Publications by authors named "Rinkel L"
Article Synopsis
- Hyperacute cardiac CT is more effective than transthoracic echocardiography in detecting intracardiac thrombus, but its routine use is limited due to costs and risks.
- A study of 1,136 ischemic stroke or TIA patients found that longer arterial input function (AIF) dispersal times correlate with the presence of thrombus and worse outcomes, with a specific cutoff of 33 seconds indicating higher risk.
- The findings support using AIF dispersal measurements to help identify patients who may benefit from cardiac imaging, potentially optimizing resource use in stroke management.
Background: Cardiac computed tomography (CT) is increasingly used to search for cardioembolic sources of acute ischemic stroke (AIS). We assessed the association between high-risk cardioembolic sources on cardiac CT and AIS.
Methods: We performed a case-control study using data from a prospective cohort including consecutive adult patients with suspected stroke who underwent cardiac CT acquired during the initial stroke imaging protocol between 2018 and 2020.
Article Synopsis
- Most stroke researchers currently use frequentist statistics, but there is a growing trend towards using Bayesian statistics in stroke research.
- Bayesian statistics focus on updating the probability of parameters based on observed data and prior beliefs, allowing for more flexible interpretations of treatment effectiveness.
- This review discusses the fundamental concepts of Bayesian statistics in stroke trials, compares them to frequentist methods with examples, and explains how to conduct and interpret Bayesian analyses.
Article Synopsis
- The study evaluated the effectiveness and safety of endovascular thrombectomy (EVT) in acute ischemic stroke patients treated within early (<6 hours) and extended (6-24 hours) time windows after symptom onset.
- It compared outcomes like good functional recovery, intracranial hemorrhage, and mortality rates between the two groups, finding that while early treatment showed slightly better recovery rates, both time frames had similar safety outcomes.
- Overall, the findings suggest that EVT remains a viable option for patients up to 24 hours after stroke symptoms, aligning with real-world clinical practices.
Article Synopsis
- This study investigates the impact of left atrial appendage (LAA) slow-flow on ischemic stroke outcomes, finding that 16% of patients had slow-flow and shared characteristics with those having LAA thrombus.
- While both slow-flow and thrombus were linked to a higher prevalence of atrial fibrillation, patients with thrombus experienced more severe strokes and worse functional outcomes than those with slow-flow.
- Ultimately, slow-flow did not significantly affect functional outcomes or major cardiovascular events, but it was associated with an increased risk of stroke recurrence in patients with unknown causes of their strokes.
Background: The benefit of intravenous thrombolysis with alteplase before endovascular thrombectomy (EVT) for acute ischemic stroke due to large vessel occlusion remains debated. In this study, we analyzed the cost-effectiveness of EVT alone versus intravenous alteplase before EVT in patients directly admitted to EVT-capable stroke centers from the Dutch health care payer perspective.
Methods: A decision analysis was performed using a Markov model with 15-year simulated follow-up to estimate total costs, quality-adjusted life years, and an incremental cost-effectiveness ratio of intravenous alteplase before EVT compared with EVT alone.
Background And Purpose: Infarcts in acute ischemic stroke (AIS) patients may continue to grow even after reperfusion, due to mechanisms such as microvascular obstruction and reperfusion injury. We investigated whether and how much infarcts grow in AIS patients after near-complete (expanded Thrombolysis in Cerebral Infarction [eTICI] 2c/3) reperfusion following endovascular treatment (EVT), and to assess the association of post-reperfusion infarct growth with clinical outcomes.
Methods: Data are from a single-center retrospective observational cohort study that included AIS patients undergoing EVT with near-complete reperfusion who received diffusion-weighted magnetic resonance imaging (MRI) within 2 hours post-EVT and 24 hours after EVT.
Article Synopsis
- The study explores the connection between infarct volume in acute ischemic stroke patients and their chances of achieving good clinical outcomes based on the modified Rankin Scale (mRS).
- Using data from the ESCAPE-NA1 trial, researchers analyzed how changes in infarct volume influence the probabilities of recovery in 1,099 patients over 24 hours post-treatment.
- Findings indicate a nearly linear relationship between infarct volume and good outcomes up to 250 mL, suggesting that significant reductions in infarct size are necessary to improve chances of recovery, especially as patients with volumes over 250 mL have very low probabilities of good outcomes.
Article Synopsis
- * The study analyzed data from the ESCAPE-NA1 trial, involving 408 patients, and found that 35% experienced hemorrhagic transformation, mostly classified as hemorrhagic infarction or parenchymal hematoma.
- * Larger volumes of low relative cerebral blood flow (CBF) were associated with an increased risk of parenchymal hematoma, suggesting that CBF metrics could help assess the risk of complications following treatment.
Background: Cardiac computed tomography (CT) acquired during the initial acute stroke imaging protocol (acute cardiac CT) is increasingly used to screen for cardioembolism, but information on the long-term clinical implications of its findings is lacking.
Methods And Results: We performed a prospective, single-center cohort study in which consecutive patients with ischemic stroke underwent ECG-gated acute cardiac CT and were followed up for 2 years. The primary outcome was functional outcome assessed using the modified Rankin Scale.
Background: Endovascular treatment (EVT) has become standard of care for patients with anterior circulation large vessel occlusion (LVO) stroke, with indications having recently expanded to late time-window and large ischemic core patients. There is conflicting evidence on whether EVT reduces mortality or only disability. We performed a meta-analysis of randomized controlled trials (RCTs) to assess the effect of EVT on mortality and severe disability.
View Article and Find Full Text PDFBackground: To assess the association of qualitative and quantitative infarct characteristics and 3 cognitive outcome tests, namely the Montreal Cognitive Assessment (MOCA) for mild cognitive impairment, the Boston Naming Test for visual confrontation naming, and the Sunnybrook Neglect Assessment Procedure for neglect, in large vessel occlusion stroke.
Methods: Secondary observational cohort study using data from the randomized-controlled ESCAPE-NA1 trial (Safety and Efficacy of Nerinetide in Subjects Undergoing Endovascular Thrombectomy for Stroke), in which patients with large vessel occlusion undergoing endovascular treatment were randomized to receive either intravenous Nerinetide or placebo. MOCA, Sunnybrook Neglect Assessment Procedure, and 15-item Boston Naming Test were obtained at 90 days.
Background: Ischemic stroke lesion volume at follow-up is an important surrogate outcome for acute stroke trials. We aimed to assess which differences in 48-hour lesion volume translate into meaningful clinical differences.
Methods: We used pooled data from 7 trials investigating the efficacy of endovascular treatment for anterior circulation large vessel occlusion in acute ischemic stroke.
Article Synopsis
- This study investigates whether the effectiveness of intravenous thrombolysis (IVT) combined with thrombectomy for treating acute ischemic stroke decreases as time from symptom onset increases.
- It involves a comprehensive analysis of data from six clinical trials, focusing on patients with anterior circulation large-vessel occlusions who arrived at treatment centers between January 2017 and July 2021.
- Results indicate a statistically significant relationship between the timing of IVT administration and treatment outcomes, suggesting that the benefit of combining IVT with thrombectomy may be time-dependent.
Purpose: Diffusion-weighted imaging (DWI) lesion expansion after endovascular thrombectomy (EVT) is not well characterized. We used serial diffusion-weighted magnetic resonance imaging (MRI) to measure lesion expansion between 2 and 24 h after EVT.
Methods: In this single-center observational analysis of patients with acute ischemic stroke due to large vessel occlusion, DWI was performed post-EVT (< 2 h after closure) and 24-h later.
Prevalence of "Ghost Infarct Core" after Endovascular Thrombectomy.
AJNR Am J Neuroradiol
March 2024
Background And Purpose: Baseline CTP sometimes overestimates the size of the infarct core ("ghost core" phenomenon). We investigated how often CTP overestimates infarct core compared with 24-hour imaging, and aimed to characterize the patient subgroup in whom a ghost core is most likely to occur.
Materials And Methods: Data are from the randomized controlled ESCAPE-NA1 trial, in which patients with acute ischemic stroke undergoing endovascular treatment were randomized to intravenous nerinetide or placebo.
Role of cardiac computed tomography in hyperacute stroke assessment.
J Stroke Cerebrovasc Dis
January 2024
Background: Incorporating cardiac CT with hyperacute stroke imaging may increase the yield for cardioembolic sources. It is not clarified whether stroke severity influences on rates of intracardiac thrombus. We aimed to investigate a National Institutes of Health Stroke Scale (NIHSS) threshold below which acute cardiac CT was unnecessary.
View Article and Find Full Text PDFA Review on Adjunctive Therapies for Endovascular Treatment in Acute Ischemic Stroke.
J Neuroendovasc Ther
July 2023
Endovascular treatment (EVT) has revolutionized the management of acute ischemic stroke (AIS), but almost half of patients undergoing EVT do not achieve a good outcome. Adjunctive therapies have been proposed to improve the outcomes of EVT in AIS. This review aims to summarize the current evidence on the use of adjunctive therapies in EVT for AIS, including antithrombotic agents, intra-arterial thrombolytics, cerebroprotective agents, normobaric oxygen, and hypothermia.
View Article and Find Full Text PDFArticle Synopsis
- The study investigates the early dissolution of cardiac thrombi, which are often missed in imaging but can cause ischemic strokes.
- Five patients with acute ischemic strokes and cardiac thrombi were monitored with cardiac CT scans.
- Results indicated that some thrombi dissolved within days of the stroke, which could explain why they are rarely detected during initial imaging.
Admission blood pressure and clinical outcomes in patients with acute ischaemic stroke treated with intravenous alteplase and endovascular treatment versus endovascular treatment alone: A MR CLEAN-NO IV substudy.
Eur Stroke J
September 2023
Introduction: High systolic blood pressure (SBP) is associated with poor functional outcome. We analysed whether the association of SBP with outcomes after endovascular treatment (EVT) is modified by prior intravenous thrombolysis (IVT).
Patients And Methods: This was a post-hoc analysis of MR CLEAN-NO IV, a randomised trial of IVT with alteplase followed by EVT versus EVT alone, within 4.
Article Synopsis
- This text discusses a study evaluating whether endovascular treatment alone is as effective as using both intravenous thrombolysis and endovascular treatment in patients with acute ischemic stroke.
- The study was conducted through a systematic review and meta-analysis of randomized controlled trials, focusing on patients' outcomes measured by their 90-day modified Rankin Scale scores.
- A total of six studies, involving over 2300 participants, were analyzed to determine the non-inferiority of endovascular treatment alone compared to the combination of treatments.
Article Synopsis
- Cardiac CT may provide a new alternative to transthoracic echocardiography (TTE) for screening cardiac issues related to ischemic strokes, especially for detecting patent foramen ovale (PFO).
- In a study involving 59 patients under 60 years, cardiac CT identified PFO in only 8% of cases, while TTE detected it in 20%, highlighting the limited effectiveness of cardiac CT in this context.
- The low sensitivity of cardiac CT prompts the need for additional echocardiography in young patients with unexplained strokes, and more extensive research is necessary to validate these findings.
Article Synopsis
- Cardiac thrombi, found in about 8% of patients with acute ischemic stroke, are often located in the left atrial appendage and are linked to more severe strokes and poor outcomes.
- In a study of 452 patients, those with cardiac thrombi had higher NIHSS scores (indicating more severe symptoms) and more complications like multiple vascular occlusions compared to those without.
- Although thrombi were associated with worse functional outcomes, the rate of stroke recurrence at 90 days was not significantly different between the two groups.