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

Henk Van Voorst*, Agnetha A.E. Bruggeman, the MR CLEAN investigators, 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

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)


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 languageEnglish
Pages (from-to)1056-1065
Number of pages10
Issue number4
Publication statusPublished - Apr 2023

Bibliographical note

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.


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