TY - JOUR
T1 - Association between type of intervention center and outcomes after endovascular treatment for acute ischemic stroke: Results from the MR CLEAN Registry
AU - Olthuis, S.G.H.
AU - Hinsenveld, W.H.
AU - Pinckaers, F.M.E.
AU - Amini, M.
AU - Lingsma, H.F.
AU - Staals, J.
AU - Schreuder, T.H.C.M.L.
AU - Schonewille, W.J.
AU - Yo, L.S.F.
AU - Roos, Y.B.W.E.M.
AU - Postma, A.A.
AU - Dippel, D.W.J.
AU - van Zwam, W.H.
AU - van Oostenbrugge, R.J.
AU - de Ridder, I.R.
AU - MR CLEAN Registry Investigators
N1 - Funding Information:
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: DWJD reports funding from the Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organisation for Health Research and Development, Health Holland Top Sector Life Sciences & Health, and unrestricted grants from Penumbra Inc., Stryker, Medtronic, Thrombolytic Science, LLC, and Cerenovus for research, all paid to the institution. DWJD participated in the DSMBs of ESCAPE-NEXT (stopped July 2021) and TESLAT (without receiving payments). AAP reports an institutional grant from Siemens Healthineers & Bayer Healthcare. WHvZ received consultation fees from Stryker, Nico.Lab and Cerenovus, paid to the institution. WHvZ participates in the DSMBs of Philips’WeTrust study, Anaconda’s Solonda study, in Extremis Studies, Montpellier, all funding was paid to the institution. YBWEMR reports being a minor share-holder of Nico-Lab, not related to the current work.
Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The MR CLEAN Registry was supported by Stichting Toegepast Wetenschappelijk Instituut voor Neuromodulatie (TWIN); Erasmus MC University Medical Centre; Maastricht University Medical Centre; and Amsterdam University Medical Centre.
Funding Information:
We thank the MR CLEAN Registry Investigators–group authors (Supplemental Material-List of MR CLEAN Registry group authors). Names listed: Diederik W.J. Dippel; Aad van der Lugt; Charles B.L.M. Majoie; Yvo B.W.E.M. Roos; Robert J. van Oostenbrugge; Wim H. van Zwam6; Jelis Boiten; Jan Albert Vos; Ivo G.H. Jansen; Maxim J.H.L. Mulder; Robert- Jan B. Goldhoorn; Kars C.J. Compagne; Manon Kappelhof; Josje Brouwer; Sanne J. den Hartog; Wouter H. Hinsenveld; Lotte van den Heuvel; Bob Roozenbeek; Pieter Jan van Doormaal; Bart J. Emmer; Jonathan M. Coutinho; Wouter J. Schonewille; Marieke J.H. Wermer; Marianne A.A. van Walderveen; Adriaan C.G.M. van Es; 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; Issam Boukrab; Jo P. Peluso; Puck Fransen; Jan S.P. van den Berg; Heleen M. den Hertog; 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; Rob A.R. Gons; Lonneke S.F. Yo; Emiel J.C. Sturm; Tomas Bulut; Paul J.A.M. Brouwers; Anouk D. Rozeman; Otto Elgersma; Michel J.M. Remmers; Thijs E.A.M. de Jong; Marieke E.S. Sprengers; Sjoerd F.M. Jenniskens; René van den Berg; Albert J. Yoo; Ludo F.M. Beenen; Alida A. Postma; Stefan D. Roosendaal; Bas F.W. van der Kallen; Ido R. van den Wijngaard; Lonneke S.F. Yo; Joost Bot; Anton Meijer; Elyas Ghariq; Marc P. van Proosdij; G. Menno Krietemeijer; Hieronymus D. Boogaarts; Wouter Dinkelaar; Auke P.A. Appelman; Bas Hammer; Sjoert Pegge; Anouk van der Hoorn; Saman Vinke; Sandra Cornelissen; Christiaan van der Leij; Rutger Brans; Jeanette Bakker; Miou Koopman; Lucas Smagge; Olvert A. Berkhemer; Jeroen Markenstein; Eef Hendriks; Patrick Brouwer; Dick Gerrits; 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; Laurine van der Steen; Esmee Venema; Vicky Chalos; Ralph R. Geuskens; Tim van Straaten; Saliha Ergezen; Roger R.M. Harmsma; Daan Muijres; Anouk de Jong; 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 L. Collette; Adrien E.D. Groot; Natalie E. LeCouffe; Praneeta R. Kondur; Haryadi Prasetya; Nerea Arrarte-Terreros; Lucas A. Ramos; Nikki Boodt; Anne F.A.V Pirson; Agnetha A.E. Bruggeman; Nadinda A.M. van der Ende; Rabia Deniz, Susanne G.H. Olthuis; Floor Pinckaers The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The MR CLEAN Registry was supported by Stichting Toegepast Wetenschappelijk Instituut voor Neuromodulatie (TWIN); Erasmus MC University Medical Centre; Maastricht University Medical Centre; and Amsterdam University Medical Centre.
Publisher Copyright:
© European Stroke Organisation 2022.
PY - 2023/3
Y1 - 2023/3
N2 - Background: Endovascular treatment (EVT) for acute ischemic stroke (AIS) is performed in intervention centers that provide the full range of neuro(endo)vascular care (level 1) and centers that only perform EVT for AIS (level 2). We compared outcomes between these center types and assessed whether differences in outcomes could be explained by center volume (CV). Patients and methods: We analyzed patients included in the MR CLEAN Registry (2014–2018), a registry of all EVT-treated patients in the Netherlands. Our primary outcome was the shift on the modified Rankin scale (mRS) after 90 days (ordinal regression). Secondary outcomes were the NIHSS 24–48 h post-EVT, door-to-groin time (DTGT), procedure time (linear regression), and recanalization (binary logistic regression). We compared outcomes between level 1 and 2 centers using multilevel regression models, with center as random intercept. We adjusted for relevant baseline factors, and in case of observed differences, we additionally adjusted for CV. Results: Of the 5144 patients 62% were treated in level 1 centers. We observed no significant differences between center types in mRS (adjusted(a)cOR: 0.79, 95% CI: 0.40 to 1.54), NIHSS (aβ: 0.31, 95% CI: −0.52 to 1.14), procedure duration (aβ: 0.88, 95% CI: −5.21 to 6.97), or DTGT (aβ: 4.24, 95% CI: −7.09 to 15.57). The probability for recanalization was higher in level 1 centers compared to level 2 centers (aOR 1.60, 95% CI: 1.10 to 2.33), and this difference probably depended on CV. Conclusions: We found no significant differences, that were independent of CV, in the outcomes of EVT for AIS between level 1 and level 2 intervention centers.
AB - Background: Endovascular treatment (EVT) for acute ischemic stroke (AIS) is performed in intervention centers that provide the full range of neuro(endo)vascular care (level 1) and centers that only perform EVT for AIS (level 2). We compared outcomes between these center types and assessed whether differences in outcomes could be explained by center volume (CV). Patients and methods: We analyzed patients included in the MR CLEAN Registry (2014–2018), a registry of all EVT-treated patients in the Netherlands. Our primary outcome was the shift on the modified Rankin scale (mRS) after 90 days (ordinal regression). Secondary outcomes were the NIHSS 24–48 h post-EVT, door-to-groin time (DTGT), procedure time (linear regression), and recanalization (binary logistic regression). We compared outcomes between level 1 and 2 centers using multilevel regression models, with center as random intercept. We adjusted for relevant baseline factors, and in case of observed differences, we additionally adjusted for CV. Results: Of the 5144 patients 62% were treated in level 1 centers. We observed no significant differences between center types in mRS (adjusted(a)cOR: 0.79, 95% CI: 0.40 to 1.54), NIHSS (aβ: 0.31, 95% CI: −0.52 to 1.14), procedure duration (aβ: 0.88, 95% CI: −5.21 to 6.97), or DTGT (aβ: 4.24, 95% CI: −7.09 to 15.57). The probability for recanalization was higher in level 1 centers compared to level 2 centers (aOR 1.60, 95% CI: 1.10 to 2.33), and this difference probably depended on CV. Conclusions: We found no significant differences, that were independent of CV, in the outcomes of EVT for AIS between level 1 and level 2 intervention centers.
KW - Acute ischemic stroke
KW - endovascular treatment
KW - center type
U2 - 10.1177/23969873221145771
DO - 10.1177/23969873221145771
M3 - Article
C2 - 37021181
SN - 2396-9873
VL - 8
SP - 224
EP - 230
JO - European Stroke Journal
JF - European Stroke Journal
IS - 1
ER -