Multicenter initial experience with the EmboTrap device in acute anterior ischemic stroke

Bourcier, Romain; Abed, Dhulfiqar Ali; Piotin, Michel; Redjem, Hocine; Ferré, Jean–Christophe; Eugène, François; Raoult, Hélène; Mirza, Mahmood; Chapot, René; Desal, Hubert; Nordmeyer, Henning

doi:10.1016/j.neurad.2018.01.052

Cited by 9 publications

(9 citation statements)

References 23 publications

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“…Studies of patients treated with the recent EmboTrap stent-retriever system were not included. Although some data from registries [20][21][22] showed promising results, no comparative data are available on clinical outcomes between the EmboTrap system and Solitaire or Trevo stent retrievers. Studies of patients with anterior circulation occlusion and concomitant cervical carotid occlusion (tandem occlusion) were not excluded.…”

Section: Methodsmentioning

confidence: 99%

First-line contact aspiration vs stent-retriever thrombectomy in acute ischemic stroke patients with large-artery occlusion in the anterior circulation: Systematic review and meta-analysis

et al. 2019

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Background In acute ischemic stroke patients with large-artery occlusion, uncertainties remain about whether clinically important outcomes are comparable between first-line contact aspiration and stent-retriever thrombectomy, although two trials have investigated whether one strategy should be preferred over another. Purpose The purpose of this article is to compare the efficacy and safety of first-line contact aspiration and stent-retriever thrombectomy in stroke patients with anterior circulation large-artery occlusion. Methods We undertook a systematic review of studies of patients treated for large-artery occlusion, with the latest devices of either strategy, within six hours of stroke onset. We determined rates of final complete reperfusion (defined as modified Thrombolysis In Cerebral Infarction score = 3), periprocedural complications and 90-day functional independence (defined as modified Rankin Scale (mRS) score 0–2), and excellent outcome (defined as mRS score 0–1) after contact aspiration and after stent-retriever thrombectomy using random-effects meta-analyses. Any differential effects in rates between the two strategies were assessed using random-effects meta-regressions. Results Fifteen studies (1817 patients) were included. There was no difference in rates of final complete reperfusion at the end of all endovascular procedures between contact aspiration and stent retrievers (51.1%, 95% confidence interval (CI) 39.3–62.9; vs 38.3%, 95% CI 28.6–48.0; pint = 0.14), 90-day functional independence (45.0%, 40.7–49.2; vs 52.4%, 47.7–57.1; pint = 0.45) and excellent outcome (32.1%, 25.7–38.5; vs 34.1%, 21.2–46.9; pint = 0.94). Rates of periprocedural complications did not differ between the two strategies. Conclusions Current data suggest no difference in efficacy and safety between first-line contact aspiration and stent-retriever thrombectomy in stroke patients with large-artery occlusion.

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Section: Methodsmentioning

confidence: 99%

First-line contact aspiration vs stent-retriever thrombectomy in acute ischemic stroke patients with large-artery occlusion in the anterior circulation: Systematic review and meta-analysis

et al. 2019

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“…The total sample comprised 9804 patients. Studies reporting treatment with each device included seven studies of EmboTrap comprising 687 patients [ 7 , 30 , 33 , 35 , 43 , 53 , 63 ], thirty-four studies of Solitaire comprising 5,690 patients, and fourteen studies of Trevo comprising 3427 patients. Eleven studies reported core-lab adjudicated angiographic results, including two EmboTrap studies [ 7 , 33 ], seven Solitaire studies [ 21–23 , 25 , 32 , 39 , 45 ], and two Trevo studies [ 24 , 26 ].…”

Section: Resultsmentioning

confidence: 99%

MASTRO I: Meta-Analysis and Systematic Review of thrombectomy stent retriever outcomes: comparing functional, safety and recanalization outcomes between EmboTrap, Solitaire and Trevo in acute ischemic stroke

Zaidat

Ikeme²,

Sheth

et al. 2023

J. Comp. Eff. Res.

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Aim: Stent-retriever (SR) thrombectomy has demonstrated superior outcomes in patients with acute ischemic stroke compared with medical management alone, but differences among SRs remain unexplored. We conducted a Systematic Review/Meta-Analysis to compare outcomes between three SRs: EmboTrap ® , Solitaire™, and Trevo ® . Methods: We conducted a PRISMA-compliant Systematic Review among English-language studies published after 2014 in PubMed/MEDLINE that reported SRs in ≥25 patients. Functional and safety outcomes included 90-day modified Rankin scale (mRS 0-2), mortality, symptomatic intracranial hemorrhage (sICH), and embolization to new territory (ENT). Recanalization outcomes included modified thrombolysis in cerebral infarction (mTICI) and first-pass recanalization (FPR). We used a random effects Meta-Analysis to compare outcomes; subgroup and outlier-influencer analysis were performed to explore heterogeneity. Results: Fifty-one articles comprising 9,804 patients were included. EmboTrap had statistically significantly higher rates of mRS 0-2 (57.4%) compared with Trevo (50.0%, p = 0.013) and Solitaire (45.3%, p < 0.001). Compared with Solitaire (20.4%), EmboTrap (11.2%, p < 0.001) and Trevo (14.5%, p = 0.018) had statistically significantly lower mortality. Compared with Solitaire (7.7%), EmboTrap (3.9%, p = 0.028) and Trevo (4.6%, p = 0.049) had statistically significantly lower rates of sICH. There were no significant differences in ENT rates across all three devices (6.0% for EmboTrap, 5.3% for Trevo, and 7.7% for Solitaire, p = 0.518). EmboTrap had numerically higher rates of recanalization; however, no statistically significant differences were found. Conclusion: The results of our Systematic Review/Meta-Analysis suggest that EmboTrap may be associated with significantly improved functional outcomes compared with Solitaire and Trevo. EmboTrap and Trevo may be associated with significantly lower rates of sICH and mortality compared with Solitaire. No significant differences in recanalization and ENT rates were found. These conclusions are tempered by limitations of the analysis including variations in thrombectomy techniques in the field, highlighting the need for multi-arm RCT studies comparing different SR devices to confirm our findings.

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“…First, large openings in the outer cages might easily accept clots into the space between the inner and outer layers and minimize maceration of the clot [ 20 21 ]. Second, articulated outer cages might allow the outer layer to open consistently and appose the vessel wall when retracted [ 28 ]. Third, distal embolism during retraction may be limited by a distal closed structure at the tip of the stent [ 20 21 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…Third, distal embolism during retraction may be limited by a distal closed structure at the tip of the stent [ 20 21 22 ]. Fourth, the inner closed-cell stent might stabilize the engaged clot during retrieval [ 28 29 ].…”

Section: Discussionmentioning

confidence: 99%

First-Pass Recanalization with EmboTrap II in Acute Ischemic Stroke (FREE-AIS): A Multicenter Prospective Study

et al. 2023

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Objective We aimed to evaluate the efficacy of EmboTrap II in terms of first-pass recanalization and to determine whether it could yield favorable outcomes. Materials and Methods In this multicenter, prospective study, we consecutively enrolled patients who underwent mechanical thrombectomy using EmboTrap II as a front-line device. The primary outcome was the first pass effect (FPE) rate defined by modified Thrombolysis In Cerebral Infarction (mTICI) grade 2c or 3 by the first pass of EmboTrap II. In addition, modified FPE (mFPE; mTICI grade 2b–3 by the first pass of EmboTrap II), successful recanalization (final mTICI grade 2b–3), and clinical outcomes were assessed. We also analyzed the effect of FPE on a modified Rankin Scale (mRS) score of 0–2 at 3 months. Results Two hundred-ten patients (mean age ± standard deviation, 73.3 ± 11.4 years; male, 55.7%) were included. Ninety-nine patients (47.1%) had FPE, and mFPE was achieved in 150 (71.4%) patients. Successful recanalization was achieved in 191 (91.0%) patients. Among them, 164 (85.9%) patients underwent successful recanalization by exclusively using EmboTrap II. The time from groin puncture to FPE was 25.0 minutes (interquartile range, 17.0–35.0 minutes). Procedure-related complications were observed in seven (3.3%) patients. Symptomatic intracranial hemorrhage developed in 14 (6.7%) patients. One hundred twenty-three (58.9% of 209 completely followed) patients had an mRS score of 0–2. Sixteen (7.7% of 209) patients died during the follow-up period. Patients who had successful recanalization with FPE were four times more likely to have an mRS score of 0–2 than those who had successful recanalization without FPE (adjusted odds ratio, 4.13; 95% confidence interval, 1.59–10.8; p = 0.004). Conclusion Mechanical thrombectomy using the front-line EmboTrap II is effective and safe. In particular, FPE rates were high. Achieving FPE was important for an mRS score of 0–2, even in patients with successful recanalization.

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Multicenter initial experience with the EmboTrap device in acute anterior ischemic stroke

Cited by 9 publications

References 23 publications

First-line contact aspiration vs stent-retriever thrombectomy in acute ischemic stroke patients with large-artery occlusion in the anterior circulation: Systematic review and meta-analysis

First-line contact aspiration vs stent-retriever thrombectomy in acute ischemic stroke patients with large-artery occlusion in the anterior circulation: Systematic review and meta-analysis

MASTRO I: Meta-Analysis and Systematic Review of thrombectomy stent retriever outcomes: comparing functional, safety and recanalization outcomes between EmboTrap, Solitaire and Trevo in acute ischemic stroke

First-Pass Recanalization with EmboTrap II in Acute Ischemic Stroke (FREE-AIS): A Multicenter Prospective Study

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