eprintid: 10047835 rev_number: 32 eprint_status: archive userid: 608 dir: disk0/10/04/78/35 datestamp: 2018-05-04 16:28:02 lastmod: 2021-09-26 23:02:04 status_changed: 2018-05-04 16:28:02 type: article metadata_visibility: show creators_name: Kimberly, WT creators_name: Dutra, BG creators_name: Boers, AMM creators_name: Alves, HCBR creators_name: Berkhemer, OA creators_name: Van Den Berg, L creators_name: Sheth, KN creators_name: Roos, YBWEM creators_name: Van Der Lugt, A creators_name: Beenen, LFM creators_name: Dippel, DWJ creators_name: Van Zwam, WH creators_name: Van Oostenbrugge, RJ creators_name: Lingsma, HF creators_name: Marquering, H creators_name: Majoie, CBLM creators_name: Koudstaal, PJ creators_name: Van Den Berg, LA creators_name: Nederkoorn, PJ creators_name: Beumer, D creators_name: Staals, J creators_name: Boiten, J creators_name: Wermer, MJH creators_name: Kappelle, LJ creators_name: Van Dijk, EJ creators_name: Schonewille, WJ creators_name: Hofmeijer, J creators_name: Van Oostayen, JA creators_name: Vroomen, PC creators_name: De Kort, PLM creators_name: Keizer, K creators_name: De Bruijn, SF creators_name: Van Den Berg, JSP creators_name: Schreuder, THCML creators_name: Aerden, LAM creators_name: Flach, HZ creators_name: Visser, MC creators_name: Den Hertog, HM creators_name: Brouwer, PA creators_name: Emmer, BJ creators_name: Sprengers, MES creators_name: Van Den Berg, R creators_name: Nijeholt, GJL creators_name: Van Walderveen, MAA creators_name: Lo, RH creators_name: De Vries, J creators_name: Vos, JA creators_name: Eshghi, O creators_name: Tielbeek, AV creators_name: Van Dijk, LC creators_name: Van Hasselt, BAAM creators_name: Heijboer, RJJ creators_name: Dallinga, RJ creators_name: Bot, JCJ creators_name: Gerrits, DG creators_name: Fransen, PSS creators_name: Marquering, HA creators_name: Steyerberg, EW creators_name: Yoo, AJ creators_name: Jenniskens, SFM creators_name: Van Den Berg-Vos, RM creators_name: Karas, GB creators_name: Brown, MM creators_name: Liebig, T creators_name: Stijnen, T creators_name: Andersson, T creators_name: Mattle, H creators_name: Wahlgren, N creators_name: Van Der Heijden, E creators_name: Ghannouti, N creators_name: Fleitour, N creators_name: Hooijenga, I creators_name: Puppels, C creators_name: Pellikaan, W creators_name: Geerling, A creators_name: Lindl-Velema, A creators_name: Van Vemde, G creators_name: Klinieken, I creators_name: De Ridder, A creators_name: Greebe, P creators_name: De Bont-Stikkelbroeck, J creators_name: De Meris, J creators_name: Janssen, K creators_name: Struijk, W creators_name: Licher, S creators_name: Boodt, N creators_name: Ros, A creators_name: Venema, E creators_name: Slokkers, I creators_name: Ganpat, RJ title: Association of reperfusion with brain edema in patients with acute ischemic stroke: A secondary analysis of the MR CLEAN Trial ispublished: pub divisions: UCL divisions: B02 divisions: C07 divisions: D07 abstract: IMPORTANCE: It is uncertain whether therapeutic reperfusion with endovascular treatment yields more or less brain edema. OBJECTIVE To elucidate the association between reperfusion and brain edema. The secondary objectives were to evaluate whether brain edema could partially be responsible for worse outcomes in patients with later reperfusion or lower Alberta Stroke Program Early Computed Tomography Score. DESIGN, SETTING, AND PARTICIPANTS: This was a post hoc analysis of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), which was a prospective, randomized, multicenter clinical trial of endovascular treatment compared with conventional care of patients with acute anterior circulation ischemic stroke. Of 502 patients enrolled from December 2010 to June 2014, 2 patients declined to participate. Additionally, exclusion criteria were absence of follow-up imaging or presence of parenchymal hematoma, resulting in 462 patients included in this study. Brain edema was assessed retrospectively, from December 10, 2016, to July 24, 2017, by measuring midline shift (MLS) in all available follow-up scans. Observers were blinded to clinical data. MAIN OUTCOMES AND MEASURES: Midline shift was assessed as present or absent and as a continuous variable. Reperfusion status was assessed by the modified thrombolysis in cerebral infarction score in the endovascular treatment arm. The modified arterial occlusive lesion score was used to evaluate the recanalization status in both arms. The modified Rankin scale score at 90 days was used for functional outcome. RESULTS Of 462 patients, the mean (SD) age was65 (11) years, and 41.8% (n = 193) were women. Successful reperfusion and recanalization were associated with a reduced likelihood of having MLS (adjusted common odds ratio, 0.25; 95% CI, 0.12-0.53; P < .001 and adjusted common odds ratio, 0.34; 95% CI, 0.21-0.55; P < .001, respectively). Midline shift was partially responsible for worse modified Rankin scale scores in patients without reperfusion or recanalization (MLS changed the logistic regression coefficients by 30.3% and 12.6%, respectively). In patients with delayed reperfusion or lower Alberta Stroke Program Early Computed Tomography Score, MLS mediated part of the worse modified Rankin scale scores, corresponding to a change in the regression coefficient of 33.3% and 64.2%, respectively. CONCLUSIONS AND RELEVANCE: Successful reperfusion was associated with reduced MLS. This study identifies an additional benefit of reperfusion in relation to edema, as well as rescuing ischemic brain tissue at risk for infarction. date: 2018-04 date_type: published official_url: http://dx.doi.org/10.1001/jamaneurol.2017.5162 full_text_type: other language: eng article_type_text: Journal Article verified: verified_manual elements_id: 1551991 doi: 10.1001/jamaneurol.2017.5162 lyricists_name: Brown, Martin lyricists_id: MMBRO52 actors_name: Zahnhausen-Stuber, Petra actors_id: PMZAH20 actors_role: owner full_text_status: restricted publication: JAMA Neurology volume: 75 number: 4 pagerange: 453-461 issn: 2168-6149 citation: Kimberly, WT; Dutra, BG; Boers, AMM; Alves, HCBR; Berkhemer, OA; Van Den Berg, L; Sheth, KN; ... Ganpat, RJ; + view all <#> Kimberly, WT; Dutra, BG; Boers, AMM; Alves, HCBR; Berkhemer, OA; Van Den Berg, L; Sheth, KN; Roos, YBWEM; Van Der Lugt, A; Beenen, LFM; Dippel, DWJ; Van Zwam, WH; Van Oostenbrugge, RJ; Lingsma, HF; Marquering, H; Majoie, CBLM; Koudstaal, PJ; Van Den Berg, LA; Nederkoorn, PJ; Beumer, D; Staals, J; Boiten, J; Wermer, MJH; Kappelle, LJ; Van Dijk, EJ; Schonewille, WJ; Hofmeijer, J; Van Oostayen, JA; Vroomen, PC; De Kort, PLM; Keizer, K; De Bruijn, SF; Van Den Berg, JSP; Schreuder, THCML; Aerden, LAM; Flach, HZ; Visser, MC; Den Hertog, HM; Brouwer, PA; Emmer, BJ; Sprengers, MES; Van Den Berg, R; Nijeholt, GJL; Van Walderveen, MAA; Lo, RH; De Vries, J; Vos, JA; Eshghi, O; Tielbeek, AV; Van Dijk, LC; Van Hasselt, BAAM; Heijboer, RJJ; Dallinga, RJ; Bot, JCJ; Gerrits, DG; Fransen, PSS; Marquering, HA; Steyerberg, EW; Yoo, AJ; Jenniskens, SFM; Van Den Berg-Vos, RM; Karas, GB; Brown, MM; Liebig, T; Stijnen, T; Andersson, T; Mattle, H; Wahlgren, N; Van Der Heijden, E; Ghannouti, N; Fleitour, N; Hooijenga, I; Puppels, C; Pellikaan, W; Geerling, A; Lindl-Velema, A; Van Vemde, G; Klinieken, I; De Ridder, A; Greebe, P; De Bont-Stikkelbroeck, J; De Meris, J; Janssen, K; Struijk, W; Licher, S; Boodt, N; Ros, A; Venema, E; Slokkers, I; Ganpat, RJ; - view fewer <#> (2018) Association of reperfusion with brain edema in patients with acute ischemic stroke: A secondary analysis of the MR CLEAN Trial. JAMA Neurology , 75 (4) pp. 453-461. 10.1001/jamaneurol.2017.5162 <https://doi.org/10.1001/jamaneurol.2017.5162>. document_url: https://discovery.ucl.ac.uk/id/eprint/10047835/3/Figure%201-4.pdf document_url: https://discovery.ucl.ac.uk/id/eprint/10047835/10/Brown_Reperfusion%20and%20brain%20edema%20supplement_2018-01-06.pdf document_url: https://discovery.ucl.ac.uk/id/eprint/10047835/16/Brown_Reperfusion%20and%20brain%20edema_2017-12-22_final.pdf