{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T15:42:58Z","timestamp":1794498178015,"version":"4.9.1"},"reference-count":30,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2022,3,22]],"date-time":"2022-03-22T00:00:00Z","timestamp":1647907200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"AMC medical Research BV, Amsterdam UMC, location AMC","award":["21937"],"award-info":[{"award-number":["21937"]}]},{"name":"TWIN Foundation, Erasmus MC University Medical Center, Amsterdam University Medical Center, Maastricht University Medical Center","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"European Union's Horizon 2020 research and innovation program","award":["777072"],"award-info":[{"award-number":["777072"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J NeuroIntervent Surg"],"accepted":{"date-parts":[[2022,3,3]]},"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>A thrombus in the M1 segment of the middle cerebral artery (MCA) can occlude this main stem only or extend into the M1-M2 bifurcation. The occlusion pattern may affect endovascular treatment (EVT) success, as a bifurcated thrombus may be more prone to fragmentation during retrieval.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To investigate whether bifurcated thrombus patterns are associated with EVT procedural and clinical outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Occlusion patterns of MCA thrombi on CT angiography from MR CLEAN Registry patients were classified into three groups: main stem occlusion, bifurcation occlusion extending into one M2 branch, and bifurcation occlusion extending into both M2 branches. Procedural parameters, procedural outcomes (reperfusion grade and embolization to new territory), and clinical outcomes (24-48 hour National Institutes of Health Stroke Scale [NIHSS<jats:sub>FU<\/jats:sub>] score, change in NIHSS scores between 24 and 48 hours and baseline \u2206[NIHSS], and 90-day modified Rankin Scale [mRS] scores) were compared between occlusion patterns.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We identified 1023 patients with an MCA occlusion of whom 370 (36%) had a main stem occlusion, 151 (15%) a single branch, and 502 (49%) a double branch bifurcation occlusion. There were no statistically significant differences in retrieval method, procedure time, number of retrieval attempts, reperfusion grade, and embolization to new territory between occlusion patterns. Patients with main stem occlusions had lower NIHSS<jats:sub>FU<\/jats:sub> scores than patients with single (7 vs 11, p=0.01) or double branch occlusions (7 vs 9, p=0.04). However, there were no statistically significant differences in \u2206NIHSS or in 90-day mRS scores.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In our population, EVT procedural and long-term clinical outcomes were similar for MCA bifurcation occlusions and MCA main stem occlusions.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/neurintsurg-2021-018560","type":"journal-article","created":{"date-parts":[[2022,3,22]],"date-time":"2022-03-22T13:26:59Z","timestamp":1647955619000},"page":"355-363","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Bifurcation occlusions and endovascular treatment outcome in acute ischemic stroke"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9912-7508","authenticated-orcid":false,"given":"Nerea","family":"Arrarte Terreros","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering and Physics, Amsterdam UMC, location AMC, Amsterdam, The Netherlands"},{"name":"Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6873-2545","authenticated-orcid":false,"given":"Agnetha A E","family":"Bruggeman","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2647-3557","authenticated-orcid":false,"given":"Henk","family":"van Voorst","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering and Physics, Amsterdam UMC, location AMC, Amsterdam, The Netherlands"},{"name":"Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praneeta R","family":"Konduri","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering and Physics, Amsterdam UMC, location AMC, Amsterdam, The Netherlands"},{"name":"Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivo G H","family":"Jansen","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5250-8955","authenticated-orcid":false,"given":"Manon","family":"Kappelhof","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering and Physics, Amsterdam UMC, location AMC, Amsterdam, The Netherlands"},{"name":"Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2695-1117","authenticated-orcid":false,"given":"Manon L","family":"Tolhuisen","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering and Physics, Amsterdam UMC, location AMC, Amsterdam, The Netherlands"},{"name":"Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikki","family":"Boodt","sequence":"additional","affiliation":[{"name":"Department of Neurology, Erasmus MC, Rotterdam, The Netherlands"},{"name":"Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9234-3515","authenticated-orcid":false,"given":"Diederik W J","family":"Dippel","sequence":"additional","affiliation":[{"name":"Department of Neurology, Erasmus MC, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aad","family":"van der Lugt","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1631-7056","authenticated-orcid":false,"given":"Wim H","family":"van Zwam","sequence":"additional","affiliation":[{"name":"Department of Radiology, Maastricht UMC, Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J","family":"van Oostenbrugge","sequence":"additional","affiliation":[{"name":"Department of Neurology, Maastricht UMC, Maastricht, The Netherlands"},{"name":"Cardiovascular Research Institute Maastricht, University of Maastricht, Maastricht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. 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