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. 2025 May 2:23969873251334271.
doi: 10.1177/23969873251334271. Online ahead of print.

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)

Wouter H Hinsenveld  1 , Josje Brouwer  2 , Sanne J den Hartog  3 , Agnetha Bruggeman  4 , Manon Kappelhof  4 , Ivo Gh Jansen  5 , Maxim Jhl Mulder  6 , Kars Cj Compagne  6 , Robert-Jan B Goldhoorn  1 , Hester Lingsma  7 , Geert Lycklama À Nijeholt  8 , Rob Ar Gons  9 , Lonneke Fs Yo  10 , Maarten Uyttenboogaart  11   12 , Reinoud Bokkers  12 , Bart H van der Worp  13 , Rob H Lo  14 , Wouter Schonewille  15 , Paul Brouwers  16 , Tomas Bulut  17 , Jasper Mm Martens  18 , Jeannette Hofmeijer  19 , Boudewijn Aam van Hasselt  20 , Heleen den Hertog  21 , Sebastiaan F de Bruijn  22 , Lukas C van Dijk  23 , Marianne A van Walderveen  24 , Marieke Wermer  11 , Hieronymus Boogaarts  25 , Ewoud J van Dijk  26 , Julia H van Tuijl  27 , Issam Boukrab  28 , Tobien Ahcml Schreuder  29 , Roeland Heijboer  30 , Anouk D Rozeman  31 , Ludo Fm Beenen  4 , Alida A Postma  32 , Albert J Yoo  33 , Stefan D Roosendaal  4 , Jeannette Bakker  34 , Adriaan Cgm van Es  24 , Sjoerd Jenniskens  35 , Ido Remy van den Wijngaard  8 , Menno Krietemeijer  10 , René van den Berg  4 , Joseph Cj Bot  36 , Sebastiaan Hammer  22 , Marieke Sprengers  4 , Frederick Jan Anton Meijer  35 , Miou S Koopman  4 , Elyas Ghariq  8 , Auke Pa Appelman  12 , Anouk van der Hoorn  12 , Marc P van Proosdij  37 , Bas Fw van der Kallen  8 , Olvert A Berkhemer  4   6 , Jeroen E Markenstein  4 , Eef J Hendriks  4   38 , Jo Pp Peluso  39 , Christiaan van der Leij  40 , Lucas Smagge  6 , Saman Vinke  25 , Sjoerd Pegge  35 , Wouter Dinkelaar  34 , Jan Albert Vos  41 , Jelis Boiten  42 , Inger de Ridder  1 , Jonathan Coutinho  2 , Bart J Emmer  4 , Pieter Jan van Doormaal  6 , Bob Roozenbeek  43 , Yvo Bwem Roos  2 , Charles Blm Majoie  4 , Diederik Wj Dippel  43 , Aad van der Lugt  6 , Wim van Zwam  40 , Robert van Oostenbrugge  1
Affiliations

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)

Wouter H Hinsenveld et al. Eur Stroke J. .

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.

Keywords: MR CLEAN; acute ischaemic stroke; endovascular treatment; interventional techniques; large vessel occlusion; patient characteristics; registry; reperfusion; stroke.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Bokkers received unrestricted grants from the Netherlands Organization for Health Research and Development, the Dutch Ministry of Economic Affairs and Climate Policy and Siemens Healthineers. He received consulting fees from Guerbet which were paid to institution. Dr Uyttenboogaart received grants from the Dutch Heart Foundation, and TKI-PPS, paid to institution. Dr Boogaarts received a consulting fee from Stryker Neurovascular, paid to institution. Dr Postma received grants from Siemens Healthineers and Bayer Healthcare, paid to institution. Dr Yoo received grants from Medtronic, Ceronovus, Penumbra, Stryker and Genentech, paid to institution, and personal fees from Cerenovus, Penumbra, Vesalio, not related to the submitted work. He has equity ownership interest from Insera Therapeutics. Dr van der Lugt received grants from Stryker, Penumbra, Medtronic, Cerenovus, Thrombolytic Science LLC, Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organisation for Health Research and Development, Health Holland Top Sector Life Sciences & Health, GE Healthcare, Siemens Healthineers, Philips Healthcare, all paid to institution. He is on the DSMB of Escape-MEVO and is research leader of the CONTRAST consortium (unpaid). Dr van der Worp received grants from Stryker, Dutch Hearth Foundation, European Commission. He received consulting fees for TargED and Bayer. He is member of the executive committee of European Stroke Organisation. He has a stock in Philips. Dr Wermer is on the DSMB of the Trident trial. Dr Majoie received grants from CVON/Dutch Heart Foundation, Stryker, European Commission, TWIN, Dutch Health Evaluation Program and is shareholder of Nico.Lab. Dr Dippel received grants from Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organisation for Health Research and Development, Health Holland Top Sector Life Sciences & Health, Stryker, Penumbra, Inc, Medtronic, Thrombolytic Science LLC, Cerenovus. Dr Coutinho received grants from Boehringer Ingelheim, Bayer, Portola, outside the submitted work. Dr van Doormaal is on the advisory board of Diagnostix.ai and is shareholder of Diagnostix.ai. Dr van Zwam received payment to institution for unrelated consultancy activities for Stryker, Cerenovus, Medtronic, Penumbra, Microvention and Nico.Lab, and chairs the DSMBs of WE-TRUST (Philips, paid to institution), In Extremis (CHU Montpellier, unpaid) and ANAIS (Anaconda, paid to institution) studies. Dr R. van den Berg received payment to institution for unrelated consultancy activities for Cerenovus. Dr van Oostenbrugge is on the scientific advisory board (DSMB) of CoreValve Advance Study (MedTronic). Dr Roos and Ivo Jansen are shareholder at Nico.Lab. Dr Emmer received grants from Leading the Change Program (the Netherlands Organisation for Health Research and Development) and grants from Health Holland Top Sector Life Sciences & Health, outside the submitted work and paid to institution. The other authors report no conflicts.

Figures

Graphical abstract
Graphical abstract
Figure 1.
Figure 1.
Flowchart study population.
Figure 2.
Figure 2.
Evolution of baseline characteristics and outcomes over time.
Figure 3.
Figure 3.
Modified Rankin Scale (mRS) score at 90 days. Stacked bar-chart showing percentages for each mRS score, with on the x-axis: percentage of patients with certain mRS, and on the y-axis: each year with number of patients. Adjusted common odds ratio for a shift towards a better outcome per year 1.14 (95%CI: 1.09–1.20).
See this image and copyright information in PMC

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