Academic Center for Stroke

Last updated: 365 days ago.

Our mission is to improve the quality of life and survival of stroke victims by providing multidisciplinary, expert care and by carrying out clinical translational and fundamental research.
The Stroke Center wants to provide education for all disciplines involved, and initiate new research for diagnosis, treatment and prevention stroke and neurovascular disease.
We want to implement and evaluate new developments in translational and clinical research into high-level patient care.

Academic Center of Excellence

Research Activities

  • Population based Rotterdam Study: involvement of epidemiology, neurology and neuroradiology
  • CVON Heart Brain Connection: involvement of epidemiology and neurology
  • CONTRAST: Consortium for New Treatments of acute stroke: large collaboration, involving translational projects, epidemiological approaches and 5 large multicenter randomized clinical trials. Coordination by Erasmus MC (Dippel, Neurology) and AMC (Majoie, Radiology).
  • ECST-2: international collaboration aimed at evaluating surgical treatment of atherosclerotic carotid disease: involvement of neurology, vascular surgery and neuroradiology
  • Lifestyle and stroke: evaluation of approaches to secondary prevention of cardiovascular disease and stroke, tailored to the elderly patients and stroke victims: involvement of neurology, public health and internal medicine
  • Leading investigator's role (Van der Jagt) in (inter)national collaborations on aneurysmal subarachnoid hemorrhage (N.I.A.S.H. – Netherlands Intracranial Aneurysm and Subarachnoid Hemorrhage study group and INSIDERR - INternational SubarachnoID Hemorrhage Effectiveness Research Registry)

Type of

Collaborations

ECST-2: international collaboration aimed at evaluating surgical treatment of atherosclerotic carotid disease: involvement of neurology, vascular surgery and neuroradiology

Educational

Contributions

Erasmus MC Stroke Center is involved in all levels of education in care and treatment of stroke victims. Within the framework of the Rotterdam Stroke Service we offer training programs for stroke nurses at hbo level, but we also offer specific training to nursing home personnel in the care of stroke patient.

Education in the BSc and MSc educational program of Medicine:

  • "Keuzeonderwijs": program is offered to 2nd year Medical Students on stroke within the COEUR program.
  • Within Theme 3B we participate in regular MD training.
  • We participate in COEUR seminars and courses.
  • A large number of "keuze-onderzoek" students are being trained by our staf (approx. 6 per year).

PhD students: 14 in the last 5 years.

Patient

Care Activities

Care for Ischemic stroke (IS), subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH) and intracranial vascular malformations and vasculopathy is labeled as academic according to the ROBIJN model. Erasmus MC Stroke Center is the tertiary referral center for the Rijnmond Region southwest Netherlands. This involves thrombectomy for IS and surgical or endovascular treatment of SAH and several types of vascular malformations including those resulting from sickle cell disease as well as a blooming multidisciplinary rapid response second opinion clinic (VASO).

  • Multidisciplinary protocols exist and are regularly updated for the main conditions, including ICH, SAH and IS. Clinical pathways have been developed for IS and teams working on ICH and SAH will start in September 2016.
  • The Stroke Center is heavily involved in VBHC with ischemic stroke (collaboration with ACE Kwaliteit).
  • The department of Neurology has undergone audits from Kenniscentrum CVA, Rotterdam Stroke Center, the NVVN, with excellent results.
  • Results of research programs on acute IS care (thrombectomy), IC management of SAH and secondary prevention strategies in stroke have been implemented and made available nationally and internationally through publications and protocols on the Erasmus MC internet page. They are among the most widely used (and copied) for stroke in NL.
  • Erasmus MC is one of the leading partners in the Rotterdam Stroke Service, the largest "stroke service" (care consortium) in NL.

Societal Relevance to Research, Education and Patient Care

Valorization: The MR CLEAN trial published in 2014 was the first trial worldwide to show that thrombectomy for acute ischemic stroke is effective and safe. The number needed to treat to save one patient from death of lifelong disability is 7. Since its results have become public, the number of interventions in Erasmus MC and in the NL has increased more than 10-fold. Erasmus MC holds the national registry of this treatment. The MR CLEAN and registry data are being used for extended FDA approval for this intervention, Erasmus MC will be compensated for this.

Guidelines: staff of the Erasmus MC Stroke Center chair the workgroup for the revised national multidisciplinary guideline for ischemic stroke and intracerebral hemorrhage and the advisory committee for development of quality criteria for tertiary stroke centers (acute stroke intervention centers). Erasmus MC Stroke Center is at the forefront of developing and testing care standards through collaboration with dr Foster, ICHOM Research and education: Erasmus MC Stroke Center is involved in new methods to translate trial results into personalized medicine by making use of e-technology in collaboration with iPublic Health (medical decision making).

Viability of Research, Education and Patient Care

Erasmus MC Stroke Center has embedded its research in COEUR, which offers the opportunity to conduct research seminars, often involving international speakers. Apart from that we have informal monthly stroke research meetings, where new proposals and early results are discussed.

Several departments (Neurology, Radiology) have a PhD monitoring system, which requires the PhD student to report their progress, every year before an independent committee and allows them to discuss their work and planning. This system also allows us to identify highly talented PhD students early. Each PhD presents at least one paper at one of our major conferences (European Stroke Organization Congress, International Stroke Conference).

PhDs are encouraged to participate in our international collaborations, which include HERMES (pooled stent thrombectomy trials) and VISTA (all pooled acute stroke trials) as well as several other collaborations. A bibliometric analysis is not available.

Key and relevant publications of the last five years

  • Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372:11-20
  • Dirks M, Niessen LW, van Wijngaarden JD, Koudstaal PJ, Franke CL, van Oostenbrugge RJ, et al. Promoting thrombolysis in acute ischemic stroke. Stroke. 2011;42:1325-1330
  • Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387:1723-1731
  • Fransen PS, Berkhemer OA, Lingsma HF, Beumer D, van den Berg LA, Yoo AJ, et al. Time to Reperfusion and Treatment Effect for Acute Ischemic Stroke: A Randomized Clinical Trial. JAMA Neurol. 2016;73:190-196
  • Bos MJ, Koudstaal PJ, Hofman A, Ikram MA. Modifiable etiological factors and the burden of stroke from the Rotterdam Study: a population-based cohort study. PLoS Med 2014;11:e1001634.
  • Poels M, Ikram M, Van der Lugt A, Hofman A, Niessen W, Krestin G, et al. Cerebral microbleeds are associated with worse cognitive function The Rotterdam Scan Study. Neurology. 2012;78:326-333
  • van der Jagt M. Fluid management of the neurological patient: a concise review. Crit Care. 2016;20:1
  • Berghauser Pont LM, Dirven CM, Dippel DW, Verweij BH, Dammers R. The role of corticosteroids in the management of chronic subdural hematoma: a systematic review. European journal of neurology: the official journal of the European Federation of Neurological Societies. 2012;19:1397-1403
  • Ehret GB, …, Sijbrands EJ, et al. Genetic variants in novel pathways influence blood pressure and cardiovascular disease risk. Nature. 2011;478:103-9.
  • Selwaness M, Bos D, van den Bouwhuijsen Q, Portegies ML, Ikram MA, Hofman A, et al. Carotid Atherosclerotic Plaque Characteristics on Magnetic Resonance Imaging Relate With History of Stroke and Coronary Heart Disease. Stroke. 2016;47:1542-1547

PhD theses of the last five years

  • Akoudad S. Microbleeds and cognitive decline. 2016
  • Fonville S. Impaired glucose tolerance and stroke. 2014
  • El Hachioui H. Prognosis of aphasia after stroke. 2014.
  • Boerboom W. Subarachnoid Haemorrhage. A study on long-term consequences. 2016
  • Wieberdink R. Etiology of ischemic and hemorrhagic stroke. 2012
  • Selwaness M. Magnetic Resonance imaging of the carotid atherosclerosis: a population based approach. 2014.
  • Van den Herik EG. Genetic and hemostatic causes of stroke. 2011
  • Visser MM. How to cope with stroke? The effectiveness of Problem Solving Therapy. 2016
  • Maasland E. Improving stroke care. 2011.
  • De Monyé C. CT Angiography of the Carotid Artery: Optimization and Accuracy. 2012

Non-scientific publications related to the ACE

Principal coordinator(s)