Prognostic Value of Thrombus Volume and Interaction With First-Line Endovascular Treatment Device Choice. Issue 4 (13th March 2023)

• Record Type: Journal Article
• Authors: van Voorst, Henk; Bruggeman, Agnetha A.E.; Andriessen, Jurr; Hoving, Jan W.; Konduri, Praneeta R.; Yang, Wenjin; Kappelhof, Manon; Arrarte Terreros, Nerea; Roos, Yvo B.W.E.M.; van Zwam, Wim H.; van der Lugt, Aad; van der Hoorn, Anouk; Boiten, Jelis; Roosendaal, Stefan; Jenniskens, Sjoerd; Caan, Matthan W.A.; Marquering, Henk A.; Emmer, Bart J.; Majoie, Charles B.L.M.
• Other Names: Dippel Diederik W.J. author non-byline.; van Oostenbrugge Robert J. author non-byline.; Vos Jan Albert author non-byline.; Jansen Ivo G.H. author non-byline.; Mulder Maxim J.H.L. author non-byline.; Goldhoorn Robert- Jan B. author non-byline.; Compagne Kars C.J. author non-byline.; Brouwer Josje author non-byline.; den Hartog Sanne J. author non-byline.; Hinsenveld Wouter H. author non-byline.; Dippel Diederik W.J. author non-byline.; Roozenbeek Bob author non-byline.; van Es Adriaan C.G.M. author non-byline.; Coutinho Jonathan M. author non-byline.; Schonewille Wouter J. author non-byline.; Vos Jan Albert author non-byline.; Wermer Marieke J.H. author non-byline.; van Walderveen Marianne A.A. author non-byline.; Staals Julie author non-byline.; van Oostenbrugge Robert J. author non-byline.; Hofmeijer Jeannette author non-byline.; Martens Jasper M. author non-byline.; Lycklama à Nijeholt Geert J. author non-byline.; de Bruijn Sebastiaan F. author non-byline.; van Dijk Lukas C. author non-byline.; van der Worp H. Bart author non-byline.; Lo Rob H. author non-byline.; van Dijk Ewoud J. author non-byline.; Boogaarts Hieronymus D. author non-byline.; de Vries J. author non-byline.; de Kort Paul L.M. author non-byline.; van Tuijl Julia author non-byline.; Peluso Jo P. author non-byline.; Fransen Puck author non-byline.; van den Berg Jan S.P. author non-byline.; van Hasselt Boudewijn A.A.M. author non-byline.; Aerden Leo A.M. author non-byline.; Dallinga René J. author non-byline.; Uyttenboogaart Maarten author non-byline.; Eschgi Omid author non-byline.; Bokkers Reinoud P.H. author non-byline.; Schreuder Tobien H.C.M.L. author non-byline.; Heijboer Roel J.J. author non-byline.; Keizer Koos author non-byline.; Yo Lonneke S.F. author non-byline.; den Hertog Heleen M. author non-byline.; Sturm Emiel J.C. author non-byline.; Brouwers Paul J.A.M. author non-byline.; Lycklama à Nijeholt Geert J. author non-byline.; van Walderveen Marianne A.A. author non-byline.; Sprengers Marieke E.S. author non-byline.; van den Berg René author non-byline.; Yoo Albert J. author non-byline.; Beenen Ludo F.M. author non-byline.; Postma Alida A. author non-byline.; van der Kallen Bas F.W. author non-byline.; van den Wijngaard Ido R. author non-byline.; van Es Adriaan C.G.M. author non-byline.; Martens Jasper M. author non-byline.; Yo Lonneke S.F. author non-byline.; Vos Jan Albert author non-byline.; Bot Joost author non-byline.; van Doormaal Pieter-Jan author non-byline.; Meijer Anton author non-byline.; Ghariq Elyas author non-byline.; Bokkers Reinoud P.H. author non-byline.; van Proosdij Marc P. author non-byline.; Krietemeijer G. Menno author non-byline.; Peluso Jo P. author non-byline.; Boogaarts Hieronymus D. author non-byline.; Lo Rob author non-byline.; Gerrits Dick author non-byline.; Dinkelaar Wouter author non-byline.; Appelman Auke P.A. author non-byline.; Hammer Bas author non-byline.; Pegge Sjoert author non-byline.; Vinke Saman author non-byline.; Dippel Diederik W.J. author non-byline.; van Oostenbrugge Robert J. author non-byline.; Lycklama à Nijeholt Geert J. author non-byline.; Vos Jan Albert author non-byline.; Schonewille Wouter J. author non-byline.; Hofmeijer Jeannette author non-byline.; Martens Jasper M. author non-byline.; van der Worp H. Bart author non-byline.; Lo Rob H. author non-byline.; van Oostenbrugge Robert J. author non-byline.; Hofmeijer Jeannette author non-byline.; Flach H. Zwenneke author non-byline.; Lingsma Hester F. author non-byline.; el Ghannouti Naziha author non-byline.; Sterrenberg Martin author non-byline.; Pellikaan Wilma author non-byline.; Sprengers Rita author non-byline.; Elfrink Marjan author non-byline.; Simons Michelle author non-byline.; Vossers Marjolein author non-byline.; de Meris Joke author non-byline.; Vermeulen Tamara author non-byline.; Geerlings Annet author non-byline.; van Vemde Gina author non-byline.; Simons Tiny author non-byline.; Messchendorp Gert author non-byline.; Nicolaij Nynke author non-byline.; Bongenaar Hester author non-byline.; Bodde Karin author non-byline.; Kleijn Sandra author non-byline.; Lodico Jasmijn author non-byline.; Droste Hanneke author non-byline.; Wollaert Maureen author non-byline.; Verheesen Sabrina author non-byline.; Jeurrissen D. author non-byline.; Bos Erna author non-byline.; Drabbe Yvonne author non-byline.; Sandiman Michelle author non-byline.; Aaldering Nicoline author non-byline.; Zweedijk Berber author non-byline.; Vervoort Jocova author non-byline.; Ponjee Eva author non-byline.; Romviel Sharon author non-byline.; Kanselaar Karin author non-byline.; Barning Denn author non-byline.; Venema Esmee author non-byline.; Chalos Vicky author non-byline.; Geuskens Ralph R. author non-byline.; van Straaten Tim author non-byline.; Ergezen Saliha author non-byline.; Harmsma Roger R.M. author non-byline.; Muijres Daan author non-byline.; de Jong Anouk author non-byline.; Berkhemer Olvert A. author non-byline.; Boers Anna M.M. author non-byline.; Huguet J. author non-byline.; Groot P.F.C. author non-byline.; Mens Marieke A. author non-byline.; van Kranendonk Katinka R. author non-byline.; Treurniet Kilian M. author non-byline.; Tolhuisen Manon L. author non-byline.; Alves Heitor author non-byline.; Weterings Annick J. author non-byline.; Kirkels Eleonora L.F. author non-byline.; Voogd Eva J.H.F. author non-byline.; Schupp Lieve M. author non-byline.; Collette Sabine author non-byline.; Groot Adrien E.D. author non-byline.; LeCouffe Natalie E. author non-byline.; Prasetya Haryadi author non-byline.; Ramos Lucas A. author non-byline.;
• Is Part Of: Stroke. Volume 54:Issue 4(2023)
• Page Start: 1056
• Page End: 1065
• Publication Date: 2023-03-13
• Subjects: functional status -- ischemic stroke -- prognosis -- stents -- thrombosis; Cerebrovascular disease -- Periodicals; Cerebral circulation -- Periodicals; 616.81
• DOI: 10.1161/STROKEAHA.122.041606
• Languages: English
• ISSNs: 0039-2499

Abstract

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.