TREVO stent-retriever mechanical thrombectomy for acute ischemic stroke secondary to large vessel occlusion registry
Department of Radiology
Cardiovascular Diseases | Nervous System Diseases | Neurology | Radiology | Surgery
BACKGROUND: Recent 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.
METHODS: Twenty-three centers enrolled consecutive AIS patients treated from March 2013 through August 2015 with the Trevo device. The primary outcome was de fi ned 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).
RESULTS: A total of 634 patients 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.
CONCLUSION: The 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.
DOI of Published Version
J Neurointerv Surg. 2017 Sep 29. pii: neurintsurg-2017-013328. doi: 10.1136/neurintsurg-2017-013328. [Epub ahead of print] Link to article on publisher's site
Journal of neurointerventional surgery
Zaidat OO, Puri AS. (2017). TREVO stent-retriever mechanical thrombectomy for acute ischemic stroke secondary to large vessel occlusion registry. Radiology Publications. https://doi.org/10.1136/neurintsurg-2017-013328. Retrieved from https://escholarship.umassmed.edu/radiology_pubs/348