- Author
-
A.J. Yoo
- Title
- Imaging‐based patient selection for intra‐arterial stroke therapy
- Supervisors
-
C.B.L.M. Majoie
Y.B.W.E.M. Roos - Co-supervisors
-
H.A. Marquering
- Award date
- 17 November 2016
- Number of pages
- 302
- ISBN
- 9789082599312
- Document type
- PhD thesis
- Faculty
- Faculty of Medicine (AMC-UvA)
- Abstract
-
Acute ischemic strokes arising from blockages of the major brain-supplying arteries put patients at risk for extensive brain injury. Left untreated, these major strokes produce significant disability and death. Fortunately, recent advances in stroke devices have improved clinical outcomes in such patients, provided that they are treated early enough after their stroke onset. Using minimally invasive techniques, these devices are delivered through the arteries using catheters in order to remove the thrombus, or blood clot, that is blocking blood flow to the brain. However, further progress is needed, as approximately half of the major stroke patients who are treated in this way remain dependent or dead at 3 months after their stroke. In particular, a better understanding of which patients are likely to benefit from intervention is crucial. This thesis investigates the role of brain imaging to improve patient selection. Part I examines the use of various imaging approaches to identify those stroke patients who have already suffered large areas of brain injury, and as a result are unlikely to do well after treatment. Excluding such patients will improve the risk-benefit profile of stroke intervention and make treatment more cost effective. Part II explores the emerging field of thrombus imaging and the impact of thrombus characteristics on outcomes after intervention. Through this work, advances in stroke devices and procedural techniques can be targeted to the most difficult to treat thrombi. The thesis concludes with a discussion of the key research questions on the horizon.
- Note
- Research conducted at: Universiteit van Amsterdam
- Persistent Identifier
- https://hdl.handle.net/11245/1.545201
- Downloads
-
Thesis (complete)
Front matter
Chapter 1: General introduction and outline
Chapter 2: Imaging‐based treatment selection for intravenous and intra‐arterial stroke therapies: A comprehensive review
Chapter 3: Infarct volume Is a pivotal biomarker following intra‐arterial stroke therapy
Chapter 4: MRI‐based selection for intra‐arterial stroke therapy: Value of pretreatment diffusion‐weighted imaging lesion volume in selecting patients with acute stroke who will benefit from early recanalization
Chapter 5: A score based on age and DWI volume predicts poor outcome following endovascular treatment for acute ischemic stroke
Chapter 6: Combining acute DWI and MTT lesion volumes with NIHSS score improves the prediction of acute stroke outcome
Chapter 7: Impact of pretreatment noncontrast CT Alberta Stroke Program Early CT Score on clinical outcome after intra‐arterial stroke therapy
Chapter 8: Effect of baseline Alberta Stroke Program Early CT Score on safety and efficacy of intra‐arterial treatment: A subgroup analysis of a randomized phase 3 trial (MR CLEAN)
Chapter 9: CT angiography source images acquired with a fast‐acquistion protocol overestimate infarct core on diffusion weighted images in acute ischemic stroke
Chapter 10: Acute ischemic stroke: Infarct core estimation on CTA source images depends on CTA protocol
Chapter 11: Malignant CTA collateral profile is highly specific for large admission DWI infarct core and poor outcome in acute stroke
Chapter 12: The added value of the clot burden score in endovascular treatment for patients with acute ischemic stroke
Chapter 13: Impact of thrombus length on outcomes after intra‐arterial aspiration thrombectomy in the THERAPY trial
Chapter 14: General discussion
Summary / Nederlandse samenvatting
Back matter
Statements and quotations
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