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
{"title":"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","authors":"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","doi":"10.1007/s00270-025-04048-0","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":9591,"journal":{"name":"CardioVascular and Interventional Radiology","volume":" ","pages":""},"PeriodicalIF":2.8000,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Outcomes After Thrombectomy for Acute Ischemic Stroke Related to Type of Stent Retriever; a MR CLEAN Registry Study.\",\"authors\":\"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\",\"doi\":\"10.1007/s00270-025-04048-0\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":9591,\"journal\":{\"name\":\"CardioVascular and Interventional Radiology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2025-06-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"CardioVascular and Interventional Radiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00270-025-04048-0\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"CardioVascular and Interventional Radiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00270-025-04048-0","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Outcomes After Thrombectomy for Acute Ischemic Stroke Related to Type of Stent Retriever; a MR CLEAN Registry Study.
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.
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.
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