Prognostic Value of Thrombus Volume and Interaction With First-Line Endovascular Treatment Device Choice

Henk Van Voorst; Agnetha A.E. Bruggeman; Jurr Andriessen; Jan W. Hoving; Praneeta R. Konduri; Wenjin Yang; Manon Kappelhof; Nerea Arrarte Terreros; Yvo B.W.E.M. Roos; Wim H. Van Zwam; Aad Van Der Lugt; Anouk Van Der Hoorn; Jelis Boiten; Stefan Roosendaal; Sjoerd Jenniskens; Matthan W.A. Caan; Henk A. Marquering; Bart J. Emmer; Charles B.L.M. Majoie; Diederik W.J. Dippel; Robert J. Van Oostenbrugge; Jan Albert Vos; Ivo G.H. Jansen; Maxim J.H.L. Mulder; Robert Jan B. Goldhoorn; Kars C.J. Compagne; Josje Brouwer; Sanne J. Den Hartog; Wouter H. Hinsenveld; Bob Roozenbeek; Adriaan C.G.M. Van Es; Jonathan M. Coutinho; Wouter J. Schonewille; Marieke J.H. Wermer; Marianne A.A. Van Walderveen; Julie Staals; Jeannette Hofmeijer; Jasper M. Martens; Geert J. Lycklama À Nijeholt; Sebastiaan F. De Bruijn; Lukas C. Van Dijk; H. Bart Van Der Worp; Rob H. Lo; Ewoud J. Van Dijk; Hieronymus D. Boogaarts; J. De Vries; Paul L.M. De Kort; Julia Van Tuijl; Jo P. Peluso; Puck Fransen; Jan S.P. Van Den Berg; Boudewijn A.A.M. Van Hasselt; Leo A.M. Aerden; René J. Dallinga; Maarten Uyttenboogaart; Omid Eschgi; Reinoud P.H. Bokkers; Tobien H.C.M.L. Schreuder; Roel J.J. Heijboer; Koos Keizer; Lonneke S.F. Yo; Heleen M. Den Hertog; Emiel J.C. Sturm; Paul J.A.M. Brouwers; Marieke E.S. Sprengers; René Van Den Berg; Albert J. Yoo; Ludo F.M. Beenen; Alida A. Postma; Bas F.W. Van Der Kallen; Ido R. Van Den Wijngaard; Joost Bot; Pieter Jan Van Doormaal; Anton Meijer; Elyas Ghariq; Marc P. Van Proosdij; G. Menno Krietemeijer; Rob H. Lo; Dick Gerrits; Wouter Dinkelaar; Auke P.A. Appelman; Bas Hammer; Sjoert Pegge; Saman Vinke; H. Zwenneke Flach; Hester F. Lingsma; Naziha El Ghannouti; Martin Sterrenberg; Wilma Pellikaan; Rita Sprengers; Marjan Elfrink; Michelle Simons; Marjolein Vossers; Joke De Meris; Tamara Vermeulen; Annet Geerlings; Gina Van Vemde; Tiny Simons; Gert Messchendorp; Nynke Nicolaij; Hester Bongenaar; Karin Bodde; Sandra Kleijn; Jasmijn Lodico; Hanneke Droste; Maureen Wollaert; Sabrina Verheesen; D. Jeurrissen; Erna Bos; Yvonne Drabbe; Michelle Sandiman; Nicoline Aaldering; Berber Zweedijk; Jocova Vervoort; Eva Ponjee; Sharon Romviel; Karin Kanselaar; Denn Barning; Esmee Venema; Vicky Chalos; Ralph R. Geuskens; Tim Van Straaten; Saliha Ergezen; Roger R.M. Harmsma; Daan Muijres; Anouk De Jong; Olvert A. Berkhemer; Anna M.M. Boers; J. Huguet; P. F.C. Groot; Marieke A. Mens; Katinka R. Van Kranendonk; Kilian M. Treurniet; Manon L. Tolhuisen; Heitor Alves; Annick J. Weterings; Eleonora L.F. Kirkels; Eva J.H.F. Voogd; Lieve M. Schupp; Sabine Collette; Adrien E.D. Groot; Natalie E. Lecouffe; Haryadi Prasetya; Lucas A. Ramos

doi:10.1161/STROKEAHA.122.041606

Prognostic Value of Thrombus Volume and Interaction With First-Line Endovascular Treatment Device Choice

Henk Van Voorst^*, Agnetha A.E. Bruggeman, Jurr Andriessen, Jan W. Hoving, Praneeta R. Konduri, Wenjin Yang, Manon Kappelhof, Nerea Arrarte Terreros, Yvo B.W.E.M. Roos, Wim H. Van Zwam, Aad Van Der Lugt, Anouk Van Der Hoorn, Jelis Boiten, Stefan Roosendaal, Sjoerd Jenniskens, Matthan W.A. Caan, Henk A. Marquering, Bart J. Emmer, Charles B.L.M. Majoie, Diederik W.J. DippelRobert J. Van Oostenbrugge, Jan Albert Vos, Ivo G.H. Jansen, Maxim J.H.L. Mulder, Robert Jan B. Goldhoorn, Kars C.J. Compagne, Josje Brouwer, Sanne J. Den Hartog, Wouter H. Hinsenveld, Bob Roozenbeek, Adriaan C.G.M. Van Es, Jonathan M. Coutinho, Wouter J. Schonewille, Marieke J.H. Wermer, Marianne A.A. Van Walderveen, Julie Staals, Jeannette Hofmeijer, Jasper M. Martens, Geert J. Lycklama À Nijeholt, Sebastiaan F. De Bruijn, Lukas C. Van Dijk, H. Bart Van Der Worp, Rob H. Lo, Ewoud J. Van Dijk, Hieronymus D. Boogaarts, J. De Vries, Paul L.M. De Kort, Julia Van Tuijl, Jo P. Peluso, Puck Fransen, Jan S.P. Van Den Berg, Boudewijn A.A.M. Van Hasselt, Leo A.M. Aerden, René J. Dallinga, Maarten Uyttenboogaart, Omid Eschgi, Reinoud P.H. Bokkers, Tobien H.C.M.L. Schreuder, Roel J.J. Heijboer, Koos Keizer, Lonneke S.F. Yo, Heleen M. Den Hertog, Emiel J.C. Sturm, Paul J.A.M. Brouwers, Marieke E.S. Sprengers, René Van Den Berg, Albert J. Yoo, Ludo F.M. Beenen, Alida A. Postma, Bas F.W. Van Der Kallen, Ido R. Van Den Wijngaard, Joost Bot, Pieter Jan Van Doormaal, Anton Meijer, Elyas Ghariq, Marc P. Van Proosdij, G. Menno Krietemeijer, Rob H. Lo, Dick Gerrits, Wouter Dinkelaar, Auke P.A. Appelman, Bas Hammer, Sjoert Pegge, Saman Vinke, H. Zwenneke Flach, Hester F. Lingsma, Naziha El Ghannouti, Martin Sterrenberg, Wilma Pellikaan, Rita Sprengers, Marjan Elfrink, Michelle Simons, Marjolein Vossers, Joke De Meris, Tamara Vermeulen, Annet Geerlings, Gina Van Vemde, Tiny Simons, Gert Messchendorp, Nynke Nicolaij, Hester Bongenaar, Karin Bodde, Sandra Kleijn, Jasmijn Lodico, Hanneke Droste, Maureen Wollaert, Sabrina Verheesen, D. Jeurrissen, Erna Bos, Yvonne Drabbe, Michelle Sandiman, Nicoline Aaldering, Berber Zweedijk, Jocova Vervoort, Eva Ponjee, Sharon Romviel, Karin Kanselaar, Denn Barning, Esmee Venema, Vicky Chalos, Ralph R. Geuskens, Tim Van Straaten, Saliha Ergezen, Roger R.M. Harmsma, Daan Muijres, Anouk De Jong, Olvert A. Berkhemer, Anna M.M. Boers, J. Huguet, P. F.C. Groot, Marieke A. Mens, Katinka R. Van Kranendonk, Kilian M. Treurniet, Manon L. Tolhuisen, Heitor Alves, Annick J. Weterings, Eleonora L.F. Kirkels, Eva J.H.F. Voogd, Lieve M. Schupp, Sabine Collette, Adrien E.D. Groot, Natalie E. Lecouffe, Haryadi Prasetya, Lucas A. Ramos

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: A larger thrombus in patients with acute ischemic stroke might result in more complex endovascular treatment procedures, resulting in poorer patient outcomes. Current evidence on thrombus volume and length related to procedural and functional outcomes remains contradicting. This study aimed to assess the prognostic value of thrombus volume and thrombus length and whether this relationship differs between first-line stent retrievers and aspiration devices for endovascular treatment. Methods: In this multicenter retrospective cohort study, 670 of 3279 patients from the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) for endovascularly treated large vessel occlusions were included. Thrombus volume (0.1 mL) and length (0.1 mm) based on manual segmentations and measurements were related to reperfusion grade (expanded Treatment in Cerebral Infarction score) after endovascular treatment, the number of retrieval attempts, symptomatic intracranial hemorrhage, and a shift for functional outcome at 90 days measured with the reverted ordinal modified Rankin Scale (odds ratio >1 implies a favorable outcome). Univariable and multivariable linear and logistic regression were used to report common odds ratios (cORs)/adjusted cOR and regression coefficients (B/aB) with 95% CIs. Furthermore, a multiplicative interaction term was used to analyze the relationship between first-line device choice, stent retrievers versus aspiration device, thrombus volume, and outcomes. Results: Thrombus volume was associated with functional outcome (adjusted cOR, 0.83 [95% CI, 0.71-0.97]) and number of retrieval attempts (aB, 0.16 [95% CI, 0.16-0.28]) but not with the other outcome measures. Thrombus length was only associated with functional independence (adjusted cOR, 0.45 [95% CI, 0.24-0.85]). Patients with more voluminous thrombi had worse functional outcomes if endovascular treatment was based on first-line stent retrievers (interaction cOR, 0.67 [95% CI, 0.50-0.89]; P=0.005; adjusted cOR, 0.74 [95% CI, 0.55-1.0]; P=0.04). Conclusions: In this study, patients with a more voluminous thrombus required more endovascular thrombus retrieval attempts and had a worse functional outcome. Patients with a lengthier thrombus were less likely to achieve functional independence at 90 days. For more voluminous thrombi, first-line stent retrieval compared with first-line aspiration might be associated with worse functional outcome.

Original language	English
Pages (from-to)	1056-1065
Number of pages	10
Journal	Stroke
Volume	54
Issue number	4
DOIs	https://doi.org/10.1161/STROKEAHA.122.041606
Publication status	Published - 1 Apr 2023

Keywords

functional status
ischemic stroke
prognosis
stents
thrombosis

Access to Document

10.1161/STROKEAHA.122.041606

Cite this

Van Voorst, H., Bruggeman, A. A. E., Andriessen, J., Hoving, J. W., Konduri, P. R., Yang, W., Kappelhof, M., Arrarte Terreros, N., Roos, Y. B. W. E. M., Van Zwam, W. H., Van Der Lugt, A., Van Der Hoorn, A., Boiten, J., Roosendaal, S., Jenniskens, S., Caan, M. W. A., Marquering, H. A., Emmer, B. J., Majoie, C. B. L. M., ... Ramos, L. A. (2023). Prognostic Value of Thrombus Volume and Interaction With First-Line Endovascular Treatment Device Choice. Stroke, 54(4), 1056-1065. https://doi.org/10.1161/STROKEAHA.122.041606

@article{57157a10b29c463298c7ef7ef8acbeec,

title = "Prognostic Value of Thrombus Volume and Interaction With First-Line Endovascular Treatment Device Choice",

abstract = "Background: A larger thrombus in patients with acute ischemic stroke might result in more complex endovascular treatment procedures, resulting in poorer patient outcomes. Current evidence on thrombus volume and length related to procedural and functional outcomes remains contradicting. This study aimed to assess the prognostic value of thrombus volume and thrombus length and whether this relationship differs between first-line stent retrievers and aspiration devices for endovascular treatment. Methods: In this multicenter retrospective cohort study, 670 of 3279 patients from the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) for endovascularly treated large vessel occlusions were included. Thrombus volume (0.1 mL) and length (0.1 mm) based on manual segmentations and measurements were related to reperfusion grade (expanded Treatment in Cerebral Infarction score) after endovascular treatment, the number of retrieval attempts, symptomatic intracranial hemorrhage, and a shift for functional outcome at 90 days measured with the reverted ordinal modified Rankin Scale (odds ratio >1 implies a favorable outcome). Univariable and multivariable linear and logistic regression were used to report common odds ratios (cORs)/adjusted cOR and regression coefficients (B/aB) with 95% CIs. Furthermore, a multiplicative interaction term was used to analyze the relationship between first-line device choice, stent retrievers versus aspiration device, thrombus volume, and outcomes. Results: Thrombus volume was associated with functional outcome (adjusted cOR, 0.83 [95% CI, 0.71-0.97]) and number of retrieval attempts (aB, 0.16 [95% CI, 0.16-0.28]) but not with the other outcome measures. Thrombus length was only associated with functional independence (adjusted cOR, 0.45 [95% CI, 0.24-0.85]). Patients with more voluminous thrombi had worse functional outcomes if endovascular treatment was based on first-line stent retrievers (interaction cOR, 0.67 [95% CI, 0.50-0.89]; P=0.005; adjusted cOR, 0.74 [95% CI, 0.55-1.0]; P=0.04). Conclusions: In this study, patients with a more voluminous thrombus required more endovascular thrombus retrieval attempts and had a worse functional outcome. Patients with a lengthier thrombus were less likely to achieve functional independence at 90 days. For more voluminous thrombi, first-line stent retrieval compared with first-line aspiration might be associated with worse functional outcome.",

keywords = "functional status, ischemic stroke, prognosis, stents, thrombosis",

author = "{Van Voorst}, Henk and Bruggeman, {Agnetha A.E.} and Jurr Andriessen and Hoving, {Jan W.} and Konduri, {Praneeta R.} and Wenjin Yang and Manon Kappelhof and {Arrarte Terreros}, Nerea and Roos, {Yvo B.W.E.M.} and {Van Zwam}, {Wim H.} and {Van Der Lugt}, Aad and {Van Der Hoorn}, Anouk and Jelis Boiten and Stefan Roosendaal and Sjoerd Jenniskens and Caan, {Matthan W.A.} and Marquering, {Henk A.} and Emmer, {Bart J.} and Majoie, {Charles B.L.M.} and Dippel, {Diederik W.J.} and {Van Oostenbrugge}, {Robert J.} and Vos, {Jan Albert} and Jansen, {Ivo G.H.} and Mulder, {Maxim J.H.L.} and Goldhoorn, {Robert Jan B.} and Compagne, {Kars C.J.} and Josje Brouwer and {Den Hartog}, {Sanne J.} and Hinsenveld, {Wouter H.} and Bob Roozenbeek and {Van Es}, {Adriaan C.G.M.} and Coutinho, {Jonathan M.} and Schonewille, {Wouter J.} and Wermer, {Marieke J.H.} and {Van Walderveen}, {Marianne A.A.} and Julie Staals and Jeannette Hofmeijer and Martens, {Jasper M.} and {Lycklama {\`A} Nijeholt}, {Geert J.} and {De Bruijn}, {Sebastiaan F.} and {Van Dijk}, {Lukas C.} and {Van Der Worp}, {H. Bart} and Lo, {Rob H.} and {Van Dijk}, {Ewoud J.} and Boogaarts, {Hieronymus D.} and {De Vries}, J. and {De Kort}, {Paul L.M.} and {Van Tuijl}, Julia and Peluso, {Jo P.} and Puck Fransen and {Van Den Berg}, {Jan S.P.} and {Van Hasselt}, {Boudewijn A.A.M.} and Aerden, {Leo A.M.} and Dallinga, {Ren{\'e} J.} and Maarten Uyttenboogaart and Omid Eschgi and Bokkers, {Reinoud P.H.} and Schreuder, {Tobien H.C.M.L.} and Heijboer, {Roel J.J.} and Koos Keizer and Yo, {Lonneke S.F.} and {Den Hertog}, {Heleen M.} and Sturm, {Emiel J.C.} and Brouwers, {Paul J.A.M.} and Sprengers, {Marieke E.S.} and {Van Den Berg}, Ren{\'e} and Yoo, {Albert J.} and Beenen, {Ludo F.M.} and Postma, {Alida A.} and {Van Der Kallen}, {Bas F.W.} and {Van Den Wijngaard}, {Ido R.} and Joost Bot and {Van Doormaal}, {Pieter Jan} and Anton Meijer and Elyas Ghariq and {Van Proosdij}, {Marc P.} and Krietemeijer, {G. Menno} and Lo, {Rob H.} and Dick Gerrits and Wouter Dinkelaar and Appelman, {Auke P.A.} and Bas Hammer and Sjoert Pegge and Saman Vinke and Flach, {H. Zwenneke} and Lingsma, {Hester F.} and {El Ghannouti}, Naziha and Martin Sterrenberg and Wilma Pellikaan and Rita Sprengers and Marjan Elfrink and Michelle Simons and Marjolein Vossers and {De Meris}, Joke and Tamara Vermeulen and Annet Geerlings and {Van Vemde}, Gina and Tiny Simons and Gert Messchendorp and Nynke Nicolaij and Hester Bongenaar and Karin Bodde and Sandra Kleijn and Jasmijn Lodico and Hanneke Droste and Maureen Wollaert and Sabrina Verheesen and D. Jeurrissen and Erna Bos and Yvonne Drabbe and Michelle Sandiman and Nicoline Aaldering and Berber Zweedijk and Jocova Vervoort and Eva Ponjee and Sharon Romviel and Karin Kanselaar and Denn Barning and Esmee Venema and Vicky Chalos and Geuskens, {Ralph R.} and {Van Straaten}, Tim and Saliha Ergezen and Harmsma, {Roger R.M.} and Daan Muijres and {De Jong}, Anouk and Berkhemer, {Olvert A.} and Boers, {Anna M.M.} and J. Huguet and Groot, {P. F.C.} and Mens, {Marieke A.} and {Van Kranendonk}, {Katinka R.} and Treurniet, {Kilian M.} and Tolhuisen, {Manon L.} and Heitor Alves and Weterings, {Annick J.} and Kirkels, {Eleonora L.F.} and Voogd, {Eva J.H.F.} and Schupp, {Lieve M.} and Sabine Collette and Groot, {Adrien E.D.} and Lecouffe, {Natalie E.} and Haryadi Prasetya and Ramos, {Lucas A.}",

year = "2023",

month = apr,

day = "1",

doi = "10.1161/STROKEAHA.122.041606",

language = "English",

volume = "54",

pages = "1056--1065",

journal = "Stroke",

issn = "0039-2499",

publisher = "Lippincott Williams & Wilkins",

number = "4",

}

Van Voorst, H, Bruggeman, AAE, Andriessen, J, Hoving, JW, Konduri, PR, Yang, W, Kappelhof, M, Arrarte Terreros, N, Roos, YBWEM, Van Zwam, WH, Van Der Lugt, A, Van Der Hoorn, A, Boiten, J, Roosendaal, S, Jenniskens, S, Caan, MWA, Marquering, HA, Emmer, BJ, Majoie, CBLM, Dippel, DWJ, Van Oostenbrugge, RJ, Vos, JA, Jansen, IGH, Mulder, MJHL, Goldhoorn, RJB, Compagne, KCJ, Brouwer, J, Den Hartog, SJ, Hinsenveld, WH, Roozenbeek, B, Van Es, ACGM, Coutinho, JM, Schonewille, WJ, Wermer, MJH, Van Walderveen, MAA, Staals, J, Hofmeijer, J, Martens, JM, Lycklama À Nijeholt, GJ, De Bruijn, SF, Van Dijk, LC, Van Der Worp, HB, Lo, RH, Van Dijk, EJ, Boogaarts, HD, De Vries, J, De Kort, PLM, Van Tuijl, J, Peluso, JP, Fransen, P, Van Den Berg, JSP, Van Hasselt, BAAM, Aerden, LAM, Dallinga, RJ, Uyttenboogaart, M, Eschgi, O, Bokkers, RPH, Schreuder, THCML, Heijboer, RJJ, Keizer, K, Yo, LSF, Den Hertog, HM, Sturm, EJC, Brouwers, PJAM, Sprengers, MES, Van Den Berg, R, Yoo, AJ, Beenen, LFM, Postma, AA, Van Der Kallen, BFW, Van Den Wijngaard, IR, Bot, J, Van Doormaal, PJ, Meijer, A, Ghariq, E, Van Proosdij, MP, Krietemeijer, GM, Lo, RH, Gerrits, D, Dinkelaar, W, Appelman, APA, Hammer, B, Pegge, S, Vinke, S, Flach, HZ, Lingsma, HF, El Ghannouti, N, Sterrenberg, M, Pellikaan, W, Sprengers, R, Elfrink, M, Simons, M, Vossers, M, De Meris, J, Vermeulen, T, Geerlings, A, Van Vemde, G, Simons, T, Messchendorp, G, Nicolaij, N, Bongenaar, H, Bodde, K, Kleijn, S, Lodico, J, Droste, H, Wollaert, M, Verheesen, S, Jeurrissen, D, Bos, E, Drabbe, Y, Sandiman, M, Aaldering, N, Zweedijk, B, Vervoort, J, Ponjee, E, Romviel, S, Kanselaar, K, Barning, D, Venema, E, Chalos, V, Geuskens, RR, Van Straaten, T, Ergezen, S, Harmsma, RRM, Muijres, D, De Jong, A, Berkhemer, OA, Boers, AMM, Huguet, J, Groot, PFC, Mens, MA, Van Kranendonk, KR, Treurniet, KM, Tolhuisen, ML, Alves, H, Weterings, AJ, Kirkels, ELF, Voogd, EJHF, Schupp, LM, Collette, S, Groot, AED, Lecouffe, NE, Prasetya, H & Ramos, LA 2023, 'Prognostic Value of Thrombus Volume and Interaction With First-Line Endovascular Treatment Device Choice', Stroke, vol. 54, no. 4, pp. 1056-1065. https://doi.org/10.1161/STROKEAHA.122.041606

TY - JOUR

T1 - Prognostic Value of Thrombus Volume and Interaction With First-Line Endovascular Treatment Device Choice

AU - Van Voorst, Henk

AU - Bruggeman, Agnetha A.E.

AU - Andriessen, Jurr

AU - Hoving, Jan W.

AU - Konduri, Praneeta R.

AU - Yang, Wenjin

AU - Kappelhof, Manon

AU - Arrarte Terreros, Nerea

AU - Roos, Yvo B.W.E.M.

AU - Van Zwam, Wim H.

AU - Van Der Lugt, Aad

AU - Van Der Hoorn, Anouk

AU - Boiten, Jelis

AU - Roosendaal, Stefan

AU - Jenniskens, Sjoerd

AU - Caan, Matthan W.A.

AU - Marquering, Henk A.

AU - Emmer, Bart J.

AU - Majoie, Charles B.L.M.

AU - Dippel, Diederik W.J.

AU - Van Oostenbrugge, Robert J.

AU - Vos, Jan Albert

AU - Jansen, Ivo G.H.

AU - Mulder, Maxim J.H.L.

AU - Goldhoorn, Robert Jan B.

AU - Compagne, Kars C.J.

AU - Brouwer, Josje

AU - Den Hartog, Sanne J.

AU - Hinsenveld, Wouter H.

AU - Roozenbeek, Bob

AU - Van Es, Adriaan C.G.M.

AU - Coutinho, Jonathan M.

AU - Schonewille, Wouter J.

AU - Wermer, Marieke J.H.

AU - Van Walderveen, Marianne A.A.

AU - Staals, Julie

AU - Hofmeijer, Jeannette

AU - Martens, Jasper M.

AU - Lycklama À Nijeholt, Geert J.

AU - De Bruijn, Sebastiaan F.

AU - Van Dijk, Lukas C.

AU - Van Der Worp, H. Bart

AU - Lo, Rob H.

AU - Van Dijk, Ewoud J.

AU - Boogaarts, Hieronymus D.

AU - De Vries, J.

AU - De Kort, Paul L.M.

AU - Van Tuijl, Julia

AU - Peluso, Jo P.

AU - Fransen, Puck

AU - Van Den Berg, Jan S.P.

AU - Van Hasselt, Boudewijn A.A.M.

AU - Aerden, Leo A.M.

AU - Dallinga, René J.

AU - Uyttenboogaart, Maarten

AU - Eschgi, Omid

AU - Bokkers, Reinoud P.H.

AU - Schreuder, Tobien H.C.M.L.

AU - Heijboer, Roel J.J.

AU - Keizer, Koos

AU - Yo, Lonneke S.F.

AU - Den Hertog, Heleen M.

AU - Sturm, Emiel J.C.

AU - Brouwers, Paul J.A.M.

AU - Sprengers, Marieke E.S.

AU - Van Den Berg, René

AU - Yoo, Albert J.

AU - Beenen, Ludo F.M.

AU - Postma, Alida A.

AU - Van Der Kallen, Bas F.W.

AU - Van Den Wijngaard, Ido R.

AU - Bot, Joost

AU - Van Doormaal, Pieter Jan

AU - Meijer, Anton

AU - Ghariq, Elyas

AU - Van Proosdij, Marc P.

AU - Krietemeijer, G. Menno

AU - Lo, Rob H.

AU - Gerrits, Dick

AU - Dinkelaar, Wouter

AU - Appelman, Auke P.A.

AU - Hammer, Bas

AU - Pegge, Sjoert

AU - Vinke, Saman

AU - Flach, H. Zwenneke

AU - Lingsma, Hester F.

AU - El Ghannouti, Naziha

AU - Sterrenberg, Martin

AU - Pellikaan, Wilma

AU - Sprengers, Rita

AU - Elfrink, Marjan

AU - Simons, Michelle

AU - Vossers, Marjolein

AU - De Meris, Joke

AU - Vermeulen, Tamara

AU - Geerlings, Annet

AU - Van Vemde, Gina

AU - Simons, Tiny

AU - Messchendorp, Gert

AU - Nicolaij, Nynke

AU - Bongenaar, Hester

AU - Bodde, Karin

AU - Kleijn, Sandra

AU - Lodico, Jasmijn

AU - Droste, Hanneke

AU - Wollaert, Maureen

AU - Verheesen, Sabrina

AU - Jeurrissen, D.

AU - Bos, Erna

AU - Drabbe, Yvonne

AU - Sandiman, Michelle

AU - Aaldering, Nicoline

AU - Zweedijk, Berber

AU - Vervoort, Jocova

AU - Ponjee, Eva

AU - Romviel, Sharon

AU - Kanselaar, Karin

AU - Barning, Denn

AU - Venema, Esmee

AU - Chalos, Vicky

AU - Geuskens, Ralph R.

AU - Van Straaten, Tim

AU - Ergezen, Saliha

AU - Harmsma, Roger R.M.

AU - Muijres, Daan

AU - De Jong, Anouk

AU - Berkhemer, Olvert A.

AU - Boers, Anna M.M.

AU - Huguet, J.

AU - Groot, P. F.C.

AU - Mens, Marieke A.

AU - Van Kranendonk, Katinka R.

AU - Treurniet, Kilian M.

AU - Tolhuisen, Manon L.

AU - Alves, Heitor

AU - Weterings, Annick J.

AU - Kirkels, Eleonora L.F.

AU - Voogd, Eva J.H.F.

AU - Schupp, Lieve M.

AU - Collette, Sabine

AU - Groot, Adrien E.D.

AU - Lecouffe, Natalie E.

AU - Prasetya, Haryadi

AU - Ramos, Lucas A.

PY - 2023/4/1

Y1 - 2023/4/1

N2 - Background: A larger thrombus in patients with acute ischemic stroke might result in more complex endovascular treatment procedures, resulting in poorer patient outcomes. Current evidence on thrombus volume and length related to procedural and functional outcomes remains contradicting. This study aimed to assess the prognostic value of thrombus volume and thrombus length and whether this relationship differs between first-line stent retrievers and aspiration devices for endovascular treatment. Methods: In this multicenter retrospective cohort study, 670 of 3279 patients from the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) for endovascularly treated large vessel occlusions were included. Thrombus volume (0.1 mL) and length (0.1 mm) based on manual segmentations and measurements were related to reperfusion grade (expanded Treatment in Cerebral Infarction score) after endovascular treatment, the number of retrieval attempts, symptomatic intracranial hemorrhage, and a shift for functional outcome at 90 days measured with the reverted ordinal modified Rankin Scale (odds ratio >1 implies a favorable outcome). Univariable and multivariable linear and logistic regression were used to report common odds ratios (cORs)/adjusted cOR and regression coefficients (B/aB) with 95% CIs. Furthermore, a multiplicative interaction term was used to analyze the relationship between first-line device choice, stent retrievers versus aspiration device, thrombus volume, and outcomes. Results: Thrombus volume was associated with functional outcome (adjusted cOR, 0.83 [95% CI, 0.71-0.97]) and number of retrieval attempts (aB, 0.16 [95% CI, 0.16-0.28]) but not with the other outcome measures. Thrombus length was only associated with functional independence (adjusted cOR, 0.45 [95% CI, 0.24-0.85]). Patients with more voluminous thrombi had worse functional outcomes if endovascular treatment was based on first-line stent retrievers (interaction cOR, 0.67 [95% CI, 0.50-0.89]; P=0.005; adjusted cOR, 0.74 [95% CI, 0.55-1.0]; P=0.04). Conclusions: In this study, patients with a more voluminous thrombus required more endovascular thrombus retrieval attempts and had a worse functional outcome. Patients with a lengthier thrombus were less likely to achieve functional independence at 90 days. For more voluminous thrombi, first-line stent retrieval compared with first-line aspiration might be associated with worse functional outcome.

AB - Background: A larger thrombus in patients with acute ischemic stroke might result in more complex endovascular treatment procedures, resulting in poorer patient outcomes. Current evidence on thrombus volume and length related to procedural and functional outcomes remains contradicting. This study aimed to assess the prognostic value of thrombus volume and thrombus length and whether this relationship differs between first-line stent retrievers and aspiration devices for endovascular treatment. Methods: In this multicenter retrospective cohort study, 670 of 3279 patients from the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) for endovascularly treated large vessel occlusions were included. Thrombus volume (0.1 mL) and length (0.1 mm) based on manual segmentations and measurements were related to reperfusion grade (expanded Treatment in Cerebral Infarction score) after endovascular treatment, the number of retrieval attempts, symptomatic intracranial hemorrhage, and a shift for functional outcome at 90 days measured with the reverted ordinal modified Rankin Scale (odds ratio >1 implies a favorable outcome). Univariable and multivariable linear and logistic regression were used to report common odds ratios (cORs)/adjusted cOR and regression coefficients (B/aB) with 95% CIs. Furthermore, a multiplicative interaction term was used to analyze the relationship between first-line device choice, stent retrievers versus aspiration device, thrombus volume, and outcomes. Results: Thrombus volume was associated with functional outcome (adjusted cOR, 0.83 [95% CI, 0.71-0.97]) and number of retrieval attempts (aB, 0.16 [95% CI, 0.16-0.28]) but not with the other outcome measures. Thrombus length was only associated with functional independence (adjusted cOR, 0.45 [95% CI, 0.24-0.85]). Patients with more voluminous thrombi had worse functional outcomes if endovascular treatment was based on first-line stent retrievers (interaction cOR, 0.67 [95% CI, 0.50-0.89]; P=0.005; adjusted cOR, 0.74 [95% CI, 0.55-1.0]; P=0.04). Conclusions: In this study, patients with a more voluminous thrombus required more endovascular thrombus retrieval attempts and had a worse functional outcome. Patients with a lengthier thrombus were less likely to achieve functional independence at 90 days. For more voluminous thrombi, first-line stent retrieval compared with first-line aspiration might be associated with worse functional outcome.

KW - functional status

KW - ischemic stroke

KW - prognosis

KW - stents

KW - thrombosis

UR - http://www.scopus.com/inward/record.url?scp=85151044019&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.122.041606

DO - 10.1161/STROKEAHA.122.041606

M3 - Article

C2 - 36912141

AN - SCOPUS:85151044019

SN - 0039-2499

VL - 54

SP - 1056

EP - 1065

JO - Stroke

JF - Stroke

IS - 4

ER -

Prognostic Value of Thrombus Volume and Interaction With First-Line Endovascular Treatment Device Choice

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