TY - JOUR
T1 - National trends in patient characteristics, interventional techniques and outcomes of endovascular treatment for acute ischaemic stroke
T2 - Final results of the MR CLEAN Registry (2014-2018)
AU - MR CLEAN Registry Investigators
AU - Hinsenveld, Wouter H
AU - Brouwer, Josje
AU - den Hartog, Sanne J
AU - Bruggeman, Agnetha
AU - Kappelhof, Manon
AU - Jansen, Ivo GH
AU - Mulder, Maxim JHL
AU - Compagne, Kars CJ
AU - Goldhoorn, Robert-Jan B
AU - Lingsma, Hester
AU - Lycklama À Nijeholt, Geert
AU - Gons, Rob AR
AU - Yo, Lonneke FS
AU - Uyttenboogaart, Maarten
AU - Bokkers, Reinoud
AU - van der Worp, Bart H
AU - Lo, Rob H
AU - Schonewille, Wouter
AU - Brouwers, Paul
AU - Bulut, Tomas
AU - Martens, Jasper MM
AU - Hofmeijer, Jeannette
AU - van Hasselt, Boudewijn AAM
AU - den Hertog, Heleen
AU - de Bruijn, Sebastiaan F
AU - van Dijk, Lukas C
AU - van Walderveen, Marianne A
AU - Wermer, Marieke
AU - Boogaarts, Hieronymus
AU - van Dijk, Ewoud J
AU - van Tuijl, Julia H
AU - Boukrab, Issam
AU - Schreuder, Tobien AHCML
AU - Heijboer, Roeland
AU - Rozeman, Anouk D
AU - Beenen, Ludo FM
AU - Postma, Alida A
AU - Yoo, Albert J
AU - Roosendaal, Stefan D
AU - Bakker, Jeannette
AU - van Es, Adriaan CGM
AU - Jenniskens, Sjoerd
AU - van den Wijngaard, Ido Remy
AU - Krietemeijer, Menno
AU - van den Berg, René
AU - Bot, Joseph CJ
AU - Hammer, Sebastiaan
AU - Sprengers, Marieke
AU - Appelman, Auke PA
AU - van der Hoorn, Anouk
AU - van Zwam, Wim
AU - van Oostenbrugge, Robert
PY - 2025/5/2
Y1 - 2025/5/2
N2 - INTRODUCTION: Endovascular thrombectomy (EVT) procedures and workflow have evolved over the years. We examined trends in patient characteristics, EVT techniques and outcomes over 5 years in the Netherlands.PATIENTS AND METHODS: Data from the MR CLEAN Registry (2014-2018) were analysed, including patients treated with EVT for anterior circulation acute ischaemic stroke (AIS). Patients were grouped by year of inclusion except for the linear regression analysis where the inclusion date was used. Baseline predicted probability of poor outcome (modified Rankin Scale (mRS) score 3-6) was calculated using a validated prediction model. Primary outcome was mRS score at 90 days. Secondary outcomes included workflow times, EVT techniques, successful reperfusion (eTICI ⩾ 2B) and symptomatic intracranial haemorrhage (sICH). Time trends were analysed using multivariable regression models (adjusted common odds ratios (acOR) per year).RESULTS: 5193 patients were included. Median age increased (from 66 in 2014 to 74 years in 2018 [
p < 0.001]). Proportion of patients with pre-stroke dependence (mRS ⩾ 3) increased from 2014 through 2018 (9% to 16%,
p < 0.001). Baseline predicted probability of poor outcome did not change (60% vs 66%,
p = 0.06). Over time, functional outcomes improved (acOR 1.14 per year, 95%CI: 1.09-1.20); mortality decreased (aOR 0.88 per year, 95%CI: 0.83-0.94). EVT under local anaesthesia increased (from 46% in 2014 to 70% in 2018; aOR 1.15, 95%CI: 1.10-1.22), as did use of direct aspiration (13%-36%; aOR 1.43, 95%CI: 1.35-1.53). Successful reperfusion became more frequent (aOR 1.32 per year, 95%CI: 1.25-1.40), despite needing more attempts (1 in 2014 vs 2 in 2018, aOR 0.93 per year, 95%CI: 0.89-0.98). Incidence of sICH remained unchanged (5% vs 5%, aOR 0.99 per year, 95%CI: 0.89-1.09). Time from emergency room to groin puncture reduced by 7 min per year (95%CI: 5-8).
DISCUSSION AND CONCLUSION: Enhanced workflow and increased EVT experience may have led to shorter time to treatment and more frequent successful reperfusion, with better functional outcomes over 5 years, despite treating older, more dependent patients.
AB - INTRODUCTION: Endovascular thrombectomy (EVT) procedures and workflow have evolved over the years. We examined trends in patient characteristics, EVT techniques and outcomes over 5 years in the Netherlands.PATIENTS AND METHODS: Data from the MR CLEAN Registry (2014-2018) were analysed, including patients treated with EVT for anterior circulation acute ischaemic stroke (AIS). Patients were grouped by year of inclusion except for the linear regression analysis where the inclusion date was used. Baseline predicted probability of poor outcome (modified Rankin Scale (mRS) score 3-6) was calculated using a validated prediction model. Primary outcome was mRS score at 90 days. Secondary outcomes included workflow times, EVT techniques, successful reperfusion (eTICI ⩾ 2B) and symptomatic intracranial haemorrhage (sICH). Time trends were analysed using multivariable regression models (adjusted common odds ratios (acOR) per year).RESULTS: 5193 patients were included. Median age increased (from 66 in 2014 to 74 years in 2018 [
p < 0.001]). Proportion of patients with pre-stroke dependence (mRS ⩾ 3) increased from 2014 through 2018 (9% to 16%,
p < 0.001). Baseline predicted probability of poor outcome did not change (60% vs 66%,
p = 0.06). Over time, functional outcomes improved (acOR 1.14 per year, 95%CI: 1.09-1.20); mortality decreased (aOR 0.88 per year, 95%CI: 0.83-0.94). EVT under local anaesthesia increased (from 46% in 2014 to 70% in 2018; aOR 1.15, 95%CI: 1.10-1.22), as did use of direct aspiration (13%-36%; aOR 1.43, 95%CI: 1.35-1.53). Successful reperfusion became more frequent (aOR 1.32 per year, 95%CI: 1.25-1.40), despite needing more attempts (1 in 2014 vs 2 in 2018, aOR 0.93 per year, 95%CI: 0.89-0.98). Incidence of sICH remained unchanged (5% vs 5%, aOR 0.99 per year, 95%CI: 0.89-1.09). Time from emergency room to groin puncture reduced by 7 min per year (95%CI: 5-8).
DISCUSSION AND CONCLUSION: Enhanced workflow and increased EVT experience may have led to shorter time to treatment and more frequent successful reperfusion, with better functional outcomes over 5 years, despite treating older, more dependent patients.
U2 - 10.1177/23969873251334271
DO - 10.1177/23969873251334271
M3 - Article
C2 - 40317163
SN - 2396-9873
JO - European Stroke Journal
JF - European Stroke Journal
ER -