Improvements in Endovascular Treatment for Acute Ischemic Stroke: A Longitudinal Study in the MR CLEAN Registry
Authors: Compagne Kars C.J. , Kappelhof Manon , Hinsenveld Wouter H. , Brouwer Josje , Goldhoorn Robert-Jan B. , Uyttenboogaart Maarten , Bokkers Reinoud P.H. , Schonewille Wouter J. , Martens Jasper M. , Hofmeijer Jeannette , van der Worp H. Bart , Lo Rob T.H. , Keizer Koos , Yo Lonneke S.F. , Lycklama à Nijeholt Geert J. , den Hertog Heleen M. , Sturm Emiel J.C. , Brouwers Paul J.A.M. , van Walderveen Marianne A.A. , Wermer Marieke J.H. , de Bruijn Sebastiaan F. , van Dijk Lukas C. , Boogaarts Hieronymus D. , van Dijk Ewout J. , van Tuijl Julia H. , Peluso Jo P.P. , de Kort Paul L.M. , van Hasselt Boudewijn A.A.M. , Fransen Puck S. , Schreuder Tobien H.C.M.L. , Heijboer Roel J.J. , Jenniskens Sjoerd F.M. , Sprengers Marieke E.S. , Ghariq Elias , van den Wijngaard Ido R. , Roosendaal Stefan D. , Meijer Anton F.J.A. , Beenen Ludo F.M. , Postma Alida A. , van den Berg René , Yoo Albert J. , van Doormaal Pieter Jan , van Proosdij Marc P. , Krietemeijer Menno G.M. , Gerrits Dick G. , Hammer Sebastiaan , Vos Jan Albert , Boiten Jelis , Coutinho Jonathan M. , Emmer Bart J. , van Es Ad C.G.M. , Roozenbeek Bob , Roos Yvo B.W.E.M. , van Zwam Wim H. , van Oostenbrugge Robert J. , Majoie Charles B.L.M. , Dippel Diederik W.J. , van der Lugt Aad , Jansen Ivo G.H. , Mulder Maxim J.H.L. , Brouwer Josje , den Hartog Sanne J. , Schonewille Wouter J. , Albert Vos Jan , Wermer Marieke J.H. , van Walderveen Marianne A.A. , Staals Julie , van Oostenbrugge Robert J. , Hofmeijer Jeannette , Martens Jasper M. , Lycklama à Nijeholt Geert J. , de Bruijn Sebastiaan F. , van Dijk Lukas C. , van der Worp H. Bart , Lo Rob H. , van Dijk Ewoud J. , Boogaarts Hieronymus D. , de Vries J. , de Kort Paul L.M. , van Tuijl Julia , Peluso Jo P. , Fransen Puck , van den Berg Jan S.P. , van Hasselt Boudewijn A.A.M. , Aerden Leo A.M. , Dallinga René J. , Eschgi Omid , Schreuder Tobien H.C.M.L. , Heijboer Roel J.J. , Keizer Koos , Yo Lonneke S.F. , den Hertog Heleen M. , Bulut Tomas , Brouwers Paul J.A.M. , Lycklama à Nijeholt Geert J. , van Walderveen Marianne A.A. , Sprengers Marieke E.S. , Jenniskens Sjoerd F.M. , van den Berg René , Yoo Albert J. , Beenen Ludo F.M. , Postma Alida A. , Roosendaal Stefan D. , van der Kallen Bas F.W. , van den Wijngaard Ido R. , Martens Jasper M. , Yo Lonneke S.F. , Bot Joost , van Doormaal Pieter-Jan , Meijer Anton , Ghariq Elyas , Bokkers Reinoud P.H. , Peluso Jo P. , Boogaarts Hieronymus D. , Lo Rob , Dinkelaar Wouter , Appelman Auke P.A. , Hammer Bas , Pegge Sjoert , van der Hoorn Anouk , Vinke Saman , Majoie Charles B.L.M. , Lycklama à Nijeholt Geert J. , Albert Vos Jan , Schonewille Wouter J. , Hofmeijer Jeannette , Martens Jasper M. , van der Worp H. Bart , Lo Rob H. , Hofmeijer Jeannette , Flach H. Zwenneke , Lingsma Hester F. , el Ghannouti Naziha , Sterrenberg Martin , Pellikaan Wilma , Sprengers Rita , Elfrink Marjan , Simons Michelle , Vossers Marjolein , de Meris Joke , Vermeulen Tamara , Geerlings Annet , van Vemde Gina , Simons Tiny , Messchendorp Gert , Nicolaij Nynke , Bongenaar Hester , Bodde Karin , Kleijn Sandra , Lodico Jasmijn , Droste Hanneke , Wollaert Maureen , Verheesen Sabrina , Jeurrissen D. , Bos Erna , Drabbe Yvonne , Sandiman Michelle , Aaldering Nicoline , Zweedijk Berber , Vervoort Jocova , Ponjee Eva , Romviel Sharon , Kanselaar Karin , Barning Denn , Venema Esmee , Chalos Vicky , Geuskens Ralph R. , van Straaten Tim , Ergezen Saliha , Harmsma Roger R.M. , Muijres Daan , de Jong Anouk , Berkhemer Olvert A. , Boers Anna M.M. , Huguet J. , Groot P.F.C. , Mens Marieke A. , van Kranendonk Katinka R. , Treurniet Kilian M. , Tolhuisen Manon L. , Alves Heitor , Weterings Annick J. , Kirkels Eleonora L.F. , Voogd Eva J.H.F. , Schupp Lieve M. , Collette Sabine L. , Groot Adrien E.D. , LeCouffe Natalie E. , Konduri Praneeta R. , Prasetya Haryadi , Arrarte-Terreros Nerea , Ramos Lucas A. 
Published: February 2022

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.