TREVO stent-retriever mechanical thrombectomy for acute ischemic stroke secondary to large vessel occlusion registry Article (Web of Science)

abstract

  • BackgroundRecent randomized clinical trials (RCTs) demonstrated the efficacy of mechanical thrombectomy using stent-retrievers in patients with acute ischemic stroke (AIS) with large vessel occlusions; however, it remains unclear if these results translate to a real-world setting. The TREVO Stent-Retriever Acute Stroke (TRACK) multicenter Registry aimed to evaluate the use of the Trevo device in everyday clinical practice.MethodsTwenty-three centers enrolled consecutive AIS patients treated from March 2013 through August 2015 with the Trevo device. The primary outcome was defined as achieving a Thrombolysis in Cerebral Infarction (TICI) score of ≥2b. Secondary outcomes included 90-day modified Rankin Scale (mRS), mortality, and symptomatic intracranial hemorrhage (sICH).ResultsA total of 634patients were included. Mean age was 66.1±14.8 years and mean baseline NIH Stroke Scale (NIHSS) score was 17.4±6.7; 86.7% had an anterior circulation occlusion. Mean time from symptom onset to puncture and time to revascularization were 363.1±264.5 min and 78.8±49.6 min, respectively. 80.3% achieved TICI ≥2b. 90-day mRS ≤2 was achieved in 47.9%, compared with 51.4% when restricting the analysis to the anterior circulation and within 6 hours (similar to recent AHA/ASA guidelines), and 54.3% for those who achieved complete revascularization. The 90-day mortality rate was 19.8%. Independent predictors of clinical outcome included age, baseline NIHSS, use of balloon guide catheter, revascularization, and sICH.ConclusionThe TRACK Registry results demonstrate the generalizability of the recent thrombectomy RCTs in real-world clinical practice. No differences in clinical and angiographic outcomes were shown between patients treated within the AHA/ASA guidelines and those treated outside the recommendations.

authors

  • Zaidat, Osama O
  • Castonguay, Alicia
  • Nogueira, Raul G
  • Haussen, Diogo C
  • English, Joey D
  • Satti, Sudhakar R
  • Chen, Jennifer
  • Farid, Hamed
  • Borders, Candace
  • Veznedaroglu, Erol
  • Binning, Mandy J
  • Puri, Ajit
  • Vora, Nirav A
  • Budzik, Ron F
  • Dabus, Guilherme
  • Linfante, Italo
  • Janardhan, Vallabh
  • Alshekhlee, Amer
  • Abraham, Michael G
  • Edgell, Randall
  • Taqi, Muhammad Asif
  • Khoury, Ramy El
  • Mokin, Maxim
  • Majjhoo, Aniel Q
  • Kabbani, Mouhammed R
  • Froehler, Michael T
  • Finch, Ira
  • Ansari, Sameer A
  • Novakovic, Roberta
  • Nguyen, Thanh N

publication date

  • 2018

number of pages

  • 8

start page

  • 516

end page

  • 524

volume

  • 10

issue

  • 6