Endovascular Treatment for Acute Ischemic Stroke : Towards Personalized Treatment in Clinical Practice

The main objective of this thesis was to improve personalized endovascular treatment (EVT) for acute ischemic stroke in clinical practice. Chapter 2 focuses on the effect of EVT in certain patient subgroups. We used MR CLEAN trial data to perform three subgroup analyses. We showed that endovascular treatment is effective and safe for patients with acute ischemic stroke caused by proximal anterior vessel occlusion irrespective of antiplatelet medication, prior intravenous alteplase treatment and blood pressure. Chapter 3 focuses on improving patient selection for EVT. In this chapter a clinical decision that predicts EVT benefit for individual patients at the emergency department, was developed and validated. The tool emphasizes the wide variety of treatment benefit in individual patients and the importance of combining multiple characteristics simultaneously. This decision tool is the first step towards individualized selection of patients for EVT. Finally chapter 4 is focused on EVT in clinical practice. Data of the MR CLEAN Registry were used. This chapter shows that in routine clinical practice, endovascular treatment is at least as safe and effective as in the ‘experimental’ trial setting. Secondly, functional outcome after endovascular treatment can be greatly improved by shortening onset to treatment times.

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