{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T11:19:29Z","timestamp":1769080769487,"version":"3.49.0"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T00:00:00Z","timestamp":1765584000000},"content-version":"vor","delay-in-days":560,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2024,6,1]],"date-time":"2024-06-01T00:00:00Z","timestamp":1717200000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2024,6,1]],"date-time":"2024-06-01T00:00:00Z","timestamp":1717200000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Toegepast Wetenschappelijk Instituut voor Neuromodulatie"},{"name":"Toegepast Wetenschappelijk Instituut voor Neuromodulatie"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Little is known about the implications of multivessel occlusions (MVO) in large vessel occlusion stroke patients who undergo endovascular treatment (EVT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods:<\/jats:title>\n                    <jats:p>We report data from the MR CLEAN Registry: a prospective, observational study on all stroke patients who underwent EVT in the Netherlands (March 2014\u2013November 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Of 2946 included patients, 71 patients (2.4%) had an MVO (87% concurrent ACA occlusion, 10% PCA occlusion, 3% \u2a7e3 occlusions). These patients were matched to 71 non-MVO patients. Before matching, MVO patients had a higher baseline NIHSS (median 18 vs 16, p\u2009=\u20090.001) and worse collateral status (absent collaterals: 17% vs 6%, p\u2009&amp;lt;\u20090.001) compared to non-MVO patients. After matching, MVO patients had worse functional outcome at 90\u2009days (median mRS 5 vs 3, cOR 0.39; 95%CI 0.25\u20130.62). Mortality was higher in MVO patients (46% vs 27%, OR 2.11, 95%CI 1.24\u20133.57).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion and conclusion:<\/jats:title>\n                    <jats:p>MVOs on baseline imaging were uncommon in LVO stroke patients undergoing EVT, but were associated with poor functional outcome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23969873231216811","type":"journal-article","created":{"date-parts":[[2023,12,16]],"date-time":"2023-12-16T00:29:25Z","timestamp":1702686565000},"page":"312-319","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcome of patients with multivessel occlusion stroke after endovascular treatment"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6668-8755","authenticated-orcid":false,"given":"Natalie E","family":"LeCouffe","sequence":"first","affiliation":[{"name":"Amsterdam UMC, Amsterdam Neuroscience, Department of Neurology, University of Amsterdam, Amsterdam, The Netherlands 1"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kilian M","family":"Treurniet","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, Department of Radiology and Nuclear Medicine, University of Amsterdam, Amsterdam, The Netherlands 2"},{"name":"Haaglanden MC, Department of Radiology, The Hague, The Netherlands 3"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manon","family":"Kappelhof","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, Department of Radiology and Nuclear Medicine, University of Amsterdam, Amsterdam, The Netherlands 2"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivo GH","family":"Jansen","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, Department of Biomedical Engineering and Physics, University of Amsterdam, Amsterdam, The Netherlands 4"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Merel","family":"Boers","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, Department of Biomedical Engineering and Physics, University of Amsterdam, Amsterdam, The Netherlands 4"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henk A","family":"Marquering","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, Department of Biomedical Engineering and Physics, University of Amsterdam, Amsterdam, The Netherlands 4"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9204-1026","authenticated-orcid":false,"given":"Ludo FM","family":"Beenen","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, Department of Radiology and Nuclear Medicine, University of Amsterdam, Amsterdam, The Netherlands 2"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jelis","family":"Boiten","sequence":"additional","affiliation":[{"name":"Haaglanden MC, Department of Neurology, The Hague, The Netherlands 5"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1631-7056","authenticated-orcid":false,"given":"Wim H","family":"van Zwam","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Department of Radiology, Maastricht, The Netherlands 6"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lonneke SF","family":"Yo","sequence":"additional","affiliation":[{"name":"Catharina Hospital Eindhoven, Department of Radiology, Eindhoven, The Netherlands 7"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles BLM","family":"Majoie","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, Department of Radiology and Nuclear Medicine, University of Amsterdam, Amsterdam, The Netherlands 2"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9205-5882","authenticated-orcid":false,"given":"Yvo BWEM","family":"Roos","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, Amsterdam Neuroscience, Department of Neurology, University of Amsterdam, Amsterdam, The Netherlands 1"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bart J","family":"Emmer","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, Department of Radiology and Nuclear Medicine, University of Amsterdam, Amsterdam, The Netherlands 2"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan M","family":"Coutinho","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, Amsterdam Neuroscience, Department of Neurology, University of Amsterdam, Amsterdam, The Netherlands 1"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"on behalf of the MR CLEAN Registry Investigators","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,6,1]]},"reference":[{"key":"2026012113085372600_bibr1-23969873231216811","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1161\/STROKEAHA.118.021276","article-title":"Multivessel occlusion in patients subjected to thrombectomy: prevalence, associated factors, and clinical implications","volume":"49","author":"Kaesmacher","year":"2018","journal-title":"Stroke"},{"key":"2026012113085372600_bibr2-23969873231216811","doi-asserted-by":"crossref","DOI":"10.1161\/STROKEAHA.120.029629","article-title":"Primary multivessel occlusions treated with mechanical thrombectomy: a multicenter analysis and systemic literature review","volume":"51","author":"Kaesmacher","year":"2020","journal-title":"Stroke"},{"key":"2026012113085372600_bibr3-23969873231216811","first-page":"1","article-title":"Endovascular thrombectomy in patients with acute ischemic stroke with simultaneous multivessel occlusions","volume":"2","author":"Chung","year":"2022","journal-title":"Stroke Vasc Interv Neurol"},{"key":"2026012113085372600_bibr4-23969873231216811","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1159\/000514369","article-title":"Differences in acute ischemic stroke management and prognosis between multiple large-vessel occlusion and single large-vessel occlusion: subanalysis of the RESCUE-Japan Registry 2","volume":"50","author":"Tatebayashi","year":"2021","journal-title":"Cerebrovasc Dis"},{"key":"2026012113085372600_bibr5-23969873231216811","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.123.043027","article-title":"Prevalence and predictors of multivessel occlusions at baseline imaging in ESCAPE-NA1 trial","author":"Singh","year":"2023","journal-title":"Stroke"},{"key":"2026012113085372600_bibr6-23969873231216811","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1017\/CBO9781139093286.037","volume-title":"Stroke syndromes","author":"Kumral","year":"2012","edition":"Boston: Cambrid"},{"key":"2026012113085372600_bibr7-23969873231216811","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1212\/CPJ.0000000000000603","article-title":"Three territory sign","volume":"9","author":"Nouh","year":"2019","journal-title":"Neurol Clin Pract"},{"key":"2026012113085372600_bibr8-23969873231216811","doi-asserted-by":"crossref","first-page":"2209","DOI":"10.1161\/STROKEAHA.116.014178","article-title":"Multiple infarcts are associated with long-term stroke recurrence and all-cause mortality in cryptogenic stroke patients","volume":"47","author":"Nezu","year":"2016","journal-title":"Stroke"},{"key":"2026012113085372600_bibr9-23969873231216811","doi-asserted-by":"crossref","first-page":"3366","DOI":"10.1161\/STROKEAHA.120.031011","article-title":"Early brain imaging shows increased severity of acute ischemic strokes with large vessel occlusion in COVID-19 patients","author":"Escalard","year":"2020","journal-title":"Stroke"},{"key":"2026012113085372600_bibr10-23969873231216811","article-title":"Endovascular treatment for acute ischaemic stroke in routine clinical practice: prospective, observational cohort study (MR CLEAN Registry)","volume":"360","author":"Jansen","year":"2018","journal-title":"BMJ"},{"key":"2026012113085372600_bibr11-23969873231216811","doi-asserted-by":"crossref","first-page":"1863","DOI":"10.1161\/STROKEAHA.121.034919","article-title":"Improvements in endovascular treatment for acute ischemic stroke: a longitudinal study in the MR CLEAN registry","volume":"53","author":"Compagne","year":"2022","journal-title":"Stroke"},{"key":"2026012113085372600_bibr12-23969873231216811","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1136\/neurintsurg-2013-010665","article-title":"2C or not 2C: defining an improved revascularization grading scale and the need for standardization of angiography outcomes in stroke trials","volume":"6","author":"Goyal","year":"2014","journal-title":"J Neurointerv Surg"},{"key":"2026012113085372600_bibr13-23969873231216811","doi-asserted-by":"crossref","first-page":"2981","DOI":"10.1161\/STROKEAHA.115.010049","article-title":"The heidelberg bleeding classification: classification of bleeding events after ischemic stroke and reperfusion therapy","volume":"46","author":"Von Kummer","year":"2015","journal-title":"Stroke"},{"key":"2026012113085372600_bibr14-23969873231216811","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0165705","article-title":"Propensity scoring after multiple imputation in a retrospective study on adjuvant radiation therapy in lymph-node positive vulvar cancer","volume":"11","author":"Eulenburg","year":"2016","journal-title":"PLoS One"},{"key":"2026012113085372600_bibr15-23969873231216811","doi-asserted-by":"crossref","DOI":"10.2139\/ssrn.721907","article-title":"Some practical guidance for the implementation of propensity score matching","author":"Caliendo","year":"2005"},{"key":"2026012113085372600_bibr16-23969873231216811","doi-asserted-by":"crossref","first-page":"525","DOI":"10.3174\/ajnr.A1408","article-title":"CT angiography clot burden score and collateral score: correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct","volume":"30","author":"Tan","year":"2009","journal-title":"AJNR Am J Neuroradiol"},{"key":"2026012113085372600_bibr17-23969873231216811","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1212\/WNL.54.3.674","article-title":"Multiple acute stroke syndrome: marker of embolic disease?","volume":"54","author":"Baird","year":"2000","journal-title":"Neurology"},{"key":"2026012113085372600_bibr18-23969873231216811","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1177\/1591019918776207","article-title":"Procedural and clinical outcomes of endovascular recanalization therapy in patients with cancer-related stroke","volume":"24","author":"Jung","year":"2018","journal-title":"Interv Neuroradiol"},{"key":"2026012113085372600_bibr19-23969873231216811","doi-asserted-by":"crossref","first-page":"1730","DOI":"10.1001\/archneur.60.12.1730","article-title":"Association of ischemic lesion patterns on early diffusion-weighted imaging with TOAST stroke subtypes","volume":"60","author":"Kang","year":"2003","journal-title":"Arch Neurol"},{"key":"2026012113085372600_bibr20-23969873231216811","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1017\/cjn.2014.40","article-title":"Left atrium dilatation and multiple vascular territory strokes","volume":"41","author":"Gagne Brosseau","year":"2014","journal-title":"Can J Neurol Sci"},{"key":"2026012113085372600_bibr21-23969873231216811","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1148\/rg.2018170107","article-title":"Bias in radiology: the how and why of misses and misinterpretations","volume":"38","author":"Busby","year":"2018","journal-title":"Radiographics"},{"key":"2026012113085372600_bibr22-23969873231216811","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.neurad.2018.03.003","article-title":"Brain CT perfusion improves intracranial vessel occlusion detection on CT angiography","volume":"46","author":"Becks","year":"2019","journal-title":"J Neuroradiol"},{"key":"2026012113085372600_bibr23-23969873231216811","doi-asserted-by":"crossref","first-page":"2650","DOI":"10.1161\/STROKEAHA.113.001972","article-title":"Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement","volume":"44","author":"Zaidat","year":"2013","journal-title":"Stroke"},{"key":"2026012113085372600_bibr24-23969873231216811","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1016\/S0140-6736(23)01142-X","article-title":"Value of intravenous thrombolysis in endovascular treatment for large-vessel anterior circulation stroke: individual participant data meta-analysis of six randomised trials","volume":"402","author":"Majoie","year":"2023","journal-title":"Lancet"},{"key":"2026012113085372600_bibr25-23969873231216811","first-page":"11","article-title":"Impact of sample size and variability on the power and type I error rates of equivalence tests: a simulation study","volume":"19","author":"Rusticus","year":"2014","journal-title":"Pract Assessment Res Eval"}],"container-title":["European Stroke Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23969873231216811","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/23969873231216811","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/esj\/article-pdf\/9\/2\/312\/64646298\/23969873231216811.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/esj\/article-pdf\/9\/2\/312\/64646298\/23969873231216811.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T18:09:37Z","timestamp":1769018977000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/esj\/article\/9\/2\/312\/8268940"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,1]]},"references-count":25,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,6,1]]}},"URL":"https:\/\/doi.org\/10.1177\/23969873231216811","relation":{},"ISSN":["2396-9873","2396-9881"],"issn-type":[{"value":"2396-9873","type":"print"},{"value":"2396-9881","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,6,1]]},"published":{"date-parts":[[2024,6,1]]}}}