Improvements in Endovascular Treatment for Acute Ischemic Stroke: A Longitudinal Study in the MR CLEAN Registry

Kars C J Compagne; Manon Kappelhof; Wouter H Hinsenveld; Josje Brouwer; Robert-Jan B Goldhoorn; Maarten Uyttenboogaart; Reinoud P H Bokkers; Wouter J Schonewille; Jasper M Martens; Jeannette Hofmeijer; H Bart van der Worp; Rob T H Lo; Koos Keizer; Lonneke S F Yo; Geert J Lycklama À Nijeholt; Heleen M den Hertog; Emiel J C Sturm; Paul J A M Brouwers; Marianne A A van Walderveen; Marieke J H Wermer; Sebastiaan F de Bruijn; Lukas C van Dijk; Hieronymus D Boogaarts; Ewout J van Dijk; Julia H van Tuijl; Jo P P Peluso; Paul L M de Kort; Boudewijn A A M van Hasselt; Puck S Fransen; Tobien H C M L Schreuder; Roel J J Heijboer; Sjoerd F M Jenniskens; Marieke E S Sprengers; Elias Ghariq; Ido R van den Wijngaard; Stefan D Roosendaal; Anton F J A Meijer; Ludo F M Beenen; Alida A Postma; René van den Berg; Albert J Yoo; Pieter Jan van Doormaal; Marc P van Proosdij; Menno G M Krietemeijer; Dick G Gerrits; Sebastiaan Hammer; Jan Albert Vos; Jelis Boiten; Wim H van Zwam; Robert J van Oostenbrugge; MR CLEAN Registry Investigators

doi:10.1161/STROKEAHA.121.034919

Improvements in Endovascular Treatment for Acute Ischemic Stroke: A Longitudinal Study in the MR CLEAN Registry

Kars C J Compagne^*, Manon Kappelhof, Wouter H Hinsenveld, Josje Brouwer, Robert-Jan B Goldhoorn, Maarten Uyttenboogaart, Reinoud P H Bokkers, Wouter J Schonewille, Jasper M Martens, Jeannette Hofmeijer, H Bart van der Worp, Rob T H Lo, Koos Keizer, Lonneke S F Yo, Geert J Lycklama À Nijeholt, Heleen M den Hertog, Emiel J C Sturm, Paul J A M Brouwers, Marianne A A van Walderveen, Marieke J H WermerSebastiaan F de Bruijn, Lukas C van Dijk, Hieronymus D Boogaarts, Ewout J van Dijk, Julia H van Tuijl, Jo P P Peluso, Paul L M de Kort, Boudewijn A A M van Hasselt, Puck S Fransen, Tobien H C M L Schreuder, Roel J J Heijboer, Sjoerd F M Jenniskens, Marieke E S Sprengers, Elias Ghariq, Ido R van den Wijngaard, Stefan D Roosendaal, Anton F J A Meijer, Ludo F M Beenen, Alida A Postma, René van den Berg, Albert J Yoo, Pieter Jan van Doormaal, Marc P van Proosdij, Menno G M Krietemeijer, Dick G Gerrits, Sebastiaan Hammer, Jan Albert Vos, Jelis Boiten, Wim H van Zwam, Robert J van Oostenbrugge, MR CLEAN Registry Investigators

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: We evaluated data from all patients in the Netherlands who underwent endovascular treatment for acute ischemic stroke in the past 3.5 years, to identify nationwide trends in time to treatment and procedural success, and assess their effect on clinical outcomes.

METHODS: We included patients with proximal occlusions of the anterior circulation from the second and first cohorts of the MR CLEAN (Multicenter Randomized Clinical trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry (March 2014 to June 2016; June 2016 to November 2017, respectively). We compared workflow times and rates of successful reperfusion (defined as an extended thrombolysis in cerebral infarction score of 2B-3) between cohorts and chronological quartiles (all included patients stratified in chronological quartiles of intervention dates to create equally sized groups over the study period). Multivariable ordinal logistic regression was used to assess differences in the primary outcome (ordinal modified Rankin Scale at 90 days).

RESULTS: Baseline characteristics were similar between cohorts (second cohort n=1692, first cohort n=1488) except for higher age, poorer collaterals, and less signs of early ischemia on computed tomography in the second cohort. Time from stroke onset to groin puncture and reperfusion were shorter in the second cohort (median 185 versus 210 minutes; P<0.001 and 236 versus 270 minutes; P<0.001, respectively). Successful reperfusion was achieved more often in the second than in the first cohort (72% versus 66%; P<0.001). Functional outcome significantly improved (adjusted common odds ratio 1.23 [95% CI, 1.07-1.40]). This effect was attenuated by adjustment for time from onset to reperfusion (adjusted common odds ratio, 1.12 [95% CI, 0.98-1.28]) and successful reperfusion (adjusted common odds ratio, 1.13 [95% CI, 0.99-1.30]). Outcomes were consistent in the analysis per chronological quartile.

CONCLUSIONS: Clinical outcomes after endovascular treatment for acute ischemic stroke in routine clinical practice have improved over the past years, likely resulting from improved workflow times and higher successful reperfusion rates.

Original language	English
Pages (from-to)	1863-1872
Number of pages	10
Journal	Stroke
Volume	53
Issue number	6
Early online date	9 Feb 2022
DOIs	https://doi.org/10.1161/STROKEAHA.121.034919
Publication status	Published - Jun 2022

Keywords

GUIDELINES
IMPUTATION
MANAGEMENT
OUTCOMES
RELIABILITY
REPERFUSION
SCALE
SOCIETY
SYSTEMATIC EVALUATION
THROMBECTOMY
groin odds
puncture
ratio
registry
reperfusion

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Compagne, K. C. J., Kappelhof, M., Hinsenveld, W. H., Brouwer, J., Goldhoorn, R.-J. B., Uyttenboogaart, M., Bokkers, R. P. H., Schonewille, W. J., Martens, J. M., Hofmeijer, J., van der Worp, H. B., Lo, R. T. H., Keizer, K., Yo, L. S. F., Lycklama À Nijeholt, G. J., den Hertog, H. M., Sturm, E. J. C., Brouwers, P. J. A. M., van Walderveen, M. A. A., ... MR CLEAN Registry Investigators (2022). Improvements in Endovascular Treatment for Acute Ischemic Stroke: A Longitudinal Study in the MR CLEAN Registry. Stroke, 53(6), 1863-1872. https://doi.org/10.1161/STROKEAHA.121.034919

@article{48d4c2a62f3d4d9a9af220b04d6dd767,

title = "Improvements in Endovascular Treatment for Acute Ischemic Stroke: A Longitudinal Study in the MR CLEAN Registry",

abstract = "BACKGROUND: We evaluated data from all patients in the Netherlands who underwent endovascular treatment for acute ischemic stroke in the past 3.5 years, to identify nationwide trends in time to treatment and procedural success, and assess their effect on clinical outcomes.METHODS: We included patients with proximal occlusions of the anterior circulation from the second and first cohorts of the MR CLEAN (Multicenter Randomized Clinical trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry (March 2014 to June 2016; June 2016 to November 2017, respectively). We compared workflow times and rates of successful reperfusion (defined as an extended thrombolysis in cerebral infarction score of 2B-3) between cohorts and chronological quartiles (all included patients stratified in chronological quartiles of intervention dates to create equally sized groups over the study period). Multivariable ordinal logistic regression was used to assess differences in the primary outcome (ordinal modified Rankin Scale at 90 days).RESULTS: Baseline characteristics were similar between cohorts (second cohort n=1692, first cohort n=1488) except for higher age, poorer collaterals, and less signs of early ischemia on computed tomography in the second cohort. Time from stroke onset to groin puncture and reperfusion were shorter in the second cohort (median 185 versus 210 minutes; P<0.001 and 236 versus 270 minutes; P<0.001, respectively). Successful reperfusion was achieved more often in the second than in the first cohort (72% versus 66%; P<0.001). Functional outcome significantly improved (adjusted common odds ratio 1.23 [95% CI, 1.07-1.40]). This effect was attenuated by adjustment for time from onset to reperfusion (adjusted common odds ratio, 1.12 [95% CI, 0.98-1.28]) and successful reperfusion (adjusted common odds ratio, 1.13 [95% CI, 0.99-1.30]). Outcomes were consistent in the analysis per chronological quartile.CONCLUSIONS: Clinical outcomes after endovascular treatment for acute ischemic stroke in routine clinical practice have improved over the past years, likely resulting from improved workflow times and higher successful reperfusion rates.",

keywords = "GUIDELINES, IMPUTATION, MANAGEMENT, OUTCOMES, RELIABILITY, REPERFUSION, SCALE, SOCIETY, SYSTEMATIC EVALUATION, THROMBECTOMY, groin odds, puncture, ratio, registry, reperfusion",

author = "Compagne, {Kars C J} and Manon Kappelhof and Hinsenveld, {Wouter H} and Josje Brouwer and Goldhoorn, {Robert-Jan B} and Maarten Uyttenboogaart and Bokkers, {Reinoud P H} and Schonewille, {Wouter J} and Martens, {Jasper M} and Jeannette Hofmeijer and {van der Worp}, {H Bart} and Lo, {Rob T H} and Koos Keizer and Yo, {Lonneke S F} and {Lycklama {\`A} Nijeholt}, {Geert J} and {den Hertog}, {Heleen M} and Sturm, {Emiel J C} and Brouwers, {Paul J A M} and {van Walderveen}, {Marianne A A} and Wermer, {Marieke J H} and {de Bruijn}, {Sebastiaan F} and {van Dijk}, {Lukas C} and Boogaarts, {Hieronymus D} and {van Dijk}, {Ewout J} and {van Tuijl}, {Julia H} and Peluso, {Jo P P} and {de Kort}, {Paul L M} and {van Hasselt}, {Boudewijn A A M} and Fransen, {Puck S} and Schreuder, {Tobien H C M L} and Heijboer, {Roel J J} and Jenniskens, {Sjoerd F M} and Sprengers, {Marieke E S} and Elias Ghariq and {van den Wijngaard}, {Ido R} and Roosendaal, {Stefan D} and Meijer, {Anton F J A} and Beenen, {Ludo F M} and Postma, {Alida A} and {van den Berg}, Ren{\'e} and Yoo, {Albert J} and {van Doormaal}, {Pieter Jan} and {van Proosdij}, {Marc P} and Krietemeijer, {Menno G M} and Gerrits, {Dick G} and Sebastiaan Hammer and Vos, {Jan Albert} and Jelis Boiten and {van Zwam}, {Wim H} and {van Oostenbrugge}, {Robert J} and {MR CLEAN Registry Investigators}",

year = "2022",

month = jun,

doi = "10.1161/STROKEAHA.121.034919",

language = "English",

volume = "53",

pages = "1863--1872",

journal = "Stroke",

issn = "0039-2499",

publisher = "LIPPINCOTT WILLIAMS & WILKINS",

number = "6",

}

Compagne, KCJ, Kappelhof, M, Hinsenveld, WH, Brouwer, J, Goldhoorn, R-JB, Uyttenboogaart, M, Bokkers, RPH, Schonewille, WJ, Martens, JM, Hofmeijer, J, van der Worp, HB, Lo, RTH, Keizer, K, Yo, LSF, Lycklama À Nijeholt, GJ, den Hertog, HM, Sturm, EJC, Brouwers, PJAM, van Walderveen, MAA, Wermer, MJH, de Bruijn, SF, van Dijk, LC, Boogaarts, HD, van Dijk, EJ, van Tuijl, JH, Peluso, JPP, de Kort, PLM, van Hasselt, BAAM, Fransen, PS, Schreuder, THCML, Heijboer, RJJ, Jenniskens, SFM, Sprengers, MES, Ghariq, E, van den Wijngaard, IR, Roosendaal, SD, Meijer, AFJA, Beenen, LFM, Postma, AA, van den Berg, R, Yoo, AJ, van Doormaal, PJ, van Proosdij, MP, Krietemeijer, MGM, Gerrits, DG, Hammer, S, Vos, JA, Boiten, J, van Zwam, WH , van Oostenbrugge, RJ & MR CLEAN Registry Investigators 2022, 'Improvements in Endovascular Treatment for Acute Ischemic Stroke: A Longitudinal Study in the MR CLEAN Registry', Stroke, vol. 53, no. 6, pp. 1863-1872. https://doi.org/10.1161/STROKEAHA.121.034919

TY - JOUR

T1 - Improvements in Endovascular Treatment for Acute Ischemic Stroke

T2 - A Longitudinal Study in the MR CLEAN Registry

AU - Compagne, Kars C J

AU - Kappelhof, Manon

AU - Hinsenveld, Wouter H

AU - Brouwer, Josje

AU - Goldhoorn, Robert-Jan B

AU - Uyttenboogaart, Maarten

AU - Bokkers, Reinoud P H

AU - Schonewille, Wouter J

AU - Martens, Jasper M

AU - Hofmeijer, Jeannette

AU - van der Worp, H Bart

AU - Lo, Rob T H

AU - Keizer, Koos

AU - Yo, Lonneke S F

AU - Lycklama À Nijeholt, Geert J

AU - den Hertog, Heleen M

AU - Sturm, Emiel J C

AU - Brouwers, Paul J A M

AU - van Walderveen, Marianne A A

AU - Wermer, Marieke J H

AU - de Bruijn, Sebastiaan F

AU - van Dijk, Lukas C

AU - Boogaarts, Hieronymus D

AU - van Dijk, Ewout J

AU - van Tuijl, Julia H

AU - Peluso, Jo P P

AU - de Kort, Paul L M

AU - van Hasselt, Boudewijn A A M

AU - Fransen, Puck S

AU - Schreuder, Tobien H C M L

AU - Heijboer, Roel J J

AU - Jenniskens, Sjoerd F M

AU - Sprengers, Marieke E S

AU - Ghariq, Elias

AU - van den Wijngaard, Ido R

AU - Roosendaal, Stefan D

AU - Meijer, Anton F J A

AU - Beenen, Ludo F M

AU - Postma, Alida A

AU - van den Berg, René

AU - Yoo, Albert J

AU - van Doormaal, Pieter Jan

AU - van Proosdij, Marc P

AU - Krietemeijer, Menno G M

AU - Gerrits, Dick G

AU - Hammer, Sebastiaan

AU - Vos, Jan Albert

AU - Boiten, Jelis

AU - van Zwam, Wim H

AU - van Oostenbrugge, Robert J

AU - MR CLEAN Registry Investigators

PY - 2022/6

Y1 - 2022/6

N2 - BACKGROUND: We evaluated data from all patients in the Netherlands who underwent endovascular treatment for acute ischemic stroke in the past 3.5 years, to identify nationwide trends in time to treatment and procedural success, and assess their effect on clinical outcomes.METHODS: We included patients with proximal occlusions of the anterior circulation from the second and first cohorts of the MR CLEAN (Multicenter Randomized Clinical trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry (March 2014 to June 2016; June 2016 to November 2017, respectively). We compared workflow times and rates of successful reperfusion (defined as an extended thrombolysis in cerebral infarction score of 2B-3) between cohorts and chronological quartiles (all included patients stratified in chronological quartiles of intervention dates to create equally sized groups over the study period). Multivariable ordinal logistic regression was used to assess differences in the primary outcome (ordinal modified Rankin Scale at 90 days).RESULTS: Baseline characteristics were similar between cohorts (second cohort n=1692, first cohort n=1488) except for higher age, poorer collaterals, and less signs of early ischemia on computed tomography in the second cohort. Time from stroke onset to groin puncture and reperfusion were shorter in the second cohort (median 185 versus 210 minutes; P<0.001 and 236 versus 270 minutes; P<0.001, respectively). Successful reperfusion was achieved more often in the second than in the first cohort (72% versus 66%; P<0.001). Functional outcome significantly improved (adjusted common odds ratio 1.23 [95% CI, 1.07-1.40]). This effect was attenuated by adjustment for time from onset to reperfusion (adjusted common odds ratio, 1.12 [95% CI, 0.98-1.28]) and successful reperfusion (adjusted common odds ratio, 1.13 [95% CI, 0.99-1.30]). Outcomes were consistent in the analysis per chronological quartile.CONCLUSIONS: Clinical outcomes after endovascular treatment for acute ischemic stroke in routine clinical practice have improved over the past years, likely resulting from improved workflow times and higher successful reperfusion rates.

AB - BACKGROUND: We evaluated data from all patients in the Netherlands who underwent endovascular treatment for acute ischemic stroke in the past 3.5 years, to identify nationwide trends in time to treatment and procedural success, and assess their effect on clinical outcomes.METHODS: We included patients with proximal occlusions of the anterior circulation from the second and first cohorts of the MR CLEAN (Multicenter Randomized Clinical trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry (March 2014 to June 2016; June 2016 to November 2017, respectively). We compared workflow times and rates of successful reperfusion (defined as an extended thrombolysis in cerebral infarction score of 2B-3) between cohorts and chronological quartiles (all included patients stratified in chronological quartiles of intervention dates to create equally sized groups over the study period). Multivariable ordinal logistic regression was used to assess differences in the primary outcome (ordinal modified Rankin Scale at 90 days).RESULTS: Baseline characteristics were similar between cohorts (second cohort n=1692, first cohort n=1488) except for higher age, poorer collaterals, and less signs of early ischemia on computed tomography in the second cohort. Time from stroke onset to groin puncture and reperfusion were shorter in the second cohort (median 185 versus 210 minutes; P<0.001 and 236 versus 270 minutes; P<0.001, respectively). Successful reperfusion was achieved more often in the second than in the first cohort (72% versus 66%; P<0.001). Functional outcome significantly improved (adjusted common odds ratio 1.23 [95% CI, 1.07-1.40]). This effect was attenuated by adjustment for time from onset to reperfusion (adjusted common odds ratio, 1.12 [95% CI, 0.98-1.28]) and successful reperfusion (adjusted common odds ratio, 1.13 [95% CI, 0.99-1.30]). Outcomes were consistent in the analysis per chronological quartile.CONCLUSIONS: Clinical outcomes after endovascular treatment for acute ischemic stroke in routine clinical practice have improved over the past years, likely resulting from improved workflow times and higher successful reperfusion rates.

KW - GUIDELINES

KW - IMPUTATION

KW - MANAGEMENT

KW - OUTCOMES

KW - RELIABILITY

KW - REPERFUSION

KW - SCALE

KW - SOCIETY

KW - SYSTEMATIC EVALUATION

KW - THROMBECTOMY

KW - groin odds

KW - puncture

KW - ratio

KW - registry

KW - reperfusion

U2 - 10.1161/STROKEAHA.121.034919

DO - 10.1161/STROKEAHA.121.034919

M3 - Article

C2 - 35135323

SN - 0039-2499

VL - 53

SP - 1863

EP - 1872

JO - Stroke

JF - Stroke

IS - 6

ER -

Improvements in Endovascular Treatment for Acute Ischemic Stroke: A Longitudinal Study in the MR CLEAN Registry

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Keywords

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