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

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.

Indications for thrombectomy in acute ischemic stroke from emergent large vessel occlusion (ELVO): report of the SNIS Standards and Guidelines Committee

“…Registries provide additional useful information by including a wider range of patients that can potentially serve to validate the findings of RCTs. The TRACK18 and NASA19 registries assessed real-world experience with thrombectomy without any specific restriction in time from symptom onset to treatment. Both registries showed rates of clinical outcomes comparable to the major RCTs (48% and 42% rates of good clinical outcome in TRACK and NASA, respectively).…”

First-in-man experience of the Versi Retriever in acute ischemic stroke

“…Although this is a small case series, these recanalization rates are higher than those of the recently published post-marketing clinical registries such as the TREVO Stent-Retriever Acute Stroke (TRACK) registry (80.3% and 44.5%)7 and the North American Solitaire Stent Retriever Acute Stroke (NASA) registry (72.5% and 40.2%)8 in which the efficacy of the stent retrievers was investigated in real-world clinical practice. In addition, first-pass TICI 3 was achieved in 45.4% in our study, higher than 25% in the TRACK registry 7. The higher rate of good angiographic outcomes may be explained by several possibilities, such as the improved performance of the device or higher rate of balloon guiding catheter usage.…”

Endovascular Acute Ischemic Stroke Treatment with FlowGate Balloon Guide Catheter: A Single-Center Observational Study of FlowGate Balloon Guide Catheter Use

“…In addition, the TRACK FPE included not just BGC use but overall FPE. Just like the NASA registry, TRACK also showed better overall good clinical outcomes at 54.3 versus 48% for the rest of the TRACK cohort [14]. We unfortunately did not have outcomes because of loss of follow-up due to insurance or snowbird population (patients leaving for their summer homes) effect and do not have 30- and 90-day outcomes.…”

“…The true FPE of TICI 3 was 46% for our cohort. The recently published TRACK registry true FPE was 25%, but this cohort included all thrombectomies, not just those with M1 or M2 clots [14]. The previously published TRACK abstract only had patients with M1 and M2 clots, reporting a true FPE TICI 3 revascularization after the first pass with the TREVO device compared to those with M1 occlusions (55.8 vs. 40.4%) [15].…”