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Article ; Online: Mechanical thrombectomy for acute ischemic stroke revealing a cardiac myxoma: histological and immunohistochemical study to determine myxomatous emboli.

Vantyghem, Soetkin / Staessens, Senna / Francois, Olivier / De Meyer, Simon F / Vanacker, Peter

2023 Volume 123, Issue 3, Page(s) 1201–1203

MeSH term(s)	Humans ; Ischemic Stroke/complications ; Ischemic Stroke/diagnostic imaging ; Stroke/complications ; Stroke/diagnostic imaging ; Brain Ischemia/complications ; Brain Ischemia/diagnostic imaging ; Thrombectomy ; Myxoma/complications ; Myxoma/diagnostic imaging ; Myxoma/pathology ; Tissue Plasminogen Activator ; Treatment Outcome
Chemical Substances	Tissue Plasminogen Activator (EC 3.4.21.68)
Language	English
Publishing date	2023-04-11
Publishing country	Italy
Document type	Letter
ZDB-ID	127315-2
ISSN	2240-2993 ; 0300-9009
ISSN (online)	2240-2993
ISSN	0300-9009
DOI	10.1007/s13760-023-02254-6
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Article ; Online: A Case Report of Acute Cervical Dystonia After Electroconvulsive Therapy.

De Moerloose, Stefanie / Geerts, Pieter-Jan / Vanacker, Peter / Lemmens, Gilbert M D

The journal of ECT

2022 Volume 38, Issue 4, Page(s) 260–261

MeSH term(s)	Humans ; Electroconvulsive Therapy/adverse effects ; Torticollis/etiology ; Torticollis/therapy ; Male ; Aged
Language	English
Publishing date	2022-05-25
Publishing country	United States
Document type	Case Reports ; Letter
ZDB-ID	1426385-3
ISSN	1533-4112 ; 1095-0680
ISSN (online)	1533-4112
ISSN	1095-0680
DOI	10.1097/YCT.0000000000000865
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Article ; Online: Multicentric validation of a reduced features case-mix set for predicting functional outcome after ischemic stroke in Belgium.

Ordies, Sofie / Lesenne, Anouk / Bekelaar, Kim / Demeestere, Jelle / Lemmens, Robin / Vanacker, Peter / Mesotten, Dieter

Acta neurologica Belgica

2022 Volume 123, Issue 2, Page(s) 545–551

Abstract: Introduction: Ischemic stroke is the second cause of death and leading cause of severe disability worldwide. A reduced features set of CT-DRAGON (age, NIHSS on admission and pre-stroke mRS) predicts 90-day functional outcome after stroke in a single ... ...

Abstract	Introduction: Ischemic stroke is the second cause of death and leading cause of severe disability worldwide. A reduced features set of CT-DRAGON (age, NIHSS on admission and pre-stroke mRS) predicts 90-day functional outcome after stroke in a single center. The current study was designed to validate this adapted CT-DRAGON score in three major Belgian hospitals, in the framework of future case-mix adjustment. Methods: This retrospective study included stroke patients, treated by thrombolysis, thrombectomy, a combination of both or neither thrombolysis or thrombectomy (conservative treatment) in 2019. Patient characteristics and 90-day mRS were collected. Multivariable logistic regression analysis of 90-day mRS 0-2 vs. 3-6 and 0-5 vs. 6 with the reduced features set was performed. Discriminative performance was assessed by the area under the receiver operating characteristic curve (AUROC). Results: Thirty-three percent of patients (413/1243) underwent treatment. Majority of strokes was treated conservatively (n = 830, 67%), 18% (n = 225) was treated by thrombolysis, 7% (n = 88) by thrombectomy and 8% (n = 100) by thrombolysis and thrombectomy. Age, NIHSS and pre-stroke mRS were independently associated with 90-day mRS 0-2 (all p ≤ 0.0001, AUROC 0.88). When treatment modality was added in the model, age, NIHSS, pre-stroke mRS and treatment modality were independently associated with 90-day mRS 0-2 (p < 0.0001, p < 0.0001, p < 0.0001 and p = 0.0001) AUROC 0.89). Age, NIHSS, pre-stroke mRS and treatment modality were independently associated with 90-day survival (p = 0.0001, p < 0.0001, p < 0.0001 and p = 0.008, AUROC 0.86). Discussion: The reduced features set (age, NIHSS and pre-mRS) was independently associated with long-term functional outcome in a Belgian multicentric cohort, making it useful for case-mix adjustments in Belgian stroke centers. Treatment modality was associated with long-term outcome.
MeSH term(s)	Humans ; Ischemic Stroke/complications ; Belgium/epidemiology ; Treatment Outcome ; Retrospective Studies ; Stroke/diagnosis ; Stroke/therapy ; Stroke/etiology ; Thrombectomy ; Brain Ischemia/complications
Language	English
Publishing date	2022-11-21
Publishing country	Italy
Document type	Journal Article
ZDB-ID	127315-2
ISSN	2240-2993 ; 0300-9009
ISSN (online)	2240-2993
ISSN	0300-9009
DOI	10.1007/s13760-022-02142-5
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Article ; Online: R-tPA Resistance Is Specific for Platelet-Rich Stroke Thrombi and Can Be Overcome by Targeting Nonfibrin Components.

Vandelanotte, Sarah / François, Olivier / Desender, Linda / Staessens, Senna / Vanhoorne, Alexander / Van Gool, Fréderick / Tersteeg, Claudia / Vanhoorelbeke, Karen / Vanacker, Peter / Andersson, Tommy / De Meyer, Simon F

Stroke

2024 Volume 55, Issue 5, Page(s) 1181–1190

Abstract: Background: Resistance to r-tPA (recombinant tissue-type plasminogen activator) is a well-known but poorly understood phenomenon that hampers successful recanalization in patients with acute ischemic stroke. Using clinically relevant thrombi from ... ...

Abstract	Background: Resistance to r-tPA (recombinant tissue-type plasminogen activator) is a well-known but poorly understood phenomenon that hampers successful recanalization in patients with acute ischemic stroke. Using clinically relevant thrombi from patients with acute ischemic stroke, we investigated if and how thrombus composition impacts r-tPA-mediated lysis. In addition, we explored strategies to overcome r-tPA resistance. Methods: Thrombi were split into 2 parts, 1 of which was used for thrombolysis and the other for detailed histological analysis. Thrombolysis was performed in normal human plasma using r-tPA alone, using r-tPA in combination with DNase-1 or using r-tPA in combination with N,N'-diacetyl-l-cystine. Thrombus lysis was calculated as the percentage of residual thrombus weight compared with its initial weight and the degree of lysis was linked to thrombus composition determined via histology. Results: Interestingly, we found that the efficacy of r-tPA-mediated thrombolysis was strongly correlated with the composition of the thrombi. Thrombi containing high amounts of red blood cells and low amounts of DNA and von Willebrand Factor were efficiently degraded by r-tPA, whereas thrombi containing low amounts of red blood cells and higher amounts of DNA and von Willebrand Factor were resistant to r-tPA. Importantly, combination of r-tPA with DNase-1 or N,N'-diacetyl-l-cystine significantly and specifically improved the lysis of these r-tPA-resistant thrombi. Conclusions: Using patient thrombus material, our results for the first time show that the composition of stroke thrombi largely determines their susceptibility to r-tPA-mediated thrombolysis. Red blood cell-poor thrombi have a specific resistance to r-tPA, which can be overcome by targeting nonfibrin components using DNase-1 or N,N'-diacetyl-l-cystine.
Language	English
Publishing date	2024-03-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	80381-9
ISSN	1524-4628 ; 0039-2499 ; 0749-7954
ISSN (online)	1524-4628
ISSN	0039-2499 ; 0749-7954
DOI	10.1161/STROKEAHA.123.045880
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Article ; Online: Be aware: COVID-19 the new stroke mimicker.

Zuurbier, Susanna M / Verschelde, Hanne-Laure / Vantyghem, Soetkin / Yperzeele, Laetitia / Vanacker, Peter

Acta neurologica Belgica

2020 Volume 121, Issue 1, Page(s) 309–310

MeSH term(s)	Awareness ; COVID-19/complications ; COVID-19/diagnostic imaging ; Diagnosis, Differential ; Humans ; Male ; Middle Aged ; Risk Factors ; Stroke/diagnostic imaging ; Stroke/etiology
Keywords	covid19
Language	English
Publishing date	2020-11-16
Publishing country	Italy
Document type	Case Reports ; Letter
ZDB-ID	127315-2
ISSN	2240-2993 ; 0300-9009
ISSN (online)	2240-2993
ISSN	0300-9009
DOI	10.1007/s13760-020-01543-8
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Article ; Online: Population health management in Belgium: a call-to-action and case study.

Steenkamer, Betty / Vaes, Bert / Rietzschel, Ernst / Crombez, John / De Geest, Sabina / Demeure, Fabian / Gielen, Marijke / Hermans, Michel P / Teughels, Stefan / Vanacker, Peter / van der Schueren, Thierry / Simoens, Steven

BMC health services research

2023 Volume 23, Issue 1, Page(s) 659

Abstract: Background: Although there are already success stories, population health management in Belgium is still in its infancy. A health system transformation approach such as population health management may be suited to address the public health issue of ... ...

Abstract	Background: Although there are already success stories, population health management in Belgium is still in its infancy. A health system transformation approach such as population health management may be suited to address the public health issue of atherosclerotic cardiovascular disease, as this is one of the main causes of mortality in Belgium. This article aims to raise awareness about population health management in Belgium by: (a) eliciting barriers and recommendations for its implementation as perceived by local stakeholders; (b) developing a population health management approach to secondary prevention of atherosclerotic cardiovascular disease; and (c) providing a roadmap to introduce population health management in Belgium. Methods: Two virtual focus group discussions were organized with 11 high-level decision makers in medicine, policy and science between October and December 2021. A semi-structured guide based on a literature review was used to anchor discussions. These qualitative data were studied by means of an inductive thematic analysis. Results: Seven inter-related barriers and recommendations towards the development of population health management in Belgium were identified. These related to responsibilities of different layers of government, shared responsibility for the health of the population, a learning health system, payment models, data and knowledge infrastructure, collaborative relationships and community involvement. The introduction of a population health management approach to secondary prevention of atherosclerotic cardiovascular disease may act as a proof-of-concept with a view to roll out population health management in Belgium. Conclusions: There is a need to instill a sense of urgency among all stakeholders to develop a joint population-oriented vision in Belgium. This call-to-action requires the support and active involvement of all Belgian stakeholders, both at the national and regional level.
MeSH term(s)	Humans ; Belgium ; Population Health Management ; Cardiovascular Diseases/prevention & control ; Focus Groups ; Government
Language	English
Publishing date	2023-06-20
Publishing country	England
Document type	Review ; Journal Article
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-023-09626-x
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Article ; Online: Smartphone-based atrial fibrillation screening in the general population: feasibility and impact on medical treatment.

Gruwez, Henri / Verbrugge, Frederik H / Proesmans, Tine / Evens, Stijn / Vanacker, Peter / Rutgers, Matthieu Pierre / Vanhooren, Geert / Bertrand, Philippe / Pison, Laurent / Haemers, Peter / Vandervoort, Pieter / Nuyens, Dieter

European heart journal. Digital health

2023 Volume 4, Issue 6, Page(s) 464–472

Abstract: Aims: The aim of this study is to determine the feasibility, detection rate, and therapeutic implications of large-scale smartphone-based screening for atrial fibrillation (AF).: Methods and results: Subjects from the general population in Belgium ... ...

Abstract	Aims: The aim of this study is to determine the feasibility, detection rate, and therapeutic implications of large-scale smartphone-based screening for atrial fibrillation (AF). Methods and results: Subjects from the general population in Belgium were recruited through a media campaign to perform AF screening during 8 consecutive days with a smartphone application. The application analyses photoplethysmography traces with artificial intelligence and offline validation of suspected signals to detect AF. The impact of AF screening on medical therapy was measured through questionnaires. Atrial fibrillation was detected in the screened population ( Conclusion: Smartphone-based AF screening is feasible at large scale. Screening increased OAC uptake and impacted therapy of both new and previously diagnosed clinical AF but failed to impact risk factor management in subjects with subclinical AF.
Language	English
Publishing date	2023-09-30
Publishing country	England
Document type	Journal Article
ISSN	2634-3916
ISSN (online)	2634-3916
DOI	10.1093/ehjdh/ztad054
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Article: Detailed histological analysis of a thrombectomy-resistant ischemic stroke thrombus: a case report.

Staessens, Senna / François, Olivier / Desender, Linda / Vanacker, Peter / Dewaele, Tom / Sciot, Raf / Vanhoorelbeke, Karen / Andersson, Tommy / De Meyer, Simon F

Thrombosis journal

2021 Volume 19, Issue 1, Page(s) 11

Abstract: Background: Mechanical removal of a thrombus by thrombectomy can be quite challenging. For reasons that are not fully understood, some thrombi require multiple passes to achieve successful recanalization, whereas other thrombi are efficiently removed in ...

Abstract	Background: Mechanical removal of a thrombus by thrombectomy can be quite challenging. For reasons that are not fully understood, some thrombi require multiple passes to achieve successful recanalization, whereas other thrombi are efficiently removed in a single pass. Since first pass success is associated with better clinical outcome, it is important to better understand the nature of thrombectomy resistant thrombi. The aim of this study was therefore to characterize the cellular and molecular composition of a thrombus that was very hard to retrieve via mechanical thrombectomy. Case presentation: In a patient that was admitted with a right middle cerebral artery M1-occlusion, 11 attempts using various thrombectomy devices and techniques were required for removal of the thrombus. This peculiar case provided a rare opportunity to perform an in-depth histopathological study of a difficult to retrieve thrombus. Thrombus material was histologically analyzed using hematoxylin and eosin, Martius Scarlet Blue stain (red blood cells and fibrin), Feulgen stain (DNA), von Kossa stain (calcifications) and immunohistochemical analysis of von Willebrand factor, platelets, leukocytes and neutrophil extracellular traps. Histological analysis revealed abnormally high amounts of extracellular DNA, leukocytes, von Willebrand factor and calcifications. Extracellular DNA stained positive for markers of leukocytes and NETs, suggesting that a significant portion of DNA is derived from neutrophil extracellular traps. Conclusion: In this unique case of a nearly thrombectomy-resistant stroke thrombus, our study showed an atypical composition compared to the common structural features found in ischemic stroke thrombi. The core of the retrieved thrombus consisted of extracellular DNA that colocalized with von Willebrand factor and microcalcifications. These results support the hypothesis that von Willebrand factor, neutrophil extracellular traps and microcalcifications contribute to mechanical thrombectomy resistance. Such information is important to identify novel targets in order to optimize technical treatment protocols and techniques to increase first pass success rates.
Language	English
Publishing date	2021-02-22
Publishing country	England
Document type	Journal Article
ISSN	1477-9560
ISSN	1477-9560
DOI	10.1186/s12959-021-00262-1
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Article ; Online: Studying Stroke Thrombus Composition After Thrombectomy: What Can We Learn?

Staessens, Senna / François, Olivier / Brinjikji, Waleed / Doyle, Karen M / Vanacker, Peter / Andersson, Tommy / De Meyer, Simon F

Stroke

2021 Volume 52, Issue 11, Page(s) 3718–3727

Abstract: The composition of ischemic stroke thrombi has gained an increasing amount of interest in recent years. The implementation of endovascular procedures in standard stroke care has granted researchers the unique opportunity to examine patient thrombus ... ...

Abstract	The composition of ischemic stroke thrombi has gained an increasing amount of interest in recent years. The implementation of endovascular procedures in standard stroke care has granted researchers the unique opportunity to examine patient thrombus material. Increasing evidence indicates that stroke thrombi are complex and heterogenous, consisting of various biochemical (eg, fibrin, von Willebrand Factor, and neutrophil extracellular traps) and cellular (eg, red blood cells, platelets, leukocytes, and bacteria) components. This complex composition may explain therapeutic limitations and also offer novel insights in several aspects of stroke management. Better understanding of thrombus characteristics could, therefore, potentially lead to improvements in the management of patients with stroke. In this review, we provide a comprehensive overview of the lessons learned by examining stroke thrombus composition after endovascular thrombectomy and its potential relevance for thrombectomy success rates, thrombolysis, clinical outcomes, stroke etiology, and radiological imaging.
MeSH term(s)	Humans ; Ischemic Stroke ; Thrombectomy ; Thrombosis
Language	English
Publishing date	2021-09-14
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	80381-9
ISSN	1524-4628 ; 0039-2499 ; 0749-7954
ISSN (online)	1524-4628
ISSN	0039-2499 ; 0749-7954
DOI	10.1161/STROKEAHA.121.034289
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Article ; Online: Influence of arterial occlusion on outcome after intravenous thrombolysis for acute ischemic stroke.

Medlin, Friedrich / Amiguet, Michael / Vanacker, Peter / Michel, Patrik

Stroke

2015 Volume 46, Issue 1, Page(s) 126–131

Abstract: Background and purpose: We aimed to assess the interaction between intravenous thrombolysis (IVT) and arterial occlusion on acute cervicocerebral computed tomographic angiography on the outcome of patients with acute ischemic stroke.: Methods: ... ...

Abstract	Background and purpose: We aimed to assess the interaction between intravenous thrombolysis (IVT) and arterial occlusion on acute cervicocerebral computed tomographic angiography on the outcome of patients with acute ischemic stroke. Methods: Patients from the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) registry with onset-to-door-time ≤4 hours, acute cervicocerebral computed tomographic angiography, a premorbid modified Rankin Scale ≤2, and a National Institute of Health Stroke Scale (NIHSS) >4 were selected. Patients with significant intracranial arterial obstruction (≥50%-99%) and undergoing acute endovascular treatment were excluded. An interaction analysis of IVT and initial arterial occlusion for favorable 3 months outcome (modified Rankin Scale <3) were performed with adjustment for potential confounders. Results: Among 654 included patients, 382 (58%) showed arterial occlusion, of whom 263 (69%) received IVT. Two hundred seventy-two showed no/minimal obstruction of whom 139 (51%) received IVT. In the adjusted interaction analysis, there was a trend in favor of the arterial occlusion group (odds ratio [OR]=3.97; 95% confidence interval [CI], 0.83-18.97; P=0.08). IVT (versus no IVT) was associated with better outcome in patients with occlusion (adjusted OR for favorable outcome, 3.01; 95% CI, 1.10-8.28) but not in patients with no/minimal obstruction (OR, 0.76; 95% CI, 0.21-2.74). Conversely, patients with occlusion had a similar rate of favorable outcome as no/minimal obstruction when thrombolysed (OR, 0.5; 95% CI, 0.17-1.47) but had a less favorable outcome without thrombolysis (OR, 0.13; 95% CI, 0.04-0.44). Conclusions: In this retrospective analysis of consecutive patients with acute ischemic stroke, there was a trend for more favorable outcomes with IVT in the setting of initial arterial occlusion than in the setting of no/minimal obstruction. Before confirmation in randomized controlled studies, this information should not influence thrombolysis decisions, however.
MeSH term(s)	Aged ; Aged, 80 and over ; Angiography ; Arterial Occlusive Diseases/complications ; Arterial Occlusive Diseases/diagnostic imaging ; Arterial Occlusive Diseases/drug therapy ; Brain Ischemia/complications ; Brain Ischemia/diagnostic imaging ; Brain Ischemia/drug therapy ; Cerebral Angiography ; Female ; Fibrinolytic Agents/therapeutic use ; Humans ; Male ; Middle Aged ; Odds Ratio ; Registries ; Stroke/diagnostic imaging ; Stroke/drug therapy ; Stroke/etiology ; Thrombolytic Therapy ; Tissue Plasminogen Activator/therapeutic use ; Tomography, X-Ray Computed ; Treatment Outcome
Chemical Substances	Fibrinolytic Agents ; Tissue Plasminogen Activator (EC 3.4.21.68)
Keywords	covid19
Language	English
Publishing date	2015-01
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80381-9
ISSN	1524-4628 ; 0039-2499 ; 0749-7954
ISSN (online)	1524-4628
ISSN	0039-2499 ; 0749-7954
DOI	10.1161/STROKEAHA.114.006408
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