Advancements in diagnostic and interventional radiology for stroke treatment: the path from trial to bedside through the pre-MR CLEAN, MR CLEAN, and MR CLEAN II eras by Noor Samuels, Rob A. van de Graaf, Yvo B. W. M. Roos, Diederik Dippel, Aad van der Lugt, the MR CLEAN and CONTRAST investigators

“…Within these MR CLEAN II trials, we proved that aspirin and heparin during EVT should be avoided due to increased symptomatic intracranial hemorrhage risk (MR CLEAN-MED). …”
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Effect of Workflow Improvements on Time to Endovascular Thrombectomy for Acute Ischemic Stroke in the MR CLEAN Registry by Paula M. Janssen, Bob Roozenbeek, Jonathan M. Coutinho, Adriaan C.G.M. van Es, Wouter J. Schonewille, Geert J. Lycklama a Nijeholt, Hester F. Lingsma, Diederik W.J. Dippel

“…Methods The authors used data from the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands) registry and included patients with acute ischemic stroke in the anterior circulation, who underwent EVT between March 2014 and November 2017. …”
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‘Mr. Clean’ and his ‘computer boys’: technology, technocracy, and de-politicisation in the Indian National Congress (1981–1991) by Sharma, AD

Management of extracranial carotid artery stenosis during endovascular treatment for acute ischaemic stroke: results from the MR CLEAN Registry by Maarten Uyttenboogaart, Jeannette Hofmeijer, Jasper M Martens, Aad van der Lugt, Charles B L M Majoie, Marianne A A van Walderveen, Paul J Nederkoorn, Reinoud P H Bokkers, Kars C J Compagne, Gert J de Borst, Sabine L Collette, Gert Jan R Luijckx, Michael P Rodgers

“…We compared the outcomes of two different strategies: EVT with vs without carotid artery stenting (CAS).Methods In this observational study, we included patients who had an acute ischaemic stroke undergoing EVT and a concomitant ipsilateral extracranial ICA stenosis of ≥50% or occlusion of presumed atherosclerotic origin, from the Dutch Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry (2014–2017). The primary endpoint was a good functional outcome at 90 days, defined as a modified Rankin Scale score ≤2. …”
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Alternative Arterial Access Routes for Endovascular Thrombectomy in Patients with Acute Ischemic Stroke: A Study from the MR CLEAN Registry by Sabine L. Collette, Elke A. van de Ven, Gert-Jan R. Luijckx, Hester F. Lingsma, Pieter Jan van Doormaal, Adriaan C. G. M. van Es, Ido R. van den Wijngaard, Robert-Jan B. Goldhoorn, Jan Cees de Groot, Wim H. van Zwam, Charles B. L. M. Majoie, Diederik W. J. Dippel, Reinoud P. H. Bokkers, Maarten Uyttenboogaart, on behalf of the MR CLEAN Registry Investigators

“…<b>Methods:</b> In this observational study, we included patients from the MR CLEAN Registry who underwent EVT for acute ischemic stroke in the anterior circulation between 2014 and 2019 in the Netherlands. …”
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Endovascular Treatment May Benefit Patients With Low Baseline Alberta Stroke Program Early CT Score: Results From the MR CLEAN Registry by Manon Kappelhof, Ivo G.H. Jansen, Johanna M. Ospel, Albert J. Yoo, Ludo F.M. Beenen, Stefan D. Roosendaal, Maxim J.H.L. Mulder, Jasper M. Martens, Alida A. Postma, Diederik W.J. Dippel, Wim H. van Zwam, Olvert A. Berkhemer, Henk A. Marquering, Charles B.L.M. Majoie

“…In this retrospective observational cohort study, we investigated outcomes of EVT in patients with low ASPECTS in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands) registry. …”
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Multicenter randomized clinical trial of endovascular treatment for acute ischemic stroke. The effect of periprocedural medication: acetylsalicylic acid, unfractionated heparin, both, or neither (MR CLEAN-MED). Rationale and study design by Chalos, V, A van de Graaf, R, Roozenbeek, B, C G M van Es, A, M den Hertog, H, Staals, J, van Dijk, L, F M Jenniskens, S, J van Oostenbrugge, R, H van Zwam, W, B W E M Roos, Y, B L M Majoie, C, F Lingsma, H, van der Lugt, A, W J Dippel, D, MR CLEAN-MED investigators, Rothwell, P

“…The aim of this study is to assess the effect of acetylsalicylic acid (ASA) and unfractionated heparin (UFH), alone, or in combination, given to patients with an ischemic stroke caused by an intracranial large vessel occlusion in the anterior circulation during EVT. <br>METHODS:<br>MR CLEAN-MED is a multicenter phase III trial with a prospective, 2&#x2009;&#xD7;&#x2009;3 factorial randomized, open label, blinded end-point (PROBE) design, which aims to enroll 1500 patients. …”

Value of CT Perfusion for Collateral Status Assessment in Patients with Acute Ischemic Stroke by Haryadi Prasetya, Manon L. Tolhuisen, Miou S. Koopman, Manon Kappelhof, Frederick J. A. Meijer, Lonneke S. F. Yo, Geert J. Lycklama á Nijeholt, Wim H. van Zwam, Aad van der Lugt, Yvo B. W. E. M. Roos, Charles B. L. M. Majoie, Ed T. van Bavel, Henk A. Marquering, on behalf of the MR CLEAN Registry Investigators

“…We included 85 patients with a baseline CTP and single-phase CTA images from the MR CLEAN Registry. We evaluated patients’ CTP parameters, including relative CBVs and tissue volumes with several time-to-maximum ranges, to be candidates for a CTP-based collateral score. …”
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Value of Automatically Derived Full Thrombus Characteristics: An Explorative Study of Their Associations with Outcomes in Ischemic Stroke Patients by Mahsa Mojtahedi, Agnetha E. Bruggeman, Henk van Voorst, Elena Ponomareva, Manon Kappelhof, Aad van der Lugt, Jan W. Hoving, Bruna G. Dutra, Diederik Dippel, Fabiano Cavalcante, Lonneke Yo, Jonathan Coutinho, Josje Brouwer, Kilian Treurniet, Manon L. Tolhuisen, Natalie LeCouffe, Nerea Arrarte Terreros, Praneeta R. Konduri, Wim van Zwam, Yvo Roos, Charles B. L. M. Majoie, Bart J. Emmer, Henk A. Marquering

“…Here, we exploratively assess the value of these novel biomarkers in terms of their association with stroke outcomes. (2) <b>Methods</b>: We studied two applications of automated full thrombus characterization as follows: one in a randomized trial, MR CLEAN-NO IV (<i>n</i> = 314), and another in a Dutch nationwide registry, MR CLEAN Registry (<i>n</i> = 1839). …”
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Outcomes After Intracranial Rescue Stenting for Acute Ischemic Stroke by Christine Tschoe, Stephanie Coffman, Carol Kittel, Patrick Brown, Sami Al Kasab, Eyad Almallouhi, Alejandro Spiotta, Brian Howard, Ali Alawieh, Adam Arthur, Nitin Goyal, Peter Kan, Joon‐Tae Kim, Reade De Leacy, Ansaar Rai, Min Park, Robert Starke, Pascal Jabbour, Roberto Crosa, Travis Dumont, Ilko Maier, Joshua Osbun, Kyle Fargen, Stacey Wolfe

“…Symptomatic intracranial hemorrhage was not significantly increased after RS compared with MR CLEAN (P=0.06), but was increased compared with DAWN. …”
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Siamese model for collateral score prediction from computed tomography angiography images in acute ischemic stroke by Valerio Fortunati, Jiahang Su, Lennard Wolff, Pieter-Jan van Doormaal, Jeanette Hofmeijer, Jeanette Hofmeijer, Jasper Martens, Reinoud P. H. Bokkers, Wim H. van Zwam, Aad van der Lugt, Theo van Walsum

“…A separate set of images, from the MR CLEAN Trial, served as an external validation set, where collateral scoring was assessed and compared with both human observers and a recent more traditional model. …”
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ENDOVASCULARAPPROACHES TOACUTE ISCHEMIC STROKE- INDIAN PERSPECTIVE by Pramod Dhonde MD DM 1, Nikhil Kadam MD DM 2

“…Due to certain limitations of IVT, in pooled patientlevel data from 5 trials (HERMES [Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials], which included the 5 trials MR CLEAN, ESCAPE, REVASCAT, SWIFT PRIME, and EXTEND-IA), mechanical thrombectomy (MT) is indicated for patients with acute ischemic stroke due to a large artery occlusion (LVO) in the anterior circulation who can be treated within 24 hours of the time last known to be well (ie, at neurologic baseline), regardless of whether they received intravenous alteplase for the same ischemic stroke event. …”
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Imaging in Acute Anterior Circulation Ischemic Stroke: Current and Future by Hyun Jeong Kim, Hong Gee Roh

“…Clinical trials on acute ischemic stroke have demonstrated the clinical effectiveness of revascularization treatments within an appropriate time window after stroke onset: intravenous thrombolysis (NINDS and ECASS-III) through the administration of tissue plasminogen activator within a 4.5-hour time window, endovascular thrombectomy (ESCAPE, REVASCAT, SWIFT-PRIME, MR CLEAN, EXTEND-IA) within a 6-hour time window, and extending the treatment time window up to 24 hours for endovascular thrombectomy (DAWN and DEFUSE 3). …”
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Outcome Prediction Based on Automatically Extracted Infarct Core Image Features in Patients with Acute Ischemic Stroke by Manon L. Tolhuisen, Jan W. Hoving, Miou S. Koopman, Manon Kappelhof, Henk van Voorst, Agnetha E. Bruggeman, Adam M. Demchuck, Diederik W. J. Dippel, Bart J. Emmer, Serge Bracard, Francis Guillemin, Robert J. van Oostenbrugge, Peter J. Mitchell, Wim H. van Zwam, Michael D. Hill, Yvo B. W. E. M. Roos, Tudor G. Jovin, Olvert A. Berkhemer, Bruce C. V. Campbell, Jeffrey Saver, Phil White, Keith W. Muir, Mayank Goyal, Henk A. Marquering, Charles B. Majoie, Matthan W. A. Caan

“…We included FU-DWI data from the HERMES, ISLES, and MR CLEAN-NO IV databases. Lesions were segmented using a deep learning model trained on the HERMES and ISLES datasets. …”
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‘Drive the doctor’ for endovascular thrombectomy in a rural area: a simulation study by Willemijn J. Maas, Durk-Jouke van der Zee, Maarten M.H. Lahr, Marc Bouma, Erik Buskens, Maarten Uyttenboogaart

“…Methods Data from EVT patients in northern Netherlands was prospectively collected in the MR CLEAN Registry between July 2014 - November 2017. …”
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Validity of Early Outcomes as Indicators for Comparing Hospitals on Quality of Stroke Care by Marzyeh Amini, Frank Eijkenaar, Hester F. Lingsma, Sanne J. den Hartog, Susanne G. H. Olthuis, Jasper Martens, Bart van der Worp, Wim van Zwam, Anouk van der Hoorn, Stefan D. Roosendaal, Bob Roozenbeek, Diederik Dippel, Nikki van Leeuwen

“…Methods and Results We used data from the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry, a large multicenter prospective cohort study including 3279 patients with acute ischemic stroke undergoing EVT. …”
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Prognostic Value of Combined Radiomic Features from Follow-Up DWI and T2-FLAIR in Acute Ischemic Stroke by Alessia Gerbasi, Praneeta Konduri, Manon Tolhuisen, Fabiano Cavalcante, Leon Rinkel, Manon Kappelhof, Lennard Wolff, Jonathan M. Coutinho, Bart J. Emmer, Vincent Costalat, Caroline Arquizan, Jeannette Hofmeijer, Maarten Uyttenboogaart, Wim van Zwam, Yvo Roos, Silvana Quaglini, Riccardo Bellazzi, Charles Majoie, Henk Marquering

“…We built a fully automated pipeline based on a tree ensemble machine learning model to predict poor long-term functional outcome in patients from the MR CLEAN-NO IV trial. Several feature sets were compared, considering only imaging, only clinical, or both types of features. …”
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Value of Thrombus Imaging Characteristics as a Guide for First‐Line Endovascular Thrombectomy Device in Patients With Acute Ischemic Stroke by Nikki Boodt, Agnetha A. E. Bruggeman, Manon Kappelhof, Sanne J. den Hartog, Nerea Arrarte Terreros, Jasper M. Martens, Reinoud P. H. Bokkers, Pieter‐Jan van Doormaal, Charles B. L. M. Majoie, Wim H. van Zwam, Henk A. Marquering, Diederik W. J. Dippel, Aad van der Lugt, Hester F. Lingsma

“…Methods For patients enrolled in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands) Registry between March 2014 and November 2017, we assessed thrombus density, thrombus length, and presence of hyperdense artery sign on thin‐slice (≤2.5 mm) admission CT. …”
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Impact of Intracranial Volume and Brain Volume on the Prognostic Value of Computed Tomography Perfusion Core Volume in Acute Ischemic Stroke by Jan W. Hoving, Praneeta R. Konduri, Manon L. Tolhuisen, Miou S. Koopman, Henk van Voorst, Laura M. Van Poppel, Jasper D. Daems, Adriaan C. G. M. van Es, Marianne A. A. van Walderveen, Hester F. Lingsma, Diederik W. J. Dippel, Wim H. Van Zwam, Henk A. Marquering, Charles B. L. M. Majoie, Bart J. Emmer

“…Materials and Methods: We retrospectively included patients from the MR CLEAN Registry. Cerebrospinal fluid (CSF) and intracranial volume (ICV) were automatically segmented on NCCT. …”
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Deep-Learning-Based Thrombus Localization and Segmentation in Patients with Posterior Circulation Stroke by Riaan Zoetmulder, Agnetha A. E. Bruggeman, Ivana Išgum, Efstratios Gavves, Charles B. L. M. Majoie, Ludo F. M. Beenen, Diederik W. J. Dippel, Nikkie Boodt, Sanne J. den Hartog, Pieter J. van Doormaal, Sandra A. P. Cornelissen, Yvo B. W. E. M. Roos, Josje Brouwer, Wouter J. Schonewille, Anne F. V. Pirson, Wim H. van Zwam, Christiaan van der Leij, Rutger J. B. Brans, Adriaan C. G. M. van Es, Henk A. Marquering

“…In this multi-center retrospective study, 187 patients with PCS from the MR CLEAN Registry were included. We developed a convolutional neural network (CNN) that segments thrombi and restricts the volume-of-interest (VOI) to the brainstem (Polar-UNet). …”
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