Jan Vos - Academia.edu (original) (raw)
Papers by Jan Vos
International journal of stroke : official journal of the International Stroke Society, Jan 25, 2016
Our aim was to assess the prognostic value of a semiquantitative computed tomography angiography-... more Our aim was to assess the prognostic value of a semiquantitative computed tomography angiography-based grading system, for the prediction of outcome in patients with acute basilar artery occlusion, based on the presence of potential collateral pathways on computed tomography angiography: the posterior circulation collateral score (PC-CS). One hundred forty-nine patients with acute basilar artery occlusion from the Basilar Artery International Cooperation Study were included. We related poor outcome at one month, defined as a modified Rankin scale score of 4 or 5, or death to collateral flow with Poisson regression. We used a 10 points grading system to quantify the potential for collateral flow in the posterior communicating arteries and the cerebellar arteries. Additionally, the relation between the presence and size of posterior communicating arteries and outcome was analyzed. Thirty-six patients had poor (PC-CS: 0-3), 59 patients intermediate (PC-CS: 4-5), and 54 patients good (P...
Scientifica, 2016
A large variety exists for many aspects of the use of heparin as periprocedural prophylactic anti... more A large variety exists for many aspects of the use of heparin as periprocedural prophylactic antithrombotics (PPAT) during peripheral arterial interventions (PAI). This variation is present, not only within countries, but also between them. Due to a lack of (robust) data, no systematic review on the use of heparin during PAI could be justified. A synopsis of all available literature on heparin during PAI describes that heparin is used on technical equipment to reduce the thrombogenicity and in the flushing solution with saline. Heparin could have a cumulative anticoagulant effect when used in combination with ionic contrast medium. No level-1 evidence exists on the use of heparin. A measurement of actual anticoagulation status by means of an activated clotting time should be mandatory.
Nederlands Tijdschrift Voor Geneeskunde, Apr 1, 2009
Annals of Vascular Surgery, Mar 21, 2006
The use of femoral artery closure devices to obtain hemostasis after percutaneous catheterization... more The use of femoral artery closure devices to obtain hemostasis after percutaneous catheterization has become widespread because of their proven feasibility in combination with patient-related advantages. Since 2002 more than 6,500 patients have undergone either diagnostic angiography or therapeutic intervention via the femoral route with an Angioseal closure device in our hospital. We were faced with six cases of limb-threatening complications, which are described here. Most (5/6) complications were of obstructive origin due to traumatic dissection or occlusion of the artery mainly caused by malpositioning of the device. Recommendations are made in order to prevent or successfully overcome this certainly increasing problem in the vascular field.
Neuroradiology, 2016
We investigated whether baseline CT angiography (CTA) and CT perfusion (CTP) in acute ischemic st... more We investigated whether baseline CT angiography (CTA) and CT perfusion (CTP) in acute ischemic stroke could improve prediction of infarct presence and infarct volume on follow-up imaging. We analyzed 906 patients with suspected anterior circulation stroke from the prospective multicenter Dutch acute stroke study (DUST). All patients underwent baseline non-contrast CT, CTA, and CTP and follow-up non-contrast CT/MRI after 3 days. Multivariable regression models were developed including patient characteristics and non-contrast CT, and subsequently, CTA and CTP measures were added. The increase in area under the curve (AUC) and R (2) was assessed to determine the additional value of CTA and CTP. At follow-up, 612 patients (67.5 %) had a detectable infarct on CT/MRI; median infarct volume was 14.8 mL (interquartile range (IQR) 2.8-69.6). Regarding infarct presence, the AUC of 0.82 (95 % confidence interval (CI) 0.79-0.85) for patient characteristics and non-contrast CT was improved with addition of CTA measures (AUC 0.85 (95 % CI 0.82-0.87); p < 0.001) and was even higher after addition of CTP measures (AUC 0.89 (95 % CI 0.87-0.91); p < 0.001) and combined CTA/CTP measures (AUC 0.89 (95 % CI 0.87-0.91); p < 0.001). For infarct volume, adding combined CTA/CTP measures (R (2) = 0.58) was superior to patient characteristics and non-contrast CT alone (R (2) = 0.44) and to addition of CTA alone (R (2) = 0.55) or CTP alone (R (2) = 0.54; all p < 0.001). In the acute stage, CTA and CTP have additional value over patient characteristics and non-contrast CT for predicting infarct presence and infarct volume on follow-up imaging. These findings could be applied for patient selection in future trials on ischemic stroke treatment.
JAMA Neurology, 2015
Intra-arterial treatment (IAT) for acute ischemic stroke caused by intracranial arterial occlusio... more 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. 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. 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 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. 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. 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. trialregister.nl Identifier: NTR1804.
Nederlands Tijdschrift Voor Geneeskunde, 2010
Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator is the standard ther... more Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator is the standard therapy for acute ischaemic stroke in the first 4.5 hours after onset of neurological symptoms. The efficacy of IVT increases strongly the sooner it is initiated after onset of neurological symptoms. Intra-arterial thrombolysis (IAT) and mechanical thrombectomy are potentially valuable treatment options in patients with severe ischemic stroke caused by an occlusion in a proximal cerebral artery. Further research is needed to evaluate the safety and efficacy of IAT and mechanical thrombectomy a) compared with IVT within 4.5 hours of symptom onset, b) outside the time window for IVT, c) when there are contraindications for IVT, d) when IVT fails to achieve recanalisation and e) in patients with basilar artery thrombosis. The results of ongoing trials are required to make a decision on the exact indication for IAT and mechanical thrombectomy. These treatments should therefore only be given in specialised centres, preferably in a research setting.
The Annals of Thoracic Surgery, Aug 31, 2006
Background. Elective endovascular repair of the thoracic aorta has shown reduced morbidity and mo... more Background. Elective endovascular repair of the thoracic aorta has shown reduced morbidity and mortality when compared with open surgery. The number of studies describing the use of thoracic endovascular stent grafts for acute pathology is limited, however. The purpose of this study was to describe our increasing experience with stent grafting for acute thoracic aortic pathology.
Journal of Stroke and Cerebrovascular Diseases, 2015
The Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in ... more The Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN) trial showed efficacy of intra-arterial (IA) treatment in acute ischemic stroke (AIS). We studied the evolution of IA treatment for AIS and its effects on clinical outcome and recanalization in The Netherlands in the pre-MR CLEAN era. Data on 517 patients with AIS treated with IA therapy were collected retrospectively from all intervention centers in The Netherlands from 2002 to the start of participation in the MR CLEAN trial. Clinical outcome was measured by means of the modified Rankin Scale score and recanalization with the Thrombolysis in Cerebral Infarction Scale. IA therapy was first used in patients with basilar artery occlusion. Over the years, there was a gradual increase in the number of anterior circulation strokes treated. There was a shift in applied therapies from primary IA therapy to combined intravenous and IA therapy and from IA thrombolysis to mechanical thrombectomy. Time from symptom onset to treatment decreased. Recanalization rates gradually increased. At the same time, there was a trend toward more favorable outcomes after 3 months and fewer deceased patients both at discharge and after 3 months. However, none of these changes reached statistical significance. The treatment approach used in the MR CLEAN trial was the result of an evolution of practise in the preceding years, with gradual improvement in technical and clinical outcomes.
The Lancet. Neurology, Jan 20, 2015
Patients with a recent vertebrobasilar transient ischaemic attack or ischaemic stroke and vertebr... more Patients with a recent vertebrobasilar transient ischaemic attack or ischaemic stroke and vertebral artery stenosis of at least 50% have a high risk of future vertebrobasilar stroke. Stenting of vertebral artery stenosis is promising, but of uncertain benefit. We investigated the safety and feasibility of stenting of symptomatic vertebral artery stenosis of at least 50%, and assessed the rate of vascular events in the vertebrobasilar supply territory to inform the design of a phase 3 trial. Between Jan 22, 2008, and April 8, 2013, patients with a recent transient ischaemic attack or minor stroke associated with an intracranial or extracranial vertebral artery stenosis of at least 50% were enrolled from seven hospitals in the Netherlands in a phase 2 open-label trial with masked assessment of outcome. Patients were randomly allocated in a 1:1 ratio to stenting plus best medical treatment or best medical treatment alone by the local investigators using a web-based randomisation system...
Stroke; a journal of cerebral circulation, Jan 7, 2015
Intra-arterial treatment (IAT) in patients with acute ischemic stroke (AIS) can be performed with... more Intra-arterial treatment (IAT) in patients with acute ischemic stroke (AIS) can be performed with or without general anesthesia (GA). Previous studies suggested that IAT without the use of GA (non-GA) is associated with better clinical outcome. Nevertheless, no consensus exists about the anesthetic management during IAT of AIS patients. This study investigates the association between type of anesthesia and clinical outcome in a large cohort of patients with AIS treated with IAT. All consecutive patients with AIS of the anterior circulation who received IAT between 2002 and 2013 in 16 Dutch hospitals were included in the study. Primary outcome was functional outcome on the modified Rankin Scale at discharge. Difference in primary outcome between GA and non-GA was estimated using multiple ordinal regression analysis, adjusting for age, stroke severity, occlusion of the internal carotid artery terminus, previous stroke, atrial fibrillation, and diabetes mellitus. Three hundred forty-ei...
Stroke; a journal of cerebral circulation, 2015
Detection of acute infarction in the posterior circulation is challenging. We aimed to determine ... more Detection of acute infarction in the posterior circulation is challenging. We aimed to determine the additional value of tomograpy (CT) perfusion to noncontrast CT and CT angiography source images for infarct detection and localization in patients suspected of acute ischemic posterior circulation stroke. Patients with suspected acute ischemic posterior circulation stroke were selected from the Dutch acute Stroke Trial (DUST) study. Patients underwent noncontrast CT, CT angiography, and CT perfusion within 9 hours after stroke onset and CT or MRI on follow-up. Images were evaluated for signs and location of ischemia. Discrimination of 3 hierarchical logistic regression models (noncontrast CT [A], added CT angiography source images [B], and CT perfusion [C]) was compared with C-statistics. Of 88 patients, 76 (86%) had a clinical diagnosis of ischemic stroke on discharge and 42 patients (48%) showed a posterior circulation infarct on follow-up imaging. Model C (area under the curve fro...
Annals of vascular surgery, 2015
To describe the transapical approach for thoracic endovascular aortic repair (TEVAR). Three patie... more To describe the transapical approach for thoracic endovascular aortic repair (TEVAR). Three patients, 2 elective and 1 emergent, with thoracic aorta aneurysm are described with vascular or direct aortic inaccessible access, who underwent TEVAR through transapical access. The technique is described in detail emphasizing the usefulness of the through-and-through guidewire, rapid pacing, and transesophageal echocardiography guidance. All patients were technical successfully treated with TEVAR through transapical access. The emergent patient, however, died due to multiorgan failure. Our early experience shows that the transapical approach for TEVAR procedures is feasible in experienced hands. The selection of the patient and careful planning based on imaging are of paramount importance and should lead to the most suitable access site tailored to the need of the individual patient.
Vascular and endovascular surgery, 2012
We present a case of a 4-fenestrated endograft repair of a suprarenal aortic patch aneurysm as us... more We present a case of a 4-fenestrated endograft repair of a suprarenal aortic patch aneurysm as useful alternative for complex open reoperation in a patient with Marfan syndrome.
Annals of Vascular Surgery, 2006
The use of femoral artery closure devices to obtain hemostasis after percutaneous catheterization... more The use of femoral artery closure devices to obtain hemostasis after percutaneous catheterization has become widespread because of their proven feasibility in combination with patient-related advantages. Since 2002 more than 6,500 patients have undergone either diagnostic angiography or therapeutic intervention via the femoral route with an Angioseal closure device in our hospital. We were faced with six cases of limb-threatening complications, which are described here. Most (5/6) complications were of obstructive origin due to traumatic dissection or occlusion of the artery mainly caused by malpositioning of the device. Recommendations are made in order to prevent or successfully overcome this certainly increasing problem in the vascular field.
PLoS ONE, 2014
Introduction: We related composition of cerebral thrombi to stroke subtype and attenuation on non... more Introduction: We related composition of cerebral thrombi to stroke subtype and attenuation on non-contrast CT (NCCT) to gain more insight in etiopathogenesis and to validate thrombus attenuation as a new imaging biomarker for acute stroke.
Annals of Vascular Surgery, 2014
We compared initial and long-term outcomes between men and women after endovascular and open repa... more We compared initial and long-term outcomes between men and women after endovascular and open repair of popliteal artery aneurysms (PAAs). Between January 1993 and July 2011, 202 patients (185 men [92%]), underwent open (n = 186) or endovascular (n = 16) repair of a PAA. Data were retrospectively analyzed. Significant differences in baseline characteristics were determined between men and women with regard to aneurysm diameter (men: 30 mm [range: 14-90]; women: 26 mm [range: 13-70]; P = 0.02) and age (men: 66 ± 10 years; women: 71 ± 9 years; P = 0.05). The 30-day mortality rate was 0% in both groups. No significant differences were determined concerning 30-day complications. The median follow-up was 55 months (range: 1-121 months) in men, compared with 35 months (range: 1-183 months) in women (P = 0.74). The primary patency rates at 1, 3, and 5 years were 88%, 82%, and 76% in men compared with 64%, 64%, and 48% in women, respectively (P = 0.007). The limb salvage rates in men at 1, 3, and 5 years were 97%, 97%, and 96%, and in women were 87%, 87%, and 87%, respectively (P = 0.07). When correcting for potential confounders with multivariable regression analysis, sex was independently associated with primary patency (hazard ratio: 2.98 [95% confidence interval: 1.39-6.42]; P = 0.005). No significant differences between men and women were observed in 30-day mortality and morbidity rates after PAA repair. In the long run, women are associated with lower primary patency rates and a trend toward lower limb salvage rates compared to men.
Journal of Vascular and Interventional Radiology, 2014
Trials, 2012
Background: Iliac artery atherosclerotic disease may cause intermittent claudication and critical... more Background: Iliac artery atherosclerotic disease may cause intermittent claudication and critical limb ischemia. It can lead to serious complications such as infection, amputation and even death. Revascularization relieves symptoms and prevents these complications. Historically, open surgical repair, in the form of endarterectomy or bypass, was used. Over the last decade, endovascular repair has become the first choice of treatment for iliac arterial occlusive disease. No definitive consensus has emerged about the best endovascular strategy and which type of stent, if any, to use. However, in more advanced disease, that is, long or multiple stenoses or occlusions, literature is most supportive of primary stenting with a balloon-expandable stent in the common iliac artery (Jongkind V et al., J Vasc Surg 52:1376-1383. Recently, a PTFE-covered balloon-expandable stent (Advanta V12, Atrium Medical Inc., Hudson, NH, USA) has been introduced for the iliac artery. Covering stents with PTFE has been shown to lead to less neo-intimal hyperplasia and this might lower restenosis rates (Dolmatch B et al. ). However, only one RCT, of mediocre quality has been published on this stent in the common iliac artery (Mwipatayi BP et al. J Vasc Surg 54:1561-1570, Bekken JA et al. J Vasc Surg 55:1545-1546. Our hypothesis is that covered balloon-expandable stents lead to better results when compared to uncovered balloon-expandable stents.
International journal of stroke : official journal of the International Stroke Society, Jan 25, 2016
Our aim was to assess the prognostic value of a semiquantitative computed tomography angiography-... more Our aim was to assess the prognostic value of a semiquantitative computed tomography angiography-based grading system, for the prediction of outcome in patients with acute basilar artery occlusion, based on the presence of potential collateral pathways on computed tomography angiography: the posterior circulation collateral score (PC-CS). One hundred forty-nine patients with acute basilar artery occlusion from the Basilar Artery International Cooperation Study were included. We related poor outcome at one month, defined as a modified Rankin scale score of 4 or 5, or death to collateral flow with Poisson regression. We used a 10 points grading system to quantify the potential for collateral flow in the posterior communicating arteries and the cerebellar arteries. Additionally, the relation between the presence and size of posterior communicating arteries and outcome was analyzed. Thirty-six patients had poor (PC-CS: 0-3), 59 patients intermediate (PC-CS: 4-5), and 54 patients good (P...
Scientifica, 2016
A large variety exists for many aspects of the use of heparin as periprocedural prophylactic anti... more A large variety exists for many aspects of the use of heparin as periprocedural prophylactic antithrombotics (PPAT) during peripheral arterial interventions (PAI). This variation is present, not only within countries, but also between them. Due to a lack of (robust) data, no systematic review on the use of heparin during PAI could be justified. A synopsis of all available literature on heparin during PAI describes that heparin is used on technical equipment to reduce the thrombogenicity and in the flushing solution with saline. Heparin could have a cumulative anticoagulant effect when used in combination with ionic contrast medium. No level-1 evidence exists on the use of heparin. A measurement of actual anticoagulation status by means of an activated clotting time should be mandatory.
Nederlands Tijdschrift Voor Geneeskunde, Apr 1, 2009
Annals of Vascular Surgery, Mar 21, 2006
The use of femoral artery closure devices to obtain hemostasis after percutaneous catheterization... more The use of femoral artery closure devices to obtain hemostasis after percutaneous catheterization has become widespread because of their proven feasibility in combination with patient-related advantages. Since 2002 more than 6,500 patients have undergone either diagnostic angiography or therapeutic intervention via the femoral route with an Angioseal closure device in our hospital. We were faced with six cases of limb-threatening complications, which are described here. Most (5/6) complications were of obstructive origin due to traumatic dissection or occlusion of the artery mainly caused by malpositioning of the device. Recommendations are made in order to prevent or successfully overcome this certainly increasing problem in the vascular field.
Neuroradiology, 2016
We investigated whether baseline CT angiography (CTA) and CT perfusion (CTP) in acute ischemic st... more We investigated whether baseline CT angiography (CTA) and CT perfusion (CTP) in acute ischemic stroke could improve prediction of infarct presence and infarct volume on follow-up imaging. We analyzed 906 patients with suspected anterior circulation stroke from the prospective multicenter Dutch acute stroke study (DUST). All patients underwent baseline non-contrast CT, CTA, and CTP and follow-up non-contrast CT/MRI after 3 days. Multivariable regression models were developed including patient characteristics and non-contrast CT, and subsequently, CTA and CTP measures were added. The increase in area under the curve (AUC) and R (2) was assessed to determine the additional value of CTA and CTP. At follow-up, 612 patients (67.5 %) had a detectable infarct on CT/MRI; median infarct volume was 14.8 mL (interquartile range (IQR) 2.8-69.6). Regarding infarct presence, the AUC of 0.82 (95 % confidence interval (CI) 0.79-0.85) for patient characteristics and non-contrast CT was improved with addition of CTA measures (AUC 0.85 (95 % CI 0.82-0.87); p < 0.001) and was even higher after addition of CTP measures (AUC 0.89 (95 % CI 0.87-0.91); p < 0.001) and combined CTA/CTP measures (AUC 0.89 (95 % CI 0.87-0.91); p < 0.001). For infarct volume, adding combined CTA/CTP measures (R (2) = 0.58) was superior to patient characteristics and non-contrast CT alone (R (2) = 0.44) and to addition of CTA alone (R (2) = 0.55) or CTP alone (R (2) = 0.54; all p < 0.001). In the acute stage, CTA and CTP have additional value over patient characteristics and non-contrast CT for predicting infarct presence and infarct volume on follow-up imaging. These findings could be applied for patient selection in future trials on ischemic stroke treatment.
JAMA Neurology, 2015
Intra-arterial treatment (IAT) for acute ischemic stroke caused by intracranial arterial occlusio... more 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. 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. 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 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. 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. 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. trialregister.nl Identifier: NTR1804.
Nederlands Tijdschrift Voor Geneeskunde, 2010
Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator is the standard ther... more Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator is the standard therapy for acute ischaemic stroke in the first 4.5 hours after onset of neurological symptoms. The efficacy of IVT increases strongly the sooner it is initiated after onset of neurological symptoms. Intra-arterial thrombolysis (IAT) and mechanical thrombectomy are potentially valuable treatment options in patients with severe ischemic stroke caused by an occlusion in a proximal cerebral artery. Further research is needed to evaluate the safety and efficacy of IAT and mechanical thrombectomy a) compared with IVT within 4.5 hours of symptom onset, b) outside the time window for IVT, c) when there are contraindications for IVT, d) when IVT fails to achieve recanalisation and e) in patients with basilar artery thrombosis. The results of ongoing trials are required to make a decision on the exact indication for IAT and mechanical thrombectomy. These treatments should therefore only be given in specialised centres, preferably in a research setting.
The Annals of Thoracic Surgery, Aug 31, 2006
Background. Elective endovascular repair of the thoracic aorta has shown reduced morbidity and mo... more Background. Elective endovascular repair of the thoracic aorta has shown reduced morbidity and mortality when compared with open surgery. The number of studies describing the use of thoracic endovascular stent grafts for acute pathology is limited, however. The purpose of this study was to describe our increasing experience with stent grafting for acute thoracic aortic pathology.
Journal of Stroke and Cerebrovascular Diseases, 2015
The Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in ... more The Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN) trial showed efficacy of intra-arterial (IA) treatment in acute ischemic stroke (AIS). We studied the evolution of IA treatment for AIS and its effects on clinical outcome and recanalization in The Netherlands in the pre-MR CLEAN era. Data on 517 patients with AIS treated with IA therapy were collected retrospectively from all intervention centers in The Netherlands from 2002 to the start of participation in the MR CLEAN trial. Clinical outcome was measured by means of the modified Rankin Scale score and recanalization with the Thrombolysis in Cerebral Infarction Scale. IA therapy was first used in patients with basilar artery occlusion. Over the years, there was a gradual increase in the number of anterior circulation strokes treated. There was a shift in applied therapies from primary IA therapy to combined intravenous and IA therapy and from IA thrombolysis to mechanical thrombectomy. Time from symptom onset to treatment decreased. Recanalization rates gradually increased. At the same time, there was a trend toward more favorable outcomes after 3 months and fewer deceased patients both at discharge and after 3 months. However, none of these changes reached statistical significance. The treatment approach used in the MR CLEAN trial was the result of an evolution of practise in the preceding years, with gradual improvement in technical and clinical outcomes.
The Lancet. Neurology, Jan 20, 2015
Patients with a recent vertebrobasilar transient ischaemic attack or ischaemic stroke and vertebr... more Patients with a recent vertebrobasilar transient ischaemic attack or ischaemic stroke and vertebral artery stenosis of at least 50% have a high risk of future vertebrobasilar stroke. Stenting of vertebral artery stenosis is promising, but of uncertain benefit. We investigated the safety and feasibility of stenting of symptomatic vertebral artery stenosis of at least 50%, and assessed the rate of vascular events in the vertebrobasilar supply territory to inform the design of a phase 3 trial. Between Jan 22, 2008, and April 8, 2013, patients with a recent transient ischaemic attack or minor stroke associated with an intracranial or extracranial vertebral artery stenosis of at least 50% were enrolled from seven hospitals in the Netherlands in a phase 2 open-label trial with masked assessment of outcome. Patients were randomly allocated in a 1:1 ratio to stenting plus best medical treatment or best medical treatment alone by the local investigators using a web-based randomisation system...
Stroke; a journal of cerebral circulation, Jan 7, 2015
Intra-arterial treatment (IAT) in patients with acute ischemic stroke (AIS) can be performed with... more Intra-arterial treatment (IAT) in patients with acute ischemic stroke (AIS) can be performed with or without general anesthesia (GA). Previous studies suggested that IAT without the use of GA (non-GA) is associated with better clinical outcome. Nevertheless, no consensus exists about the anesthetic management during IAT of AIS patients. This study investigates the association between type of anesthesia and clinical outcome in a large cohort of patients with AIS treated with IAT. All consecutive patients with AIS of the anterior circulation who received IAT between 2002 and 2013 in 16 Dutch hospitals were included in the study. Primary outcome was functional outcome on the modified Rankin Scale at discharge. Difference in primary outcome between GA and non-GA was estimated using multiple ordinal regression analysis, adjusting for age, stroke severity, occlusion of the internal carotid artery terminus, previous stroke, atrial fibrillation, and diabetes mellitus. Three hundred forty-ei...
Stroke; a journal of cerebral circulation, 2015
Detection of acute infarction in the posterior circulation is challenging. We aimed to determine ... more Detection of acute infarction in the posterior circulation is challenging. We aimed to determine the additional value of tomograpy (CT) perfusion to noncontrast CT and CT angiography source images for infarct detection and localization in patients suspected of acute ischemic posterior circulation stroke. Patients with suspected acute ischemic posterior circulation stroke were selected from the Dutch acute Stroke Trial (DUST) study. Patients underwent noncontrast CT, CT angiography, and CT perfusion within 9 hours after stroke onset and CT or MRI on follow-up. Images were evaluated for signs and location of ischemia. Discrimination of 3 hierarchical logistic regression models (noncontrast CT [A], added CT angiography source images [B], and CT perfusion [C]) was compared with C-statistics. Of 88 patients, 76 (86%) had a clinical diagnosis of ischemic stroke on discharge and 42 patients (48%) showed a posterior circulation infarct on follow-up imaging. Model C (area under the curve fro...
Annals of vascular surgery, 2015
To describe the transapical approach for thoracic endovascular aortic repair (TEVAR). Three patie... more To describe the transapical approach for thoracic endovascular aortic repair (TEVAR). Three patients, 2 elective and 1 emergent, with thoracic aorta aneurysm are described with vascular or direct aortic inaccessible access, who underwent TEVAR through transapical access. The technique is described in detail emphasizing the usefulness of the through-and-through guidewire, rapid pacing, and transesophageal echocardiography guidance. All patients were technical successfully treated with TEVAR through transapical access. The emergent patient, however, died due to multiorgan failure. Our early experience shows that the transapical approach for TEVAR procedures is feasible in experienced hands. The selection of the patient and careful planning based on imaging are of paramount importance and should lead to the most suitable access site tailored to the need of the individual patient.
Vascular and endovascular surgery, 2012
We present a case of a 4-fenestrated endograft repair of a suprarenal aortic patch aneurysm as us... more We present a case of a 4-fenestrated endograft repair of a suprarenal aortic patch aneurysm as useful alternative for complex open reoperation in a patient with Marfan syndrome.
Annals of Vascular Surgery, 2006
The use of femoral artery closure devices to obtain hemostasis after percutaneous catheterization... more The use of femoral artery closure devices to obtain hemostasis after percutaneous catheterization has become widespread because of their proven feasibility in combination with patient-related advantages. Since 2002 more than 6,500 patients have undergone either diagnostic angiography or therapeutic intervention via the femoral route with an Angioseal closure device in our hospital. We were faced with six cases of limb-threatening complications, which are described here. Most (5/6) complications were of obstructive origin due to traumatic dissection or occlusion of the artery mainly caused by malpositioning of the device. Recommendations are made in order to prevent or successfully overcome this certainly increasing problem in the vascular field.
PLoS ONE, 2014
Introduction: We related composition of cerebral thrombi to stroke subtype and attenuation on non... more Introduction: We related composition of cerebral thrombi to stroke subtype and attenuation on non-contrast CT (NCCT) to gain more insight in etiopathogenesis and to validate thrombus attenuation as a new imaging biomarker for acute stroke.
Annals of Vascular Surgery, 2014
We compared initial and long-term outcomes between men and women after endovascular and open repa... more We compared initial and long-term outcomes between men and women after endovascular and open repair of popliteal artery aneurysms (PAAs). Between January 1993 and July 2011, 202 patients (185 men [92%]), underwent open (n = 186) or endovascular (n = 16) repair of a PAA. Data were retrospectively analyzed. Significant differences in baseline characteristics were determined between men and women with regard to aneurysm diameter (men: 30 mm [range: 14-90]; women: 26 mm [range: 13-70]; P = 0.02) and age (men: 66 ± 10 years; women: 71 ± 9 years; P = 0.05). The 30-day mortality rate was 0% in both groups. No significant differences were determined concerning 30-day complications. The median follow-up was 55 months (range: 1-121 months) in men, compared with 35 months (range: 1-183 months) in women (P = 0.74). The primary patency rates at 1, 3, and 5 years were 88%, 82%, and 76% in men compared with 64%, 64%, and 48% in women, respectively (P = 0.007). The limb salvage rates in men at 1, 3, and 5 years were 97%, 97%, and 96%, and in women were 87%, 87%, and 87%, respectively (P = 0.07). When correcting for potential confounders with multivariable regression analysis, sex was independently associated with primary patency (hazard ratio: 2.98 [95% confidence interval: 1.39-6.42]; P = 0.005). No significant differences between men and women were observed in 30-day mortality and morbidity rates after PAA repair. In the long run, women are associated with lower primary patency rates and a trend toward lower limb salvage rates compared to men.
Journal of Vascular and Interventional Radiology, 2014
Trials, 2012
Background: Iliac artery atherosclerotic disease may cause intermittent claudication and critical... more Background: Iliac artery atherosclerotic disease may cause intermittent claudication and critical limb ischemia. It can lead to serious complications such as infection, amputation and even death. Revascularization relieves symptoms and prevents these complications. Historically, open surgical repair, in the form of endarterectomy or bypass, was used. Over the last decade, endovascular repair has become the first choice of treatment for iliac arterial occlusive disease. No definitive consensus has emerged about the best endovascular strategy and which type of stent, if any, to use. However, in more advanced disease, that is, long or multiple stenoses or occlusions, literature is most supportive of primary stenting with a balloon-expandable stent in the common iliac artery (Jongkind V et al., J Vasc Surg 52:1376-1383. Recently, a PTFE-covered balloon-expandable stent (Advanta V12, Atrium Medical Inc., Hudson, NH, USA) has been introduced for the iliac artery. Covering stents with PTFE has been shown to lead to less neo-intimal hyperplasia and this might lower restenosis rates (Dolmatch B et al. ). However, only one RCT, of mediocre quality has been published on this stent in the common iliac artery (Mwipatayi BP et al. J Vasc Surg 54:1561-1570, Bekken JA et al. J Vasc Surg 55:1545-1546. Our hypothesis is that covered balloon-expandable stents lead to better results when compared to uncovered balloon-expandable stents.