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 - MR CLEAN Registry Investigators
AU - Jenniskens, Sjoerd
AU - Caan, Matthan W. A.
AU - Marquering, Henk A.
AU - Emmer, Bart J.
AU - Majoie, Charles B. L. M.
AU - MR-CLEAN Registry Investigators
N1 - Funding Information: Dr van der Lugt received funding from the Dutch Heart Foundation, Brain Foundation Netherlands, the Netherlands Organization for Health Research and Development, and Health~Holland (Topsector Life Sciences & Health) and unrestricted grants from Penumbra, Inc, Stryker, Medtronic, Thrombolytic Science, and Cerenovus for research, all paid to the institution. Consultation fees were received by Dr van der Lugt from Stryker and Bracco Imaging. Amsterdam UMC received a grant from Stryker for research led by Drs Majoie and Roos. DR Majoie, Roos, Emmer, Caan, and Marquering are shareholders of Nico.lab. Maastricht University MC received funds from Philips and Stryker for consultations and for an international grant/contract by Johnson and Johnson by Dr van Zwam. Funding Information: This study was partly funded by the CONTRAST consortium. The CONTRAST consortium is supported by the Netherlands Cardiovascular Research Initiative (CVON), an initiative of the Dutch Heart Foundation, the Brain Foundation Netherlands, Medtronic, and Cerenovus. The MR CLEAN Registry was partly funded by the TWIN Foundation and by Erasmus MC University Medical Center, Maastricht University Medical Center, and Amsterdam UMC. Publisher Copyright: © 2023 Lippincott Williams and Wilkins. All rights reserved.
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 - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85151044019&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/36912141
UR - http://www.scopus.com/inward/record.url?scp=85151044019&partnerID=8YFLogxK
U2 - https://doi.org/10.1161/STROKEAHA.122.041606
DO - https://doi.org/10.1161/STROKEAHA.122.041606
M3 - Article
C2 - 36912141
SN - 0039-2499
VL - 54
SP - 1056
EP - 1065
JO - Stroke
JF - Stroke
IS - 4
ER -