Outcomes After Thrombectomy for Acute Ischemic Stroke Related to Type of Stent Retriever; a MR CLEAN Registry Study.

IF 2.8 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CardioVascular and Interventional Radiology Pub Date : 2025-06-09 DOI:10.1007/s00270-025-04048-0

Robrecht R M M Knapen, Robert-Jan B Goldhoorn, Jan Albert Vos, Bart J Emmer, Maarten Uyttenboogaart, Jeannette Hofmeijer, Wouter J Schonewille, Charles B Majoie, Yvo B W E M Roos, Aad van der Lugt, Diederik W J van Dippel, Hester F Lingsma, Christiaan van der Leij, Robert J van Oostenbrugge, Wim H van Zwam

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引用次数: 0

Abstract

Purpose: Endovascular treatment (EVT) with a stent retriever is known to be effective and safe in patients with acute ischemic stroke due to large vessel occlusion. We aimed to compare the most used stent retrievers in a nationwide registry of EVT-treated stroke patients (MR CLEAN Registry).

Methods: Patients with ischemic stroke due to large vessel occlusion, treated with stent retriever thrombectomy (each stent retriever with at least 100 EVTs) as first-line technique in the MR CLEAN Registry, were included. The primary outcome was the modified Rankin Scale (mRS) score at 90-day follow-up. Secondary outcomes included reperfusion (expanded Treatment In Cerebral Infarction [eTICI]), mortality at 90 days, symptomatic intracranial hemorrhage, National Institutes of Health Stroke Scale (NIHSS) score between 24 and 48 h post-EVT, and procedure time. With multivariable regression analyses, we calculated odds ratios (OR) and β-estimates to compare outcomes between the most frequently used stent retrievers, with adjustments for predefined variables. One subgroup analysis focused on the effect of the stent retriever on outcomes in M1 occlusions.

Results: Trevo (Stryker) was the most frequently used stent retriever (n = 1541, 70%). Other types were Solitaire (n = 301, 14%) (Medtronic), Embotrap (n = 255, 11%) (Cerenovus; Johnson&Johnson), and Revive (n = 103, 5.2%) (Cerenovus; Johnson&Johnson). There was a slightly, but statistically significant, higher 90-day mRS score (adjusted common [ac]OR: 0.75, 95%CI: 0.57-0.99) and mortality rate (aOR: 1.77, 95%CI: 1.16-2.68) for the Solitaire and longer procedure times for the Revive stent (mean: 67.6 versus 58.9 min; adjusted β-estimate: 11.6, 95%CI: 2.69-20.6) compared to the Trevo retriever. There were no outcome differences in the M1 subgroup analyses.

Conclusion: Differences in clinical, technical, and safety outcomes after EVT between the Trevo, Solitaire, Embotrap, and Revive stent retrievers were-although statistically significant-small. Treating physicians should use the stent retriever they are used to, and further studies with more strict patient selection should be conducted to validate these results.

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急性缺血性脑卒中取栓后疗效与支架回收器类型的关系MR CLEAN注册研究

目的：血管内治疗（EVT）与支架回收器是已知的有效和安全的急性缺血性卒中患者由于大血管闭塞。我们的目的是比较全国evt治疗的中风患者（MR CLEAN registry）中最常用的支架回收器。方法：纳入MR CLEAN Registry中采用支架取栓器（每个支架取栓器至少有100个evt）作为一线技术治疗的大血管闭塞缺血性卒中患者。主要终点为90天随访时的改良Rankin量表（mRS）评分。次要结局包括再灌注（脑梗死扩展治疗[eTICI]）、90天死亡率、症状性颅内出血、evt后24至48小时的美国国立卫生研究院卒中量表（NIHSS）评分和手术时间。通过多变量回归分析，我们计算了优势比（OR）和β-估计，比较了最常用支架取出器的结果，并对预定义变量进行了调整。一个亚组分析侧重于支架回收器对M1闭塞结局的影响。结果：Trevo （Stryker）是最常用的支架取出器（n = 1541, 70%）。其他类型为Solitaire (n = 301, 14%)（美敦力），Embotrap (n = 255, 11%) (Cerenovus；（n = 103, 5.2%） (Cerenovus；强生公司)。Solitaire的90天mRS评分（调整后常见[ac]OR: 0.75, 95%CI: 0.57-0.99）和死亡率（aOR: 1.77, 95%CI: 1.16-2.68）略高，但有统计学意义，Revive支架的手术时间更长(平均：67.6 vs 58.9分钟；调整后的β-估计：11.6,95%CI: 2.69-20.6)与Trevo猎犬相比。在M1亚组分析中没有结果差异。结论：Trevo、Solitaire、Embotrap和Revive支架置换器在EVT后的临床、技术和安全性结果上的差异虽然具有统计学意义，但很小。治疗医生应该使用他们习惯的支架回收器，并且应该进行更严格的患者选择的进一步研究来验证这些结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

CardioVascular and Interventional Radiology 医学-核医学

CiteScore

5.50

自引率

13.80%

发文量

306

审稿时长

3-8 weeks

期刊介绍： CardioVascular and Interventional Radiology (CVIR) is the official journal of the Cardiovascular and Interventional Radiological Society of Europe, and is also the official organ of a number of additional distinguished national and international interventional radiological societies. CVIR publishes double blinded peer-reviewed original research work including clinical and laboratory investigations, technical notes, case reports, works in progress, and letters to the editor, as well as review articles, pictorial essays, editorials, and special invited submissions in the field of vascular and interventional radiology. Beside the communication of the latest research results in this field, it is also the aim of CVIR to support continuous medical education. Articles that are accepted for publication are done so with the understanding that they, or their substantive contents, have not been and will not be submitted to any other publication.