Randomized Study Comparing First-Line Dual Versus Single-Stent Retriever Technique: TWIN2WIN

Area of Science:

• Neurology
• Interventional Neuroradiology
• Cardiovascular Diseases

Background:

• The double-stent retriever (SR) technique is recognized as a rescue strategy for thrombectomy when single-SR fails.
• This study evaluated the safety and efficacy of employing the double-SR technique as a primary treatment for stroke.

Purpose of the Study:

• To assess the effectiveness of the double-stent retriever (SR) technique as a first-line approach in stroke thrombectomy.
• To compare the first-pass recanalization rates between single-SR and double-SR techniques.
• To evaluate the safety of the double-SR technique, specifically the incidence of symptomatic intracerebral hemorrhage.

Main Methods:

• A multicenter, randomized, controlled, blinded outcome study included patients with large vessel occlusion stroke within 24 hours.
• Patients were randomized to either a single-SR or double-SR first-line strategy.
• Efficacy was defined by first-pass complete recanalization (eTICI 2c-3); safety was assessed by symptomatic intracerebral hemorrhage.

Main Results:

• First-pass recanalization was achieved in 46% of patients in the double-SR group versus 24% in the single-SR group (aOR, 2.72).
• Substantial reperfusion within 3 attempts was similar between groups (89% double-SR vs. 84% single-SR).
• Symptomatic intracerebral hemorrhage occurred in 10% of the double-SR group and 6% of the single-SR group.

Conclusions:

• First-line double-SR is a safe and effective strategy for improving first-pass recanalization in stroke thrombectomy.
• The double-SR technique demonstrated superiority in achieving initial recanalization but not final recanalization compared to single-SR.
• Further research is needed to determine the impact of this technique on overall clinical outcomes in stroke patients.