{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T15:49:39Z","timestamp":1772552979689,"version":"3.50.1"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["SVIN"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">It has been suggested that selection of a first\u2010line endovascular thrombectomy device, that is, contact aspiration (CA) or stent retriever (SR) thrombectomy, could be based on thrombus type. Thrombus composition and mechanical behavior can partially be predicted with thrombus computed tomography (CT) characteristics. We aimed to assess the influence of thrombus CT characteristics on the association between first\u2010line device and outcomes of endovascular thrombectomy.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods<\/jats:title>\n            <jats:p xml:lang=\"en\">For patients enrolled in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands) Registry between March 2014 and November 2017, we assessed thrombus density, thrombus length, and presence of hyperdense artery sign on thin\u2010slice (\u22642.5\u00a0mm) admission CT. We used regression models to estimate the relationship between first\u2010line endovascular thrombectomy device (CA versus stent retriever) and first\u2010pass reperfusion (FPR, expanded Thrombolysis in Cerebral Infarction score 2C\u20103 after first attempt), final reperfusion, procedure duration, 24\u2010hour National Institutes of Health Stroke Scale, and 90\u2010day modified Rankin scale score and tested for interaction of thrombus characteristics with first\u2010line device by adding interaction terms.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Of 703 included patients, 520 (74%) received first\u2010line stent retriever and 183 (26%) first\u2010line CA. Overall, the first\u2010line device was not associated with FPR (adjusted odds ratio [aOR], 1.32 [95% CI, 0.88\u20131.98]). In patients with thrombus density below the median (&lt;50\u00a0Hounsfield units), FPR was more often achieved with CA than with a stent retriever (34% versus 24%, aOR, 1.95 [95% CI, 1.09\u20133.50]), whereas in patients with thrombus density above the median (\u226550\u00a0Hounsfield units), first\u2010line device was not associated with FPR (aOR, 0.90 [95% CI, 0.50\u20131.62]). The interaction between thrombus density as a continuous variable and first\u2010line device on outcome was not significant (\n              <jats:italic>P<\/jats:italic>\n              =0.38). There was also no interaction between first\u2010line device and the other thrombus characteristics for FPR or the other outcomes.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p xml:lang=\"en\">Our study does not provide evidence that the association between first\u2010line thrombectomy device and endovascular thrombectomy outcomes depends on thrombus CT characteristics. Based on our results, there are no arguments for thrombectomy device selection based on thrombus CT characteristics. A possible better performance of CA in low\u2010density, fibrin\u2010rich clots needs further study.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/svin.122.000450","type":"journal-article","created":{"date-parts":[[2022,9,13]],"date-time":"2022-09-13T13:24:25Z","timestamp":1663075465000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Value of Thrombus Imaging Characteristics as a Guide for First\u2010Line Endovascular Thrombectomy Device in Patients With Acute Ischemic Stroke"],"prefix":"10.1161","volume":"3","author":[{"given":"Nikki","family":"Boodt","sequence":"first","affiliation":[{"name":"Department of Radiology and Nuclear Medicine Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands"},{"name":"Department of Neurology Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands"},{"name":"Department of Public Health Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agnetha A. E.","family":"Bruggeman","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manon","family":"Kappelhof","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands"},{"name":"Department of Biomedical Engineering and Physics Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanne J.","family":"den Hartog","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands"},{"name":"Department of Neurology Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands"},{"name":"Department of Public Health Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nerea Arrarte","family":"Terreros","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands"},{"name":"Department of Biomedical Engineering and Physics Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jasper M.","family":"Martens","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine Rijnstate Hospital Arnhem The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reinoud P. H.","family":"Bokkers","sequence":"additional","affiliation":[{"name":"Medical Imaging Center, Department of Radiology Groningen University of Groningen University Medical Center Groningen Groningen The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pieter\u2010Jan","family":"van Doormaal","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles B. L. M.","family":"Majoie","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wim H.","family":"van Zwam","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine Cardiovascular Research Institute Maastricht (CARIM) Maastricht University Medical Center Maastricht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henk A.","family":"Marquering","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"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, University Medical Center Rotterdam Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aad","family":"van der Lugt","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hester F.","family":"Lingsma","sequence":"additional","affiliation":[{"name":"Department of Public Health Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"the MR CLEAN Registry Investigators","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)00163-X"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.9644"},{"key":"e_1_3_2_4_2","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1016\/S0140-6736(19)30297-1","article-title":"Aspiration thrombectomy versus stent retriever thrombectomy as first\u2010line approach for large vessel occlusion (COMPASS): a multicentre, randomised, open label, blinded outcome, non\u2010inferiority trial","volume":"393","author":"Turk 3rd AS","year":"2019","unstructured":"Turk 3rd AS, Siddiqui A, Fifi JT, De Leacy RA, Fiorella DJ, Gu E, Levy EI, Snyder KV, Hanel RA, Aghaebrahim A, et\u00a0al. 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Eur Radiol. 2022.","journal-title":"Eur Radiol"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.117.020315"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.019988"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k949"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2013-010665"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1109\/TMI.2009.2035616"},{"key":"e_1_3_2_21_2","doi-asserted-by":"crossref","first-page":"2058","DOI":"10.1161\/STROKEAHA.116.013306","article-title":"Permeable thrombi are associated with higher intravenous recombinant tissue\u2010type plasminogen activator treatment success in patients with acute ischemic stroke","volume":"47","author":"Santos EM","year":"2016","unstructured":"Santos EM, Dankbaar JW, Treurniet KM, Horsch AD, Roos YB, Kappelle LJ, Niessen WJ, Majoie CB, Velthuis B, Marquering HA, et\u00a0al. Permeable thrombi are associated with higher intravenous recombinant tissue\u2010type plasminogen activator treatment success in patients with acute ischemic stroke. Stroke. 2016;47:2058\u20102065.","journal-title":"Stroke"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00234-015-1607-4"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00234-014-1460-x"},{"key":"e_1_3_2_24_2","doi-asserted-by":"crossref","DOI":"10.1111\/eci.13145","article-title":"Understanding of interaction (subgroup) analysis in clinical trials","volume":"49","author":"Brankovic M","year":"2019","unstructured":"Brankovic M, Kardys I, Steyerberg EW, Lemeshow S, Markovic M, Rizopoulos D, Boersma E. Understanding of interaction (subgroup) analysis in clinical trials. Eur J Clin Invest. 2019;49:e13145.","journal-title":"Eur J Clin Invest"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2018-014270"}],"container-title":["Stroke: Vascular and Interventional Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/SVIN.122.000450","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T15:38:41Z","timestamp":1715614721000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/SVIN.122.000450"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1]]},"references-count":24,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,1]]}},"alternative-id":["10.1161\/SVIN.122.000450"],"URL":"https:\/\/doi.org\/10.1161\/svin.122.000450","relation":{},"ISSN":["2694-5746"],"issn-type":[{"value":"2694-5746","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1]]},"assertion":[{"value":"2022-03-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-06-24","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-09-13","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e000450"}}