Mechanical Thrombectomy for TRACE-III-Eligible Patients With Ischemic Stroke: A Multicenter Retrospective Study Compared to TRACE-III and TIMELESS Trials

Objective

The results of the TRACE-III trial demonstrated that tenecteplase (TNK) might be comparable to TNK combined with mechanical thrombectomy (MT) for large vessel occlusion (LVO) stroke within 4.5 to 24 h of onset, as tested in the TIMELESS trial. We aimed to evaluate the safety and effectiveness of MT alone in TRACE-III-eligible patients in routine clinical settings, comparing the results of both trials.

Methods

This retrospective multicenter cohort study involved consecutive patients who underwent MT alone at three stroke centers between March 2021 and July 2024. Only those meeting the inclusion and exclusion criteria of TRACE-III were included. Safety, clinical, and imaging outcomes were compared with the TRACE-III and TIMELESS trial data.

Results

336 TRACE-III-eligible patients were enrolled in our cohort. MT alone had a higher percentage of patients with a modified Rankin scale (mRS) score of 0–2 at 90 days (58.9%) compared to the TNK group in TRACE-III, TNK and placebo groups in TIMELESS (43.6%, 46.0%, and 42.4%, respectively; all p < 0.01). Additionally, MT achieved a higher rate of early-stage reperfusion (86.0%) compared to the TRACE-III TNK, TIMELESS TNK, and TIMELESS placebo groups (27.9%, 76.7%, and 63.9%; all p < 0.05). The mRS 0–1 at 90 days, incidence of symptomatic intracerebral hemorrhage, and mortality at 90 days were 36.0%, 5.4%, and 14.9%, respectively, similar to those in the three groups (all p > 0.05).

Interpretation

In clinical practice, MT can achieve higher rate of early-stage reperfusion and tended to yield better functional outcomes than intravenous TNK, with similar safety, in TRACE-III-eligible patients.