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

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, 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 journal › Article › Academic › peer-review

5 Citations (Scopus)

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 - 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.

Access to Document

10.1161/strokeaha.122.041606

https://pure.rug.nl/ws/files/688371716/Prognostic_Value_of_Thrombus_Volume_and_Interaction_With_First_Line_Endovascular_Treatment_Device_Choice.pdfLicence: Article 25fa Dutch Copyright Act

Cite this

Van Voorst, H., Bruggeman, A. A. E., the MR CLEAN investigators, 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. (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{41a6da8df8de499abed116653dd88bc5,

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.",

author = "{Van Voorst}, Henk and Bruggeman, {Agnetha A.E.} and {the MR CLEAN investigators} 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 Dippel, {Diederik W.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 {Van Walderveen}, {Marianne A.A.} and Puck Fransen and {Den Hertog}, {Heleen M.} and Brouwers, {Paul J.A.M.} and {Van Der Kallen}, {Bas F.W.} and {Van Den Wijngaard}, {Ido R.} and {Van Doormaal}, {Pieter Jan} and Elyas Ghariq and Wouter Dinkelaar and Lingsma, {Hester F.} and {El Ghannouti}, Naziha and Martin Sterrenberg and Rita Sprengers and Sabrina Verheesen and Esmee Venema and Vicky Chalos and Saliha Ergezen and Harmsma, {Roger R.M.} and Daan Muijres and {De Jong}, Anouk and Berkhemer, {Olvert A.} and Treurniet, {Kilian M.} and Lecouffe, {Natalie E.}",

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: {\textcopyright} 2023 Lippincott Williams and Wilkins. All rights reserved.",

year = "2023",

month = apr,

doi = "10.1161/strokeaha.122.041606",

language = "English",

volume = "54",

pages = "1056--1065",

journal = "Stroke",

issn = "0039-2499",

publisher = "Wolters Kluwer Health",

number = "4",

}

Van Voorst, H, Bruggeman, AAE, the MR CLEAN investigators, 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 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 - the MR CLEAN investigators

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 - Dippel, Diederik W.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 - Van Walderveen, Marianne A.A.

AU - Fransen, Puck

AU - Den Hertog, Heleen M.

AU - Brouwers, Paul J.A.M.

AU - Van Der Kallen, Bas F.W.

AU - Van Den Wijngaard, Ido R.

AU - Van Doormaal, Pieter Jan

AU - Ghariq, Elyas

AU - Dinkelaar, Wouter

AU - Lingsma, Hester F.

AU - El Ghannouti, Naziha

AU - Sterrenberg, Martin

AU - Sprengers, Rita

AU - Verheesen, Sabrina

AU - Venema, Esmee

AU - Chalos, Vicky

AU - Ergezen, Saliha

AU - Harmsma, Roger R.M.

AU - Muijres, Daan

AU - De Jong, Anouk

AU - Berkhemer, Olvert A.

AU - Treurniet, Kilian M.

AU - Lecouffe, Natalie E.

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

Y1 - 2023/4

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.

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

Abstract

Bibliographical note

Access to Document

Other files and links

Fingerprint

Cite this