{"id":10315,"date":"2026-04-09T10:50:26","date_gmt":"2026-04-09T10:50:26","guid":{"rendered":"https:\/\/www.proefschriftmaken.nl\/portfolio\/roel-snijder\/"},"modified":"2026-04-23T07:34:05","modified_gmt":"2026-04-23T07:34:05","slug":"roel-snijder","status":"publish","type":"us_portfolio","link":"https:\/\/www.proefschriftmaken.nl\/en\/portfolio\/roel-snijder\/","title":{"rendered":"Roel Snijder"},"content":{"rendered":"","protected":false},"excerpt":{"rendered":"","protected":false},"author":8,"featured_media":12744,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"us_portfolio_category":[45],"class_list":["post-10315","us_portfolio","type-us_portfolio","status-publish","has-post-thumbnail","hentry","us_portfolio_category-new-template"],"acf":{"naam_van_het_proefschift":"Closure of the interatrial septum: should we do it?","samenvatting":"Er is geen Nederlandse samenvatting beschikbaar. De Engelse samenvatting vind je <a href=\"https:\/\/www.proefschriftmaken.nl\/en\/portfolio\/roel-snijder\/\">hier<\/a>.","summary":"Ninety-seven percent of the patients were referred by a neurologist because they suffered a cryptogenic stroke or transient ischemic attack (TIA). During two-years follow-up no major adverse cardiac events or strokes occurred. However, there was a moderate- or severe residual right-to-left shunt (RLS) present in 28.3% of the patients one day after closure. After two-years follow-up a moderate- or severe RLS was present in still 9.1% of the patients, which is much higher when compared to other devices. In conclusion, the bioabsorbable BioSTAR device is insufficient for percutaneous PFO closure.\n\nChapter 3 evaluates the safety and efficacy of the Occlutech PFO closure device during long-term follow-up. All consecutive patients that underwent percutaneous PFO closure between 2008 and 2015 in the St. Antonius Hospital were included. In total, 250 patients underwent closure and were included. Main indication for closure was stroke or TIA (89.6%). There were no major peri-procedural complications. Minor complications occurred in 7.2%. During a mean follow-up of 5.9+1.8 years, a cerebrovascular event occurred in 7.4%, a total cerebrovascular event rate of 0.02% per patient-year of follow-up. There was a residual moderate- or severe RLS in 5.9% at one-year follow-up. In conclusion, the Occlutech PFO Occluder is safe at long-term follow-up with a low annual cerebrovascular event rate and has a high closure rate at one-year follow-up.\n\nIn chapter 4 we studied the association between migraine and atrial septum anatomy. All patients who underwent agitated saline transesophageal echocardiography (TEE) in the St. Antonius Hospital, Nieuwegein, the Netherlands and University Hospital Gasthuisberg, Leuven, Belgium were included. All patients received headache questionnaires, which were evaluated by two neurologists. Indication for TEE was evaluation of cardio-embolic source (45.1%), atrial thrombi pre-pulmonary vein isolation (20.2%), valve abnormalities (18.9%) and other (15.8%). A total of 889 patients were included. A PFO was present in 23.2%, an isolated atrial septal aneurysm (ASA) in 2.7% and a PFO with ASA in 6.9%. The occurrence of migraine was 18.9%, migraine with aura (MA) was 8.1% and migraine without aura (MA-) was 10.8%. In univariate analysis, the presence of a PFO with ASA was associated with MA (odds ratio 3.73, 95% confidence interval 1.86-7.44, P<0.001). A PFO without ASA was not associated with MA or MA-. Further, younger age and female sex were associated with MA as well. Thus, PFO with ASA is significantly associated with MA only.\n\nIn chapter 5 we evaluate the literature in a point of view about percutaneous PFO closure and gives our perspective on how to decide which patients are suitable for percutaneous PFO closure.\n\nChapter 6 describes a case about a reclosure of a PFO after bioabsorbable device implantation.\n\nPart three of the thesis concerns the efficacy and safety of percutaneous ASD closure for different devices.\n\nIn chapter 7 we describe the efficacy and safety of two different devices more than five years after percutaneous ASD closure. All patients that underwent percutaneous ASD closure in the St. Antonius Hospital between 1998 and 2006 were included. The Amplatzer device (ASO) was implanted in 76 patients and the Cardioseal\/Starflex (CS\/SF) device in 28 patients. Major peri-procedural events occurred 1.9%. Two devices embolized during hospitalization (1 ASO, 1 CS\/SF). There were two more embolizations during the first 6-months after closure, both with the CS\/SF device. There was no difference in recurrent strokes or TIA\u2019s between both devices (0.4% per follow-up year). During a mean follow-up of 6.4+3.4 years, a supraventricular tachycardia (SVT) occurred in 3.9% in the ASO group and in 0% in the CS\/SF group respectively. There was no residual left-to-right shunt (LRS) present in both groups. A moderate- or severe RLS was present in 6.5% in the ASO group and in 18.2% in the CS\/SF group. Percutaneous ASD closure using the ASO and CS\/SF device is safe during long-term follow-up, however, a relatively high RLS rate is present, especially in the CS\/SF group. There was no residual LRS.\n\nChapter 8 reports on the efficacy and safety of the Occlutech Figulla ASD device during long-term follow-up. A total of 166 patients underwent percutaneous ASD closure using the Occlutech device between 2008 and 2015. The Occlutech Flex I was implanted in 70% and the Flex II in 30%. Indication for closure was right ventricle volume overload (62.7%), cryptogenic stroke or TIA (28.3%) and other (9.0%). Device embolization occurred in 1.8% during hospitalization. All devices were extracted successfully. During a mean follow-up of 5.9+2.6 years an SVT occurred in 9.8% and a stroke in 2.1%. There was no LRS at 12-months follow-up. In conclusion, percutaneous ASD closure using the Occlutech device is safe during long-term follow-up with a high successful closure rate after 12-months follow-up.\n\nChapter 9 provides a case of an unusual type of ASD, an unroofed coronary sinus.\n\nPart five of this thesis consists of image modalities during percutaneous ASD- and PFO closure.\n\nIn chapter 10 we compare the efficacy and safety of micro-TEE with local anesthesia to TEE with general anesthesia. All patients that underwent percutaneous ASD- and PFO closure with micro-TEE guidance between 2016 and 2018 in the St. Antonius Hospital were included and were compared to all patients that underwent ASD- and PFO closure with TEE guidance between 2013 and 2015. In total, 36 patients underwent ASD closure with micro-TEE guidance and 46 patients with TEE guidance. PFO closure was performed using micro-TEE guidance in 65 patients and TEE guidance in 55 patients. There were no peri-procedural complications in all groups. There was no significant difference in residual LRS after ASD closure using micro-TEE and TEE. There was also no significant difference in residual RLS after PFO closure using micro-TEE and TEE. Therefore, micro-TEE guidance during percutaneous ASD- and PFO closure is safe without a significant difference in residual shunt rate.\n\nPart six consists of chapter 11, the general discussion, gives an overview of the literature about the treatment of an ASD- and PFO. A short overview of the relationship between migraine and PFO is described. The limitations of these studies are discussed and recommendation for future research is given.","auteur":"Roel Snijder","auteur_slug":"roel-snijder","publicatiedatum":"10 december 2020","taal":"EN","url_flipbook":"https:\/\/ebook.proefschriftmaken.nl\/ebook\/roelsnijder?iframe=true","url_download_pdf":"","url_epub":"","ordernummer":"FTP-202604091046","isbn":"978-94-6423-029-1","doi_nummer":"","naam_universiteit":"Universiteit Utrecht","afbeeldingen":12744,"naam_student:":"","binnenwerk":"","universiteit":"Universiteit Utrecht","cover":"","afwerking":"","cover_afwerking":"","design":""},"_links":{"self":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio\/10315","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio"}],"about":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/types\/us_portfolio"}],"author":[{"embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/comments?post=10315"}],"version-history":[{"count":1,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio\/10315\/revisions"}],"predecessor-version":[{"id":10316,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio\/10315\/revisions\/10316"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/media\/12744"}],"wp:attachment":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/media?parent=10315"}],"wp:term":[{"taxonomy":"us_portfolio_category","embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio_category?post=10315"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}