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Goyal, M.; Yoshimura, S.; Milot, G.; Fiehler, J.; Jayaraman, M.; Dorn, F.; ... ; Ospel, J.M. 2020

Considerations for antiplatelet management of carotid stenting in the setting of mechanical thrombectomy: a Delphi consensus statement

Article / Letter to editor

open access

BACKGROUND AND PURPOSE: There are only few data and lack of consensus regarding antiplatelet management for carotid stent placement in the setting of endovascular stroke treatment. We aimed to... Show moreBACKGROUND AND PURPOSE: There are only few data and lack of consensus regarding antiplatelet management for carotid stent placement in the setting of endovascular stroke treatment. We aimed to develop a consensus-based algorithm for antiplatelet management in acute ischemic stroke patients undergoing endovascular treatment and simultaneous emergent carotid stent placement.MATERIALS AND METHODS: We performed a literature search and a modified Delphi approach used Web-based questionnaires that were sent in several iterations to an international multidisciplinary panel of 19 neurointerventionalists from 7 countries. The first round included open-ended questions and formed the basis for subsequent rounds, in which closed-ended questions were used. Participants continuously received feedback on the results from previous rounds. Consensus was defined as agreement of >= 70% for binary questions and agreement of $50% for questions with.2 answer options. The results of the Delphi process were then summarized in a draft manuscript that was circulated among the panel members for feedback.RESULTS: A total of 5 Delphi rounds were performed. Panel members preferred a single intravenous aspirin bolus or, in jurisdictions in which intravenous aspirin is not available, a glycoprotein IIb/IIIa receptor inhibitor as intraprocedural antiplatelet regimen and a combination therapy of oral aspirin and a P2Y12 inhibitor in the postprocedural period. There was no consensus on the role of platelet function testing in the postprocedural period.CONCLUSIONS: More and better data on antiplatelet management for carotid stent placement in the setting of endovascular treatment are urgently needed. Panel members preferred intravenous aspirin or, alternatively, a glycoprotein IIb/IIIa receptor inhibitor as an intraprocedural antiplatelet agent, followed by a dual oral regimen of aspirin and a P2Y12 inhibitor in the postprocedural period. Show less

Ospel, J.M.; Brouwer, P.; Dorn, F.; Arthur, A.; Jensen, M.E.; Nogueira, R.; ... ; Goyal, M. 2020

Antiplatelet management for stent-assisted coiling and flow diversion of ruptured intracranial aneurysms: a DELPHI consensus statement

Article / Letter to editor

open access

BACKGROUND AND PURPOSE: There is a paucity of data regarding antiplatelet management strategies in the setting of stent-assisted coiling/flow diversion for ruptured intracranial aneurysms. This... Show moreBACKGROUND AND PURPOSE: There is a paucity of data regarding antiplatelet management strategies in the setting of stent-assisted coiling/flow diversion for ruptured intracranial aneurysms. This study aimed to identify current challenges in antiplatelet management during stent-assisted coiling/flow diversion for ruptured intracranial aneurysms and to outline possible antiplatelet management strategies. MATERIALS AND METHODS: The modified DELPHI approach with an on-line questionnaire was sent in several iterations to an international, multidisciplinary panel of 15 neurointerventionalists. The first round consisted of open-ended questions, followed by closed-ended questions in the subsequent rounds. Responses were analyzed in an anonymous fashion and summarized in the final manuscript draft. The statement received endorsement from the World Federation of Interventional and Therapeutic Neuroradiology, the Japanese Society for Neuroendovascular Therapy, and the Chinese Neurosurgical Society. RESULTS: Data were collected from December 9, 2019, to March 13, 2020. Panel members achieved consensus that platelet function testing may not be necessary and that antiplatelet management for stent-assisted coiling and flow diversion of ruptured intracranial aneurysms can follow the same principles. Preprocedural placement of a ventricular drain was thought to be beneficial in cases with a high risk of hydrocephalus. A periprocedural dual, intravenous, antiplatelet regimen with aspirin and a glycoprotein IIb/IIIa inhibitor was preferred as a standard approach. The panel agreed that intravenous medication can be converted to oral aspirin and an oral P2Y12 inhibitor within 24 hours after the procedure. CONCLUSIONS: More and better data on antiplatelet management of patients with ruptured intracranial aneurysms undergoing stent-assisted coiling or flow diversion are urgently needed. Panel members in this DELPHI consensus study preferred a periprocedural dual-antiplatelet regimen with aspirin and a glycoprotein IIb/IIIa inhibitor. Show less

Goyal, M.; Orlov, K.; Jensen, M.E.; Taylor, A.; Majoie, C.; Jayaraman, M.; ... ; Ospel, J.M. 2020

A DELPHI consensus statement on antiplatelet management for intracranial stenting due to underlying atherosclerosis in the setting of mechanical thrombectomy

Article / Letter to editor

open access

Purpose There is little data and lack of consensus regarding antiplatelet management for intracranial stenting due to underlying intracranial atherosclerosis in the setting of endovascular... Show morePurpose There is little data and lack of consensus regarding antiplatelet management for intracranial stenting due to underlying intracranial atherosclerosis in the setting of endovascular treatment (EVT). In this DELPHI study, we aimed to assess whether consensus on antiplatelet management in this situation among experienced experts can be achieved, and what this consensus would be. Methods We used a modified DELPHI approach to address unanswered questions in antiplatelet management for intracranial stenting due to underlying atherosclerosis in the setting of EVT. An expert-panel (19 neurointerventionalists from 8 countries) answered structured, anonymized on-line questionnaires with iterative feedback-loops. Panel-consensus was defined as agreement >= 70% for binary closed-ended questions/>= 50% for closed-ended questions with > 2 response options. Results Panel members answered a total of 5 survey rounds. They acknowledged that there is insufficient data for evidence-based recommendations in many aspects of antiplatelet management for intracranial stenting due to underlying atherosclerosis in the setting of EVT. They believed that antiplatelet management should follow a standardized regimen, irrespective of imaging findings and reperfusion quality. There was no consensus on the timing of antiplatelet-therapy initiation. Aspirin was the preferred antiplatelet agent for the peri-procedural period, and oral Aspirin in combination with a P2Y12 inhibitor was the favored postprocedural regimen. Conclusion Data on antiplatelet management for intracranial stenting due to underlying atherosclerosis in the setting of EVT are limited. Panel-members in this study achieved consensus on postprocedural antiplatelet management but did not agree upon a preprocedural and intraprocedural antiplatelet regimen. Further prospective studies to optimize antiplatelet regimens are needed. Show less

Fiehler, J.; Brouwer, P.; Diaz, C.; Hirsch, J.A.; Kulcsar, Z.; Liebeskind, D.; ... ; Taylor, A. 2020

COVID-19 and neurointerventional service worldwide: a survey of the European Society of Minimally Invasive Neurological Therapy (ESMINT), the Society of NeuroInterventional Surgery (SNIS), the Sociedad Iberolatinoamericana de Neuroradiologia Diagnostica y Terapeutica (SILAN), the Society of Vascular and Interventional Neurology (SVIN), and the World Federation of Interventional and Therapeutic Neuroradiology (WFITN)

Article / Letter to editor

open access

Background This survey was focused on the provision of neurointerventional services, the current practices of managing patients under COVID-19 conditions, and the expectations for the future.... Show moreBackground This survey was focused on the provision of neurointerventional services, the current practices of managing patients under COVID-19 conditions, and the expectations for the future. Methods Invitations for this survey were sent out as a collaborative effort of the European Society of Minimally Invasive Neurological Therapy (ESMINT), the Society of NeuroInterventional Surgery (SNIS), the Sociedad Iberolatinoamericana de Neuroradiologia Diagnostica y Terapeutica (SILAN), the Society of Vascular and Interventional Neurology (SVIN), and the World Federation of Interventional and Therapeutic Neuroradiology (WFITN). Results Overall, 475 participants from 61 countries responded (six from Africa (1%), 81 from Asia (17%), 156 from Europe (33%), 53 from Latin America (11%), and 172 from North America (11%)). The majority of participants (96%) reported being able to provide emergency services, though 26% of these reported limited resources. A decrease in emergency procedures was reported by 69% of participants (52% in ischemic and hemorrhagic stroke, 11% ischemic, and 6% hemorrhagic stroke alone). Only 4% reported an increase in emergency cases. The emerging need for social distancing and the rapid adoption of remote communication was reflected in the interest in establishing case discussion forums (43%), general online forums (37%), and access to angio video streaming for live mentoring and support (33%). Conclusion Neurointerventional emergency services are available in almost all centers, while the number of emergency patients is markedly decreased. Half of the participants have abandoned neurointerventions in non-emergent situations. There are considerable variations in the management of neurointerventions and in the expectations for the future. Show less

Aggour, M.; White, P.; Kulcsar, Z.; Fiehler, J.; Brouwer, P. 2020

European society of minimally invasive neurological therapy (ESMINT) recommendations for optimal interventional neurovascular management in the COVID-19 era

Article / Letter to editor

open access

Sasiadek, M.; Kocer, N.; Szikora, I.; Vilela, P.; Muto, M.; Jansen, O.; ... ; Ricci, P. 2020

Standards for European training requirements in interventional neuroradiology guidelines by the Division of Neuroradiology/Section of Radiology European Union of Medical Specialists (UEMS), in cooperation with the Division of Interventional Radiology/UEMS, the European Society of Neuroradiology (ESNR), and the European Society of Minimally Invasive Neurological Therapy (ESMINT) (Reprinted from Neuroradiology)

Other

open access

Pierot, L.; Jarayaman, M.; Szikora, I.; Hirsch, J.; Baxter, B.; Miyachi, S.; ... ; World Federation Interventional Th 2019

Standards of Practice in Acute Ischemic Stroke Intervention International Recommendations

Article / Letter to editor

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Bendszus, M.; Bonekamp, S.; Berge, E.; Boutitie, F.; Brouwer, P.; Gizewski, E.; ... ; Thomalla, G. 2019

A randomized controlled trial to test efficacy and safety of thrombectomy in stroke with extended lesion and extended time window

Article / Letter to editor

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Maus, V.; Behme, D.; Borggrefe, J.; Kabbasch, C.; Seker, F.; Huseyin, C.; ... ; Mpotsaris, A. 2018

Carotid Artery Stenosis Contralateral to Acute Tandem Occlusion: An Independent Predictor of Poor Clinical Outcome after Mechanical Thrombectomy with Concomitant Carotid Artery Stenting

Article / Letter to editor

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Kan, C. van; Brouwer, P.; Smit, B.H.J.; Spreeuwenberg, L.; Swet, J. van; Admiraal, W.F. 2018

From master student to master teacher: The meaning of teacher research for school practice

Still image (photo, video, movie)

open access

Teachers generally seem to have limited knowledge of, access to and interest in insights from academic educational research. A possible way to bridge the gap between research and practice might be... Show moreTeachers generally seem to have limited knowledge of, access to and interest in insights from academic educational research. A possible way to bridge the gap between research and practice might be research by teachers. This line of thinking has found its way to policy actions of the Dutch government, in which master programs for teachers are promoted. Yet evidence of positive effects of teacher research is minimal and somewhat ambiguous. The current study aims to answer the following research question: ‘How is teacher research evaluated with respect to the professional development of teachers and knowledge utilization in schools?’ First, a biographical study has been conducted with 36 teachers (primary education, secondary education and vocational education). Second, a Q-sort questionnaire was administered with a small group of teachers from each educational sector, which measures beliefs about teacher research as a professional development strategy. The preliminary conclusions indicate that a master program contributes to teachers’ professional development, among others, in terms of their ability to conduct teacher research. However, for knowledge utilization in schools to take place, teachers with a master degree are a helpful but not a sufficient condition. Show less

Lavine, S.D.; Cockroft, K.; Hoh, B.; Bambakidis, N.; Khalessi, A.A.; Woo, H.; ... ; Zhang, H.Q. 2017

Training guidelines for endovascular stroke intervention: an international multi-society consensus document (vol 58, pg 537, 2016)

Article / Letter to editor

open access

Kan, C. van; Brouwer, P.; Smit, B.H.J.; Spreeuwenberg, L.; Swet, J. van; Admiraal, W.F. 2017

Voorbij de kloof tussen onderwijsonderzoek en de onderwijspraktijk

Event

open access

Kan, C. van; Brouwer, P.; Smit, B.H.J.; Spreeuwenberg, L.; Swet, J. van; Admiraal, W.F. 2017

Moving Beyond the Research-practice Gap: Impact of Teacher Research on Professional Development and Knowledge Utilization in Schools

Event

open access

In various policy actions of the Dutch government, an assumption is made that teachers who had carried out a master thesis are able to generate knowledge and stimulate knowledge utilization in schools (Ministerie van OCW, 2013). Yet evidence of positive effects of teacher research, either as part of a master’s program or carried out by inservice teachers is minimal and somewhat ambiguous. The current study aims to answer the following research questions:

How is teacher research evaluated with respect to the professional development as teacher?
How is teacher research evaluated with respect to knowledge utilization in schools?

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Heijden, M.P.C. van der; Brouwer, P.; Denewith, H.; Furnée, J.H.; Van Gelder, M.; Muurling, S. 2016

Stadsgeschiedenis in buitenlandse tijdschriften

Article / Letter to editor

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Brouwer, P.; De Block, G.; Eersels, B.; Greefs, H.; Vrints, T.; Heijden, M.P.C. van der 2015

Stadsgeschiedenis in buitenlandse tijdschriften (2014)

Article / Letter to editor

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Brouwer, P.; Kroonenberg, P.M. 1991

Some notes on the diagonalization of extended core matrices

Article / Letter to editor

open access

Kroonenberg, P.M.; Berge, Jos M.F. ten; Brouwer, P.; Kiers, H. 1989

Gram-Schmidt versus Bauer-Rutishauser in alternating least-squares algorithms for three-way data

Article / Letter to editor

open access

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