National trends in patient characteristics, interventional techniques and outcomes of endovascular treatment for acute ischaemic stroke: Final results of the MR CLEAN Registry (2014-2018)

MR CLEAN Registry Investigators; Wouter H Hinsenveld; Josje Brouwer; Sanne J den Hartog; Agnetha Bruggeman; Manon Kappelhof; Ivo GH Jansen; Maxim JHL Mulder; Kars CJ Compagne; Robert-Jan B Goldhoorn; Hester Lingsma; Geert Lycklama À Nijeholt; Rob AR Gons; Lonneke FS Yo; Maarten Uyttenboogaart; Reinoud Bokkers; Bart H van der Worp; Rob H Lo; Wouter Schonewille; Paul Brouwers; Tomas Bulut; Jasper MM Martens; Jeannette Hofmeijer; Boudewijn AAM van Hasselt; Heleen den Hertog; Sebastiaan F de Bruijn; Lukas C van Dijk; Marianne A van Walderveen; Marieke Wermer; Hieronymus Boogaarts; Ewoud J van Dijk; Julia H van Tuijl; Issam Boukrab; Tobien AHCML Schreuder; Roeland Heijboer; Anouk D Rozeman; Ludo FM Beenen; Alida A Postma; Albert J Yoo; Stefan D Roosendaal; Jeannette Bakker; Adriaan CGM van Es; Sjoerd Jenniskens; Ido Remy van den Wijngaard; Menno Krietemeijer; René van den Berg; Joseph CJ Bot; Sebastiaan Hammer; Marieke Sprengers; Auke PA Appelman; Anouk van der Hoorn; Wim van Zwam; Robert van Oostenbrugge

doi:10.1177/23969873251334271

National trends in patient characteristics, interventional techniques and outcomes of endovascular treatment for acute ischaemic stroke: Final results of the MR CLEAN Registry (2014-2018)

MR CLEAN Registry Investigators, Wouter H Hinsenveld, Josje Brouwer, Sanne J den Hartog, Agnetha Bruggeman, Manon Kappelhof, Ivo GH Jansen, Maxim JHL Mulder, Kars CJ Compagne, Robert-Jan B Goldhoorn, Hester Lingsma, Geert Lycklama À Nijeholt, Rob AR Gons, Lonneke FS Yo, Maarten Uyttenboogaart, Reinoud Bokkers, Bart H van der Worp, Rob H Lo, Wouter Schonewille, Paul BrouwersTomas Bulut, Jasper MM Martens, Jeannette Hofmeijer, Boudewijn AAM van Hasselt, Heleen den Hertog, Sebastiaan F de Bruijn, Lukas C van Dijk, Marianne A van Walderveen, Marieke Wermer, Hieronymus Boogaarts, Ewoud J van Dijk, Julia H van Tuijl, Issam Boukrab, Tobien AHCML Schreuder, Roeland Heijboer, Anouk D Rozeman, Ludo FM Beenen, Alida A Postma, Albert J Yoo, Stefan D Roosendaal, Jeannette Bakker, Adriaan CGM van Es, Sjoerd Jenniskens, Ido Remy van den Wijngaard, Menno Krietemeijer, René van den Berg, Joseph CJ Bot, Sebastiaan Hammer, Marieke Sprengers, Auke PA Appelman, Anouk van der Hoorn, Wim van Zwam, Robert van Oostenbrugge^*

^*Corresponding author for this work

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Abstract

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.

Original language	English
Journal	European Stroke Journal
DOIs	https://doi.org/10.1177/23969873251334271
Publication status	E-pub ahead of print - 2-May-2025

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MR CLEAN Registry Investigators, Hinsenveld, W. H., Brouwer, J., den Hartog, S. J., Bruggeman, A., Kappelhof, M., Jansen, I. GH., Mulder, M. JHL., Compagne, K. CJ., Goldhoorn, R.-J. B., Lingsma, H., Lycklama À Nijeholt, G., Gons, R. AR., Yo, L. FS., Uyttenboogaart, M., Bokkers, R., van der Worp, B. H., Lo, R. H., Schonewille, W., ... van Oostenbrugge, R. (2025). National trends in patient characteristics, interventional techniques and outcomes of endovascular treatment for acute ischaemic stroke: Final results of the MR CLEAN Registry (2014-2018). European Stroke Journal. Advance online publication. https://doi.org/10.1177/23969873251334271

@article{76cb287607be425e8b19d1d62d6015af,

title = "National trends in patient characteristics, interventional techniques and outcomes of endovascular treatment for acute ischaemic stroke: Final results of the MR CLEAN Registry (2014-2018)",

abstract = "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.",

author = "{MR CLEAN Registry Investigators} and Hinsenveld, {Wouter H} and Josje Brouwer and {den Hartog}, {Sanne J} and Agnetha Bruggeman and Manon Kappelhof and Jansen, {Ivo GH} and Mulder, {Maxim JHL} and Compagne, {Kars CJ} and Goldhoorn, {Robert-Jan B} and Hester Lingsma and {Lycklama {\`A} Nijeholt}, Geert and Gons, {Rob AR} and Yo, {Lonneke FS} and Maarten Uyttenboogaart and Reinoud Bokkers and {van der Worp}, {Bart H} and Lo, {Rob H} and Wouter Schonewille and Paul Brouwers and Tomas Bulut and Martens, {Jasper MM} and Jeannette Hofmeijer and {van Hasselt}, {Boudewijn AAM} and {den Hertog}, Heleen and {de Bruijn}, {Sebastiaan F} and {van Dijk}, {Lukas C} and {van Walderveen}, {Marianne A} and Marieke Wermer and Hieronymus Boogaarts and {van Dijk}, {Ewoud J} and {van Tuijl}, {Julia H} and Issam Boukrab and Schreuder, {Tobien AHCML} and Roeland Heijboer and Rozeman, {Anouk D} and Beenen, {Ludo FM} and Postma, {Alida A} and Yoo, {Albert J} and Roosendaal, {Stefan D} and Jeannette Bakker and {van Es}, {Adriaan CGM} and Sjoerd Jenniskens and {van den Wijngaard}, {Ido Remy} and Menno Krietemeijer and {van den Berg}, Ren{\'e} and Bot, {Joseph CJ} and Sebastiaan Hammer and Marieke Sprengers and Appelman, {Auke PA} and {van der Hoorn}, Anouk and {van Zwam}, Wim and {van Oostenbrugge}, Robert",

year = "2025",

month = may,

day = "2",

doi = "10.1177/23969873251334271",

language = "English",

journal = "European Stroke Journal",

issn = "2396-9873",

publisher = "SAGE Publishing",

}

MR CLEAN Registry Investigators, Hinsenveld, WH, Brouwer, J, den Hartog, SJ, Bruggeman, A, Kappelhof, M, Jansen, IGH, Mulder, MJHL, Compagne, KCJ, Goldhoorn, R-JB, Lingsma, H, Lycklama À Nijeholt, G, Gons, RAR, Yo, LFS, Uyttenboogaart, M , Bokkers, R, van der Worp, BH, Lo, RH, Schonewille, W, Brouwers, P, Bulut, T, Martens, JMM, Hofmeijer, J, van Hasselt, BAAM, den Hertog, H, de Bruijn, SF, van Dijk, LC, van Walderveen, MA, Wermer, M, Boogaarts, H, van Dijk, EJ, van Tuijl, JH, Boukrab, I, Schreuder, TAHCML, Heijboer, R, Rozeman, AD, Beenen, LFM, Postma, AA, Yoo, AJ, Roosendaal, SD, Bakker, J, van Es, ACGM, Jenniskens, S, van den Wijngaard, IR, Krietemeijer, M, van den Berg, R, Bot, JCJ, Hammer, S, Sprengers, M, Appelman, APA , van der Hoorn, A, van Zwam, W & van Oostenbrugge, R 2025, 'National trends in patient characteristics, interventional techniques and outcomes of endovascular treatment for acute ischaemic stroke: Final results of the MR CLEAN Registry (2014-2018)', European Stroke Journal. https://doi.org/10.1177/23969873251334271

National trends in patient characteristics, interventional techniques and outcomes of endovascular treatment for acute ischaemic stroke: Final results of the MR CLEAN Registry (2014-2018). / MR CLEAN Registry Investigators; Hinsenveld, Wouter H; Brouwer, Josje et al.
In: European Stroke Journal, 02.05.2025.

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

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 -

MR CLEAN Registry Investigators, Hinsenveld WH, Brouwer J, den Hartog SJ, Bruggeman A, Kappelhof M et al. National trends in patient characteristics, interventional techniques and outcomes of endovascular treatment for acute ischaemic stroke: Final results of the MR CLEAN Registry (2014-2018). European Stroke Journal. 2025 May 2. Epub 2025 May 2. doi: 10.1177/23969873251334271

National trends in patient characteristics, interventional techniques and outcomes of endovascular treatment for acute ischaemic stroke: Final results of the MR CLEAN Registry (2014-2018)

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