TREVO stent-retriever mechanical thrombectomy for acute ischemic stroke secondary to large vessel occlusion registry

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

Research output: Contribution to journalArticle

33 Scopus citations

Abstract

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 (TRAC K) 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 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). Results: A 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. Conclusion: The TRAC K 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.

Original languageEnglish (US)
Pages (from-to)516-524
Number of pages9
JournalJournal of NeuroInterventional Surgery
Volume10
Issue number6
DOIs
StatePublished - Jun 2018

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Zaidat, O. O., Castonguay, A. C., Nogueira, R. G., Haussen, D. C., English, J. D., Satti, S. R., Chen, J., Farid, H., Borders, C., Veznedaroglu, E., Binning, M. J., Puri, A., Vora, N. A., Budzik, R. F., Dabus, G., Linfante, I., Janardhan, V., Alshekhlee, A., Abraham, M. G., ... Nguyen, T. N. (2018). TREVO stent-retriever mechanical thrombectomy for acute ischemic stroke secondary to large vessel occlusion registry. Journal of NeuroInterventional Surgery, 10(6), 516-524. https://doi.org/10.1136/neurintsurg-2017-013328