PhD defence W. (Wouter) van der Steen

Summary:

The aim of this thesis was to improve the outcome of patients treated with endovascular stroke treatment. Specific aims were to assess the safety and effectiveness of the periprocedural use of intravenous antithrombotics and to evaluate the impact and characteristics of intracranial hemorrhages that can occur as a complication. Results show that both standard periprocedural use of aspirin and standard periprocedural use of heparin are associated with an increased risk of symptomatic intracranial hemorrhage, without a positive effect on functional outcome or reperfusion. Therefore, it concludes that routine periprocedural use of intravenous aspirin or heparin should be avoided. A promising finding is a nonlinear relationship between post-procedural APTT ratio and functional outcome. This may indicate that an APTT-guided treatment strategy is safe and effective. However, this should be investigated in further studies before it becomes clinical practice. Furthermore, the impact and characteristics of the occurrence and of the different types of intracranial hemorrhages that can occur as a complication after endovascular stroke treatment are described. These results can be used for the early detection and prevention of this common and feared complication. Altogether, the results described in this thesis make endovascular stroke treatment safer, which will have a positive effect on the functional outcome of this severely affect patient population.