms, independent of global cognitive function, by applying the tract-based spatial statistics (TBSS). DESIGN Prospective cohort study with cross-sectional baseline data. SETTING Radboud University Nijmegen Medical Centre, The Netherlands. PARTICIPANTS 438 individuals aged between 50-85 years, with SVD without dementia. MEASUREMENTS Diffusion tensor imaging parameters and depressive symptoms, assessed with the Center for Epidemiologic Studies Depression Scale. RESULTS Compared with non-depressed participants (N = 287), those with depressive symptoms (N = 151) had lower fractional anisotropy in the genu and body of the corpus callosum, bilateral inferior fronto-occipital fasciculus, uncinate fasciculus, and corona radiata. These differences disappeared after adjustment for white matter hyperintensities (WMH) and lacunar infarcts. Mean-, axial- and radial diffusivity were higher in these areas in participants with depressive symptoms. After additional adjustment for WMH and lacunar infarcts, the changes observed in radial diffusivity also disappeared. Adding global cognition as confounding variable altered the diffusion parameters only slightly. CONCLUSION This study indicates that elderly with depressive symptoms show a lower WM integrity, independent of global cognitive function, and that the presence of SVD is mostly responsible, affecting the fronto-subcortical regions and hereby disrupting the neural circuitry involved in mood regulation.
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Affiliation(s)
- Ingeborg W M van Uden
- Department of Neurology, Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Centre for Cognitive Neuroimaging, Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Karlijn F de Laat
- Department of Neurology, Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Neurology, HagaZiekenhuis, The Hague, The Netherlands
| | - Anouk G W van Norden
- Department of Neurology, Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Neurology, Amphia Ziekenhuis, Breda, The Netherlands
| | - David G Norris
- Centre for Cognitive Neuroimaging, Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Essen, Germany
| | - Ewoud J van Dijk
- Department of Neurology, Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Indira Tendolkar
- Department of Psychiatry, Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
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Wilbers J, Meijer FJA, Kappelle AC, Kaanders JH, Boogerd W, Dorresteijn LD, van Dijk EJ, Steens SCA. Magnetic resonance imaging of the carotid artery in long-term head and neck cancer survivors treated with radiotherapy. Acta Oncol 2015; 54:1175-80. [PMID: 25831144 DOI: 10.3109/0284186x.2015.1023901] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND In head and neck cancer (HNC) patients, long-term treatment-related complications include radiotherapy (RT)-induced carotid vasculopathy and stroke. The current study investigated the magnetic resonance imaging (MRI) characteristics of the carotid wall in long-term HNC survivors treated with RT. METHODS MRI of the carotid arteries was performed within a prospective cohort of 42 HNC patients on average 7 years after RT. Two independent radiologists assessed maximal vessel wall thickness of common and internal carotid arteries. In case of wall thickening (≥ 2 mm) the MRI signals as well as length of the thickened segment were assessed. RESULTS Mean (SD) age of the 42 patients at baseline was 53 (13) years and mean (SD) follow-up time after RT was 6.8 (1.3) years. In total 62% were men and 60% had one or more cerebrovascular risk factors. Mean (SD) dose of RT on the common carotid arteries and internal carotid arteries was 57 Gy (11) and 61 Gy (10), respectively. Wall thickening was observed in 58% of irradiated versus 27% of non-irradiated common carotid arteries and 24% of irradiated versus 6% of non-irradiated internal carotid arteries (p < 0.05). Mean (SD) thickness of the irradiated and non-irradiated common carotid arteries was 2.5 (0.9) and 2 (0.7) mm (p = 0.02). Mean thickness of the irradiated and non-irradiated internal carotid arteries was 1.8 (0.8) and 1.5 mm (0.3) (n.s.). Mean length of the thickened vessel wall was 48 mm versus 36 mm in the irradiated versus non-irradiated common carotid arteries (p = 0.03) and 20 mm versus 15 mm in the irradiated versus non-irradiated internal carotid arteries (n.s.). No significant differences were observed for signal intensities of the vessel walls. CONCLUSIONS Our study showed significantly more vessel wall thickening in irradiated versus non-irradiated carotid arteries years after RT for HNC, while no differences in signal intensities were observed.
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Affiliation(s)
- Joyce Wilbers
- a Department of Neurology , Radboud University Nijmegen Medical Center, Donders Institute for Brain, Cognition and Behaviour Centre for Neuroscience , Nijmegen , The Netherlands
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van Rooij FG, Tuladhar AM, Kessels RPC, Vermeer SE, Góraj BM, Koudstaal PJ, Norris DG, de Leeuw FE, van Dijk EJ. Cohort study ON Neuroimaging, Etiology and Cognitive consequences of Transient neurological attacks (CONNECT): study rationale and protocol. BMC Neurol 2015; 15:36. [PMID: 25880287 PMCID: PMC4379587 DOI: 10.1186/s12883-015-0295-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 03/05/2015] [Indexed: 12/04/2022] Open
Abstract
Background Transient ischemic attacks (TIA) are characterized by acute onset focal neurological symptoms and complete recovery within 24 hours. Attacks of nonfocal symptoms not fulfilling the criteria for TIA but lacking a clear alternative diagnosis are called transient neurological attacks (TNA). Although TIA symptoms are transient in nature, cognitive complaints may persist. In particular, attacks consisting of both focal and nonfocal symptoms (mixed TNA) have been found to be associated with an increased risk of dementia. We aim to study the prevalence, etiology and risk factors of cognitive impairment after TIA or TNA. Methods/Design CONNECT is a prospective cohort study on cognitive function after TIA and TNA. In total, 150 patients aged ≥45 years with a recent (<7 days after onset) TIA or TNA and no history of stroke or dementia will be included. We will classify events as: TIA, nonfocal TNA, or mixed TNA. Known short lasting paroxysmal neurological disorders like migraine aura, seizures and Ménière disease are excluded from the diagnosis of TNA. Patients will complete a comprehensive neuropsychological assessment and undergo MRI <7 days after the qualifying event and again after six months. The primary clinical outcomes will be cognitive function at baseline and six months after the primary event. Imaging outcomes include the prevalence and evolution of DWI lesions, white matter hyperintensities and lacunes, as well as resting state networks functionality and white matter microstructural integrity. Differences between types of event and DWI, as well as determinants of both clinical and imaging outcomes, will be assessed. Discussion CONNECT can provide insight in the prevalence, etiology and risk factors of cognitive impairment after TIA and TNA and thereby potentially identify a new group of patients at increased risk of cognitive impairment.
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Affiliation(s)
- Frank G van Rooij
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, Netherlands.
| | - Anil M Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, Netherlands.
| | - Roy P C Kessels
- Department of Medical Psychology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, Netherlands. .,Department of Geriatrics, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, Netherlands. .,Donders Institute for Brain, Cognition and Behaviour, Centre for Cognition, Radboud University Nijmegen, 6500 HE, Nijmegen, Netherlands.
| | - Sarah E Vermeer
- Department of Neurology, Rijnstate Hospital, PO Box 9555, 6800 TA, Arnhem, Netherlands.
| | - Bozena M Góraj
- Department of Radiology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, Netherlands.
| | - Peter J Koudstaal
- Erasmus Medical Center, Department of Neurology, PO Box 2040, 3000 CA, Rotterdam, Netherlands.
| | - David G Norris
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, 6500 HE, Nijmegen, Netherlands.
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, Netherlands.
| | - Ewoud J van Dijk
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, Netherlands.
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Schaapsmeerders P, van Uden IWM, Tuladhar AM, Maaijwee NAM, van Dijk EJ, Rutten-Jacobs LCA, Arntz RM, Schoonderwaldt HC, Dorresteijn LDA, de Leeuw FE, Kessels RPC. Ipsilateral hippocampal atrophy is associated with long-term memory dysfunction after ischemic stroke in young adults. Hum Brain Mapp 2015; 36:2432-42. [PMID: 25757914 DOI: 10.1002/hbm.22782] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [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: 11/22/2014] [Revised: 01/16/2015] [Accepted: 02/24/2015] [Indexed: 11/06/2022] Open
Abstract
Memory impairment after stroke in young adults is poorly understood. In elderly stroke survivors memory impairments and the concomitant loss of hippocampal volume are usually explained by coexisting neurodegenerative disease (e.g., amyloid pathology) in interaction with stroke. However, neurodegenerative disease, such as amyloid pathology, is generally absent at young age. Accumulating evidence suggests that infarction itself may cause secondary neurodegeneration in remote areas. Therefore, we investigated the relation between long-term memory performance and hippocampal volume in young patients with first-ever ischemic stroke. We studied all consecutive first-ever ischemic stroke patients, aged 18-50 years, admitted to our academic hospital center between 1980 and 2010. Episodic memory of 173 patients was assessed using the Rey Auditory Verbal Learning Test and the Rey Complex Figure and compared with 87 stroke-free controls. Hippocampal volume was determined using FSL-FIRST, with manual correction. On average 10 years after stroke, patients had smaller ipsilateral hippocampal volumes compared with controls after left-hemispheric stroke (5.4%) and right-hemispheric stroke (7.7%), with most apparent memory dysfunctioning after left-hemispheric stroke. A larger hemispheric stroke was associated with a smaller ipsilateral hippocampal volume (b=-0.003, P<0.0001). Longer follow-up duration was associated with smaller ipsilateral hippocampal volume after left-hemispheric stroke (b=-0.028 ml, P=0.002) and right-hemispheric stroke (b=-0.015 ml, P=0.03). Our results suggest that infarction is associated with remote injury to the hippocampus, which may lower or expedite the threshold for cognitive impairment or even dementia later in life.
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Affiliation(s)
- Pauline Schaapsmeerders
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Inge W M van Uden
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Noortje A M Maaijwee
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ewoud J van Dijk
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Loes C A Rutten-Jacobs
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Renate M Arntz
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Hennie C Schoonderwaldt
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Roy P C Kessels
- Centre for Neuroscience and Centre for Cognition, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands.,Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Rutten-Jacobs LC, Arntz RM, Maaijwee NA, Schoonderwaldt HC, Dorresteijn LD, van Dijk EJ, de Leeuw FE. Cardiovascular Disease Is the Main Cause of Long-Term Excess Mortality After Ischemic Stroke in Young Adults. Hypertension 2015; 65:670-5. [DOI: 10.1161/hypertensionaha.114.04895] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adults with stroke at a young age (18–50 years) remain at an increased risk of death for decades. It is unclear what cause underlies this long-term excess mortality and whether this is sex and time specific. Therefore, we investigated sex-specific temporal changes in cause of death after transient ischemic attack or ischemic stroke in young adults aged 18 to 50 years. We included all 845 consecutive 30-day survivors, of a first-ever transient ischemic attack (n=261) or ischemic stroke (n=584), admitted to our hospital between 1980 and 2010. Survival status was assessed at April 1, 2013. Observed cause-specific mortality was compared with expected mortality, derived from mortality rates in the general population with similar age, sex, and calendar-year characteristics. During a median follow-up of 9.2 years, 146 patients (17.3%) died, such that 29 years of life was lost by each individual. For all causes of death, observed mortality exceeded expected mortality. The absolute excess risk of death was for 74% attributable to a vascular cause (absolute excess risk, 2.8 per 1000 person-years [95% confidence interval, 1.8–4.1] for stroke and absolute excess risk, 4.3 per 1000 person-years [95% confidence interval, 2.9–5.9] for other vascular causes). The absolute excess risk was highest between 10 and 15 years after stroke and this peak was most pronounced in men and mainly attributable to vascular death. Long-term excess death after stroke in young adults is mainly attributable to a vascular cause and most pronounced in men. Attempts to reduce the risk of vascular disease after stroke in young adults should extend beyond the acute phase into the long term.
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Affiliation(s)
- Loes C.A. Rutten-Jacobs
- From the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands (L.C.A.R.-J., R.M.A., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.D.)
| | - Renate M. Arntz
- From the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands (L.C.A.R.-J., R.M.A., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.D.)
| | - Noortje A.M. Maaijwee
- From the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands (L.C.A.R.-J., R.M.A., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.D.)
| | - Hennie C. Schoonderwaldt
- From the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands (L.C.A.R.-J., R.M.A., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.D.)
| | - Lucille D. Dorresteijn
- From the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands (L.C.A.R.-J., R.M.A., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.D.)
| | - Ewoud J. van Dijk
- From the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands (L.C.A.R.-J., R.M.A., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.D.)
| | - Frank-Erik de Leeuw
- From the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands (L.C.A.R.-J., R.M.A., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.D.)
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Tuladhar AM, van Norden AGW, de Laat KF, Zwiers MP, van Dijk EJ, Norris DG, de Leeuw FE. White matter integrity in small vessel disease is related to cognition. Neuroimage Clin 2015; 7:518-24. [PMID: 25737960 PMCID: PMC4338206 DOI: 10.1016/j.nicl.2015.02.003] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 02/06/2015] [Accepted: 02/10/2015] [Indexed: 01/21/2023]
Abstract
Cerebral small vessel disease, including white matter hyperintensities (WMH) and lacunes of presumed vascular origin, is common in elderly people and is related to cognitive impairment and dementia. One possible mechanism could be the disruption of white matter tracts (both within WMH and normal-appearing white matter) that connect distributed brain regions involved in cognitive functions. Here, we investigated the relation between microstructural integrity of the white matter and cognitive functions in patients with small vessel disease. The Radboud University Nijmegen Diffusion tensor and Magnetic resonance Cohort study is a prospective cohort study among 444 independently living, non-demented elderly with cerebral small vessel disease, aged between 5500 and 85 years. All subjects underwent magnetic resonance imaging and diffusion tensor imaging scanning and an extensive neuropsychological assessment. We showed that loss of microstructural integrity of the white matter at specific locations was related to specific cognitive disturbances, which was mainly located in the normal-appearing white matter (p < 0.05, FWE-corrected for multiple comparisons). The microstructural integrity in the genu and splenium showed the highest significant relation with global cognitive function and executive functions, in the cingulum bundle with verbal memory performance. Associations between diffusion tensor imaging parameters and most cognitive domains remained present after adjustment for WMH and lacunes. In conclusion, cognitive disturbances in subjects with cerebral small vessel disease are related to microstructural integrity of multiple white matter fibers (within WMH and normal-appearing white matter) connecting different cortical and subcortical regions. White matter integrity in small vessel disease (SVD) was assessed with DTI. White matter integrity was related to cognition independent of SVD-markers. This relation was seen in multiple fibers within white matter hyperintensities. But also in normal-appearing white matter connecting different (sub)cortical regions
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Affiliation(s)
- Anil M Tuladhar
- Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Radboudumc, PO Box 9101, Nijmegen 6500 HB, The Netherlands ; Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, PO Box 9101, Nijmegen 6500 HB, The Netherlands
| | | | | | - Marcel P Zwiers
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, PO Box 9101, Nijmegen 6500 HB, The Netherlands
| | - Ewoud J van Dijk
- Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Radboudumc, PO Box 9101, Nijmegen 6500 HB, The Netherlands
| | - David G Norris
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, PO Box 9101, Nijmegen 6500 HB, The Netherlands ; Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Essen, Germany ; MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Frank-Erik de Leeuw
- Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Radboudumc, PO Box 9101, Nijmegen 6500 HB, The Netherlands ; Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Psychiatry, Radboud University Nijmegen Medical Centre, PO Box 9101, Nijmegen 6500 HB, The Netherlands
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