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Article ; Online: Sex differences in clot, vessel and tissue characteristics in patients with a large vessel occlusion treated with endovascular thrombectomy.

van der Meij, Anne / Holswilder, Ghislaine / Bernsen, Marie Louise E / van Os, Hendrikus Ja / Hofmeijer, Jeannette / Spaander, Fianne Hm / Martens, Jasper M / van den Wijngaard, Ido R / Lingsma, Hester F / Konduri, Praneeta R / Blm Majoie, Charles / Schonewille, Wouter J / Dippel, Diederik Wj / Kruyt, Nyika D / Nederkoorn, Paul J / van Walderveen, Marianne Aa / Wermer, Marieke Jh

European stroke journal

2024 , Page(s) 23969873241231125

Abstract: Introduction: To improve our understanding of the relatively poor outcome after endovascular treatment (EVT) in women we assessed possible sex differences in baseline neuroimaging characteristics of acute ischemic stroke patients with large anterior ... ...

Abstract	Introduction: To improve our understanding of the relatively poor outcome after endovascular treatment (EVT) in women we assessed possible sex differences in baseline neuroimaging characteristics of acute ischemic stroke patients with large anterior vessel occlusion (LVO). Patients and methods: We included all consecutive patients from the MR CLEAN Registry who underwent EVT between 2014 and 2017. On baseline non-contrast CT and CT angiography, we assessed clot location and clot burden score (CBS), vessel characteristics (presence of atherosclerosis, tortuosity, size, and collateral status), and tissue characteristics with the Alberta Stroke Program Early Computed Tomography Score (ASPECTS). Radiological outcome was assessed with the extended thrombolysis in cerebral infarction score (eTICI) and functional outcome with the modified Rankin Scale score (mRS) at 90 days. Sex-differences were assessed with multivariable regression analyses with adjustments for possible confounders. Results: 3180 patients were included (median age 72 years, 48% women). Clots in women were less often located in the intracranial internal carotid artery (ICA) (25%vs 28%, odds ratio (OR) 0.85;95% confidence interval: 0.73-1.00). CBS was similar between sexes (median 6, IQR 4-8). Intracranial (aOR 0.73;95% CI:0.62-0.87) and extracranial (aOR 0.64;95% CI:0.43-0.95) atherosclerosis was less prevalent in women. Vessel tortuosity was more frequent in women in the cervical ICA (aOR 1.89;95% CI:1.39-2.57) and women more often had severe elongation of the aortic arch (aOR 1.38;95% CI:1.00-1.91). ICA radius was smaller in women (2.3vs 2.5 mm, mean difference 0.22;95% CI:0.09-0.35) while M1 radius was essentially equal (1.6vs 1.7 mm, mean difference 0.09;95% CI:-0.02-0.21). Women had better collateral status (⩾50% filling in 62%vs 53% in men, aOR 1.48;95% CI:1.29-1.70). Finally, ASPECT scores were equal between women and men (median 9 in both sexes, IQR 8-10vs 9-10). Reperfusion rates were similar between women and men (acOR 0.94;95% CI:0.83-1.07). However, women less often reached functional independence than men (34%vs 46%, aOR 0.68;95% CI:0.53-0.86). Discussion and conclusion: On baseline imaging of this Dutch Registry, men and women with LVO mainly differ in vessel characteristics such as atherosclerotic burden, extracranial vessel tortuosity, and collateral status. These sex differences do not result in different reperfusion rates and are, therefore, not likely to explain the worse functional outcome in women after EVT.
Language	English
Publishing date	2024-02-29
Publishing country	England
Document type	Journal Article
ZDB-ID	2851287-X
ISSN	2396-9881 ; 2396-9873
ISSN (online)	2396-9881
ISSN	2396-9873
DOI	10.1177/23969873241231125
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Article ; Online: Sex Differences in Prehospital Identification of Large Vessel Occlusion in Patients With Suspected Stroke.

Ali, Mariam / Dekker, Luuk / Daems, Jasper D / Ali, Mahsoem / van Zwet, Erik W / Steyerberg, Ewout W / Duvekot, Martijne H C / Nguyen, T Truc My / Moudrous, Walid / van de Wijdeven, Ruben M / Visser, Marieke C / de Laat, Karlijn F / Kerkhoff, Henk / van den Wijngaard, Ido R / Dippel, Diederik W J / Roozenbeek, Bob / Kruyt, Nyika D / Wermer, Marieke J H

Stroke

2024 Volume 55, Issue 3, Page(s) 548–554

Abstract: Background: Differences in clinical presentation of acute ischemic stroke between men and women may affect prehospital identification of anterior circulation large vessel occlusion (aLVO). We assessed sex differences in diagnostic performance of 8 ... ...

Abstract	Background: Differences in clinical presentation of acute ischemic stroke between men and women may affect prehospital identification of anterior circulation large vessel occlusion (aLVO). We assessed sex differences in diagnostic performance of 8 prehospital scales to detect aLVO. Methods: We analyzed pooled individual patient data from 2 prospective cohort studies (LPSS [Leiden Prehospital Stroke Study] and PRESTO [Prehospital Triage of Patients With Suspected Stroke Study]) conducted in the Netherlands between 2018 and 2019, including consecutive patients ≥18 years suspected of acute stroke who presented within 6 hours after symptom onset. Ambulance paramedics assessed clinical items from 8 prehospital aLVO detection scales: Los Angeles Motor Scale, Rapid Arterial Occlusion Evaluation, Cincinnati Stroke Triage Assessment Tool, Cincinnati Prehospital Stroke Scale, Prehospital Acute Stroke Severity, gaze-face-arm-speech-time, Conveniently Grasped Field Assessment Stroke Triage, and Face-Arm-Speech-Time Plus Severe Arm or Leg Motor Deficit. We assessed the diagnostic performance of these scales for identifying aLVO at prespecified cut points for men and women. Results: Of 2358 patients with suspected stroke (median age, 73 years; 47% women), 231 (10%) had aLVO (100/1114 [9%] women and 131/1244 [11%] men). The area under the curve of the scales ranged from 0.70 (95% CI, 0.65-0.75) to 0.77 (95% CI, 0.73-0.82) in women versus 0.69 (95% CI, 0.64-0.73) to 0.75 (95% CI, 0.71-0.79) in men. Positive predictive values ranged from 0.23 (95% CI, 0.20-0.27) to 0.29 (95% CI, 0.26-0.31) in women versus 0.29 (95% CI, 0.24-0.33) to 0.37 (95% CI, 0.32-0.43) in men. Negative predictive values were similar (0.95 [95% CI, 0.94-0.96] to 0.98 [95% CI, 0.97-0.98] in women versus 0.94 [95% CI, 0.93-0.95] to 0.96 [95% CI, 0.94-0.97] in men). Sensitivity of the scales was slightly higher in women than in men (0.53 [95% CI, 0.43-0.63] to 0.76 [95% CI, 0.68-0.84] versus 0.49 [95% CI, 0.40-0.57] to 0.63 [95% CI, 0.55-0.73]), whereas specificity was lower (0.79 [95% CI, 0.76-0.81] to 0.87 [95% CI, 0.84-0.89] versus 0.82 [95% CI, 0.79-0.84] to 0.90 [95% CI, 0.88-0.91]). Rapid arterial occlusion evaluation showed the highest positive predictive values in both sexes (0.29 in women and 0.37 in men), reflecting the different event rates. Conclusions: aLVO scales show similar diagnostic performance in both sexes. The rapid arterial occlusion evaluation scale may help optimize prehospital transport decision-making in men as well as in women with suspected stroke.
MeSH term(s)	Humans ; Female ; Male ; Aged ; Emergency Medical Services ; Ischemic Stroke ; Sex Characteristics ; Prospective Studies ; Stroke/diagnosis ; Triage ; Arterial Occlusive Diseases/diagnosis ; Brain Ischemia/diagnosis
Language	English
Publishing date	2024-02-01
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.123.044898
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Article ; Online: Sex differences in outcomes after endovascular treatment in posterior circulation stroke: results from the MR CLEAN Registry.

Ali, Mariam / Dekker, Luuk / Ali, Mahsoem / Van Zwet, Erik W / Hofmeijer, Jeanette / Nederkoorn, Paul J / Majoie, Charles Blm / van Es, Adriaan Cgm / Uyttenboogaart, Maarten / van der Meij, Anne / van Walderveen, Marianne A A / Visser, Marieke C / Dippel, Diederik Wj / Schonewille, Wouter J / van den Wijngaard, Ido R / Kruyt, Nyika D / Wermer, Marieke J H

Journal of neurointerventional surgery

2024

Abstract: Background: Women with anterior circulation large vessel occlusion (LVO) have been reported to have worse outcomes after endovascular treatment (EVT) than men. Whether these disparities also exist in LVO of the posterior circulation is yet uncertain. We ...

Abstract	Background: Women with anterior circulation large vessel occlusion (LVO) have been reported to have worse outcomes after endovascular treatment (EVT) than men. Whether these disparities also exist in LVO of the posterior circulation is yet uncertain. We assessed sex differences in clinical, technical, and safety outcomes of EVT in posterior circulation LVO. Methods: We used data of patients with posterior circulation LVO included in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry (2014-2018). Primary outcome was the modified Rankin Scale (mRS) score at 90 days assessed with multivariable ordinal regression analysis. Secondary outcomes included favorable functional outcome (mRS ≤3), functional independence (mRS ≤2), death within 90 days, National Institutes of Health Stroke Scale (NIHSS) score 24-48 hours postintervention, complications, successful reperfusion (extended Thrombolysis in Cerebral Ischemia 2B-3), and procedure duration analyzed with multivariable logistic and linear regression analyses. Results: We included 264 patients (42% women). Compared with men, women were older (median age 68 vs 63 years), more often had prestroke disability (mRS ≥1: 37% vs 30%), and received intravenous thrombolytics less often (45% vs 56%). Clinical outcomes were similar between sexes (adjusted (common) OR (aOR) 0.82, 95% CI 0.51 to 1.34; favorable functional outcome 50% vs 43%, aOR 1.31, 95% CI 0.77 to 2.25; death 32% vs 29%, aOR 0.98, 95% CI 0.52 to 1.84). In addition, NIHSS score after 24-48 hours (median 7 vs 9), successful reperfusion (77% vs 73%), and complications did not differ between men and women. Conclusions: Outcomes in women treated with EVT for posterior circulation LVO were similar compared with men despite less favorable baseline characteristics in women. Therefore men and women may benefit equally from EVT.
Language	English
Publishing date	2024-01-03
Publishing country	England
Document type	Journal Article
ZDB-ID	2514982-9
ISSN	1759-8486 ; 1759-8478
ISSN (online)	1759-8486
ISSN	1759-8478
DOI	10.1136/jnis-2023-021086
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Article ; Online: Symptomatic Intracranial Hemorrhage After Endovascular Stroke Treatment: External Validation of Prediction Models.

van der Ende, Nadinda A M / Kremers, Femke C C / van der Steen, Wouter / Venema, Esmee / Kappelhof, Manon / Majoie, Charles B L M / Postma, Alida A / Boiten, Jelis / van den Wijngaard, Ido R / van der Lugt, Aad / Dippel, Diederik W J / Roozenbeek, Bob

Stroke

2023 Volume 54, Issue 2, Page(s) 476–487

Abstract: Background: Symptomatic intracranial hemorrhage (sICH) is a severe complication of reperfusion therapy for ischemic stroke. Multiple models have been developed to predict sICH or intracranial hemorrhage (ICH) after reperfusion therapy. We provide an ... ...

Abstract	Background: Symptomatic intracranial hemorrhage (sICH) is a severe complication of reperfusion therapy for ischemic stroke. Multiple models have been developed to predict sICH or intracranial hemorrhage (ICH) after reperfusion therapy. We provide an overview of published models and validate their ability to predict sICH in patients treated with endovascular treatment in daily clinical practice. Methods: We conducted a systematic search to identify models either developed or validated to predict sICH or ICH after reperfusion therapy (intravenous thrombolysis and/or endovascular treatment) for ischemic stroke. Models were externally validated in the MR CLEAN Registry (n=3180; Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands). The primary outcome was sICH according to the Heidelberg Bleeding Classification. Model performance was evaluated with discrimination (c-statistic, ideally 1; a c-statistic below 0.7 is considered poor in discrimination) and calibration (slope, ideally 1, and intercept, ideally 0). Results: We included 39 studies describing 40 models. The most frequently used predictors were baseline National Institutes of Health Stroke Scale (NIHSS; n=35), age (n=22), and glucose level (n=22). In the MR CLEAN Registry, sICH occurred in 188/3180 (5.9%) patients. Discrimination ranged from 0.51 (SPAN-100 [Stroke Prognostication Using Age and National Institutes of Health Stroke Scale]) to 0.61 (SITS-SICH [Safe Implementation of Treatments in Stroke Symptomatic Intracerebral Hemorrhage] and STARTING-SICH [STARTING Symptomatic Intracerebral Hemorrhage]). Best calibrated models were IST-3 (intercept, -0.15 [95% CI, -0.01 to -0.31]; slope, 0.80 [95% CI, 0.50-1.09]), SITS-SICH (intercept, 0.15 [95% CI, -0.01 to 0.30]; slope, 0.62 [95% CI, 0.38-0.87]), and STARTING-SICH (intercept, -0.03 [95% CI, -0.19 to 0.12]; slope, 0.56 [95% CI, 0.35-0.76]). Conclusions: The investigated models to predict sICH or ICH discriminate poorly between patients with a low and high risk of sICH after endovascular treatment in daily clinical practice and are, therefore, not clinically useful for this patient population.
MeSH term(s)	Humans ; Tissue Plasminogen Activator/therapeutic use ; Fibrinolytic Agents/therapeutic use ; Ischemic Stroke/drug therapy ; Risk Factors ; Stroke/epidemiology ; Intracranial Hemorrhages/epidemiology ; Cerebral Hemorrhage/complications ; Treatment Outcome ; Brain Ischemia/drug therapy ; Endovascular Procedures/adverse effects
Chemical Substances	Tissue Plasminogen Activator (EC 3.4.21.68) ; Fibrinolytic Agents
Language	English
Publishing date	2023-01-23
Publishing country	United States
Document type	Randomized Controlled Trial ; Multicenter Study ; 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.122.040065
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Article ; Online: Cerebral vasculitis and stroke due to Lyme neuroborreliosis: A favorable clinical outcome after early antibiotic treatment.

Seelen, Meinie / van den Wijngaard, Ido R / Rundervoort, Rob S

Journal of the neurological sciences

2017 Volume 375, Page(s) 165–166

MeSH term(s)	Adult ; Anti-Bacterial Agents/therapeutic use ; Borrelia burgdorferi Group ; Brain/diagnostic imaging ; Female ; Humans ; Lyme Neuroborreliosis/complications ; Lyme Neuroborreliosis/diagnostic imaging ; Lyme Neuroborreliosis/drug therapy ; Stroke/diagnostic imaging ; Stroke/therapy ; Vasculitis, Central Nervous System/diagnostic imaging ; Vasculitis, Central Nervous System/etiology ; Vasculitis, Central Nervous System/therapy
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2017-01-26
Publishing country	Netherlands
Document type	Case Reports ; Letter
ZDB-ID	80160-4
ISSN	1878-5883 ; 0022-510X ; 0374-8642
ISSN (online)	1878-5883
ISSN	0022-510X ; 0374-8642
DOI	10.1016/j.jns.2017.01.067
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Article ; Online: Night-time confusion in an elderly woman post-stroke.

van der Linden, M Christien / van den Wijngaard, Ido R / van der Linden, Shanna / van der Linden, Naomi

BMJ case reports

2020 Volume 13, Issue 5

Abstract: For patients with acute ischaemic stroke, faster recanalisation improves the chances of a disability-free life and a quick discharge from the hospital. Hospital discharge, certainly after suffering a major life-changing event such as a stroke, is a ... ...

Abstract	For patients with acute ischaemic stroke, faster recanalisation improves the chances of a disability-free life and a quick discharge from the hospital. Hospital discharge, certainly after suffering a major life-changing event such as a stroke, is a complex and vulnerable phase in the patient's journey. Elderly are particularly vulnerable to the stressors caused by hospitalisation. Recently hospitalised patients are not only recovering from their acute illness; they also experience a period of generalised risk for a range of adverse events. At the same time, elderly generally prefer living in their own homes and should be discharged from the hospital and return home as quickly as possible. Both premature and delayed discharge are potential threats to patient well-being. We present a 90-year-old patient who underwent successful thrombectomy but suffered from night-time confusion at the hospital and discuss the transition process from hospital to home.
MeSH term(s)	Aged, 80 and over ; Circadian Rhythm ; Confusion/etiology ; Female ; Humans ; Ischemic Stroke/complications ; Ischemic Stroke/surgery ; Patient Discharge ; Thrombectomy
Language	English
Publishing date	2020-05-21
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2019-230693
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Article ; Online: Estimation of treatment effects in observational stroke care data: comparison of statistical approaches.

Amini, Marzyeh / van Leeuwen, Nikki / Eijkenaar, Frank / van de Graaf, Rob / Samuels, Noor / van Oostenbrugge, Robert / van den Wijngaard, Ido R / van Doormaal, Pieter Jan / Roos, Yvo B W E M / Majoie, Charles / Roozenbeek, Bob / Dippel, Diederik / Burke, James / Lingsma, Hester F

BMC medical research methodology

2022 Volume 22, Issue 1, Page(s) 103

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 ... ...

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.
MeSH term(s)	Endovascular Procedures/methods ; Fibrinolytic Agents/therapeutic use ; Humans ; Stroke/drug therapy ; Thrombolytic Therapy ; Treatment Outcome
Chemical Substances	Fibrinolytic Agents
Language	English
Publishing date	2022-04-10
Publishing country	England
Document type	Journal Article ; Observational Study
ZDB-ID	2041362-2
ISSN	1471-2288 ; 1471-2288
ISSN (online)	1471-2288
ISSN	1471-2288
DOI	10.1186/s12874-022-01590-0
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Article: Alternative Arterial Access Routes for Endovascular Thrombectomy in Patients with Acute Ischemic Stroke: A Study from the MR CLEAN Registry.

Collette, Sabine L / van de Ven, Elke A / Luijckx, Gert-Jan R / Lingsma, Hester F / van Doormaal, Pieter Jan / van Es, Adriaan C G M / van den Wijngaard, Ido R / Goldhoorn, Robert-Jan B / de Groot, Jan Cees / van Zwam, Wim H / Majoie, Charles B L M / Dippel, Diederik W J / Bokkers, Reinoud P H / Uyttenboogaart, Maarten / On Behalf Of The Mr Clean Registry Investigators

Journal of clinical medicine

2023 Volume 12, Issue 9

Abstract: Background: ...

Abstract	Background:
Language	English
Publishing date	2023-05-02
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12093257
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Article ; Online: Costs and health effects of CT perfusion-based selection for endovascular thrombectomy within 6 hours of stroke onset: a model-based health economic evaluation.

van Voorst, Henk / Hoving, Jan W / Koopman, Miou S / Daems, Jasper D / Peerlings, Daan / Buskens, Erik / Lingsma, Hester / Marquering, Henk A / de Jong, Hugo W A M / Berkhemer, Olvert A / van Zwam, Wim H / van Walderveen, Marianne A A / van den Wijngaard, Ido R / Dippel, Diederik W J / Yoo, Albert J / Campbell, Bruce / Kunz, Wolfgang G / Majoie, Charles B / Emmer, Bart J

Journal of neurology, neurosurgery, and psychiatry

2023

Abstract: Background: Although CT perfusion (CTP) is often incorporated in acute stroke workflows, it remains largely unclear what the associated costs and health implications are in the long run of CTP-based patient selection for endovascular treatment (EVT) in ... ...

Abstract	Background: Although CT perfusion (CTP) is often incorporated in acute stroke workflows, it remains largely unclear what the associated costs and health implications are in the long run of CTP-based patient selection for endovascular treatment (EVT) in patients presenting within 6 hours after symptom onset with a large vessel occlusion. Methods: Patients with a large vessel occlusion were included from a Dutch nationwide cohort (n=703) if CTP imaging was performed before EVT within 6 hours after stroke onset. Simulated cost and health effects during 5 and 10 years follow-up were compared between CTP based patient selection for EVT and providing EVT to all patients. Outcome measures were the net monetary benefit at a willingness-to-pay of €80 000 per quality-adjusted life year, incremental cost-effectiveness ratio), difference in costs from a healthcare payer perspective (ΔCosts) and quality-adjusted life years (ΔQALY) per 1000 patients for 1000 model iterations as outcomes. Results: Compared with treating all patients, CTP-based selection for EVT at the optimised ischaemic core volume (ICV≥110 mL) or core-penumbra mismatch ratio (MMR≤1.4) thresholds resulted in losses of health (median ΔQALYs for ICV≥110 mL: -3.3 (IQR: -5.9 to -1.1), for MMR≤1.4: 0.0 (IQR: -1.3 to 0.0)) with median ΔCosts for ICV≥110 mL of -€348 966 (IQR: -€712 406 to -€51 158) and for MMR≤1.4 of €266 513 (IQR: €229 403 to €380 110)) per 1000 patients. Sensitivity analyses did not yield any scenarios for CTP-based selection of patients for EVT that were cost-effective for improving health, including patients aged ≥80 years CONCLUSION: In EVT-eligible patients presenting within 6 hours after symptom onset, excluding patients based on CTP parameters was not cost-effective and could potentially harm patients.
Language	English
Publishing date	2023-12-30
Publishing country	England
Document type	Journal Article
ZDB-ID	3087-9
ISSN	1468-330X ; 0022-3050
ISSN (online)	1468-330X
ISSN	0022-3050
DOI	10.1136/jnnp-2023-331862
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Article ; Online: Association between computed tomography perfusion and the effect of intravenous alteplase prior to endovascular treatment in acute ischemic stroke.

Hoving, Jan W / van Voorst, Henk / Peerlings, Daan / Daems, Jasper D / Koopman, Miou S / Wouters, Anke / Kappelhof, Manon / LeCouffe, Natalie E / Treurniet, Kilian M / Bruggeman, Agnetha A E / Rinkel, Leon A / van den Wijngaard, Ido R / Coutinho, Jonathan M / van der Lugt, Aad / Marquering, Henk A / Roos, Yvo B W E M / Majoie, Charles B L M / Emmer, Bart J

Neuroradiology

2023 Volume 65, Issue 6, Page(s) 1053–1061

Abstract: Purpose: Intravenous alteplase (IVT) prior to endovascular treatment (EVT) is neither superior nor noninferior to EVT alone in acute ischemic stroke patients. We aim to assess whether the effect of IVT prior to EVT differs according to CT perfusion (CTP) ...

Abstract	Purpose: Intravenous alteplase (IVT) prior to endovascular treatment (EVT) is neither superior nor noninferior to EVT alone in acute ischemic stroke patients. We aim to assess whether the effect of IVT prior to EVT differs according to CT perfusion (CTP)-based imaging parameters. Methods: In this retrospective post hoc analysis, we included patients from the MR CLEAN-NO IV with available CTP data. CTP data were processed using syngo.via (version VB40). We performed multivariable logistic regression to obtain the effect size estimates (adjusted common odds ratio a[c]OR) on 90-day functional outcome (modified Rankin Scale [mRS]) and functional independence (mRS 0-2) for CTP parameters with two-way multiplicative interaction terms between IVT administration and the studied parameters. Results: In 227 patients, median CTP-estimated core volume was 13 (IQR 5-35) mL. The treatment effect of IVT prior to EVT on outcome was not altered by CTP-estimated ischemic core volume, penumbral volume, mismatch ratio, and presence of a target mismatch profile. None of the CTP parameters was significantly associated with functional outcome after adjusting for confounders. Conclusion: In directly admitted patients with limited CTP-estimated ischemic core volumes who presented within 4.5 h after symptom onset, CTP parameters did not statistically significantly alter the treatment effect of IVT prior to EVT. Further studies are needed to confirm these results in patients with larger core volumes and more unfavorable baseline perfusion profiles on CTP imaging.
MeSH term(s)	Humans ; Tissue Plasminogen Activator/therapeutic use ; Stroke/diagnostic imaging ; Stroke/drug therapy ; Ischemic Stroke/diagnostic imaging ; Ischemic Stroke/drug therapy ; Ischemic Stroke/surgery ; Retrospective Studies ; Treatment Outcome ; Tomography, X-Ray Computed/methods ; Thrombectomy/methods ; Perfusion ; Endovascular Procedures ; Brain Ischemia/diagnostic imaging ; Brain Ischemia/drug therapy
Chemical Substances	Tissue Plasminogen Activator (EC 3.4.21.68)
Language	English
Publishing date	2023-03-08
Publishing country	Germany
Document type	Journal Article
ZDB-ID	123305-1
ISSN	1432-1920 ; 0028-3940
ISSN (online)	1432-1920
ISSN	0028-3940
DOI	10.1007/s00234-023-03139-4
Database	MEDical Literature Analysis and Retrieval System OnLINE

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