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Observational Study
. 2024 Jun;9(2):312-319.
doi: 10.1177/23969873231216811. Epub 2023 Dec 15.

Outcome of patients with multivessel occlusion stroke after endovascular treatment

Natalie E LeCouffe  1 , Kilian M Treurniet  2   3 , Manon Kappelhof  2 , Ivo Gh Jansen  4 , Merel Boers  4 , Henk A Marquering  4 , Ludo Fm Beenen  2 , Jelis Boiten  5 , Wim H van Zwam  6 , Lonneke Sf Yo  7 , Charles Blm Majoie  2 , Yvo Bwem Roos  1 , Bart J Emmer  2 , Jonathan M Coutinho  1
Affiliations
Observational Study

Outcome of patients with multivessel occlusion stroke after endovascular treatment

Natalie E LeCouffe et al. Eur Stroke J. 2024 Jun.

Abstract

Introduction: Little is known about the implications of multivessel occlusions (MVO) in large vessel occlusion stroke patients who undergo endovascular treatment (EVT).

Patients and methods: We report data from the MR CLEAN Registry: a prospective, observational study on all stroke patients who underwent EVT in the Netherlands (March 2014-November 2017). We included patients with an intracranial target occlusion in the anterior circulation. An MVO was defined as an MCA occlusion (M1/M2) or intracranial ICA/ICA-T occlusion, with a concurrent second occlusion in the ACA or PCA territory confirmed on baseline CTA. To compare outcomes, we performed a 10:1 propensity score matching analysis with a logistic regression model including potential confounders. Outcome measures included 90-day functional outcome (modified Rankin Scale, mRS) and mortality.

Results: Of 2946 included patients, 71 patients (2.4%) had an MVO (87% concurrent ACA occlusion, 10% PCA occlusion, 3% ⩾3 occlusions). These patients were matched to 71 non-MVO patients. Before matching, MVO patients had a higher baseline NIHSS (median 18 vs 16, p = 0.001) and worse collateral status (absent collaterals: 17% vs 6%, p < 0.001) compared to non-MVO patients. After matching, MVO patients had worse functional outcome at 90 days (median mRS 5 vs 3, cOR 0.39; 95%CI 0.25-0.62). Mortality was higher in MVO patients (46% vs 27%, OR 2.11, 95%CI 1.24-3.57).

Discussion and conclusion: MVOs on baseline imaging were uncommon in LVO stroke patients undergoing EVT, but were associated with poor functional outcome.

Keywords: Endovascular treatment; multivessel occlusions; stroke.

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Conflict of interest statement

Declaration of conflicting interestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr LeCouffe, Dr Treurniet, Dr Kappelhof, Dr Emmer and Dr Coutinho were research coordinators for the MR CLEAN-NO IV trial (ISRCTN80619088). Dr Roos and Dr Majoie were principal investigators of the MR CLEAN-NO IV trial. Drs Roos, Majoie, Treurniet and Kappelhof are co-principal investigators for the IRIS study (https://mrclean-noiv.nl/DOC/IRIS_SAP_220928.pdf). Dr Majoie reports grants from TWIN Foundation (related) and CVON/Dutch Heart Foundation, European Commission, Healthcare Evaluation Netherlands and Stryker, outside the submitted work (all paid to institution). In addition, Dr Majoie is shareholder of Nicolab, a company that focuses on the use of artificial intelligence for medical image analysis. Dr Roos reports stockholdings from Nicolab outside the submitted work. Dr Emmer received research support from Health Holland, Nicolab and The Netherlands Organisation for Health Research and Development. Dr van Zwam received speaker fees from Stryker, Cerenovus and Nicolab and consulting fees from Philips, all paid to Institution. Dr Coutinho received related research support from the Dutch Heart Foundation, Medtronic, unrelated research support from Bayer and Boehringer (all fees were paid to his employer), and is co-founder and shareholder of Trianect. Dr Jansen is Head of Clinical Development and shareholder of Nicolab. Dr Boers is CEO and shareholder of Nicolab. Dr Marquering is cofounder and shareholder in Nicolab.

Figures

Graphical abstract
Graphical abstract
Figure 1.
Figure 1.
Distribution of the modified Rankin Scale score at 90 days in multivessel occlusion (MVO) versus single occlusion patients.
See this image and copyright information in PMC

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