Outcomes After Thrombectomy for Acute Ischemic Stroke Related to Type of Stent Retriever; a MR CLEAN Registry Study

Endovascular treatment (EVT) with a stent retriever is known to be effective and safe in patients with acute ischemic stroke due to large vessel occlusion. We aimed to compare the most used stent retrievers in a nationwide registry of EVT-treated stroke patients (MR CLEAN Registry).

Patients with ischemic stroke due to large vessel occlusion, treated with stent retriever thrombectomy (each stent retriever with at least 100 EVTs) as first-line technique in the MR CLEAN Registry, were included. The primary outcome was the modified Rankin Scale (mRS) score at 90-day follow-up. Secondary outcomes included reperfusion (expanded Treatment In Cerebral Infarction [eTICI]), mortality at 90 days, symptomatic intracranial hemorrhage, National Institutes of Health Stroke Scale (NIHSS) score between 24 and 48 h post-EVT, and procedure time. With multivariable regression analyses, we calculated odds ratios (OR) and β-estimates to compare outcomes between the most frequently used stent retrievers, with adjustments for predefined variables. One subgroup analysis focused on the effect of the stent retriever on outcomes in M1 occlusions.

Trevo (Stryker) was the most frequently used stent retriever (n = 1541, 70%). Other types were Solitaire (n = 301, 14%) (Medtronic), Embotrap (n = 255, 11%) (Cerenovus; Johnson&Johnson), and Revive (n = 103, 5.2%) (Cerenovus; Johnson&Johnson). There was a slightly, but statistically significant, higher 90-day mRS score (adjusted common [ac]OR: 0.75, 95%CI: 0.57-0.99) and mortality rate (aOR: 1.77, 95%CI: 1.16-2.68) for the Solitaire and longer procedure times for the Revive stent (mean: 67.6 versus 58.9 min; adjusted β-estimate: 11.6, 95%CI: 2.69-20.6) compared to the Trevo retriever. There were no outcome differences in the M1 subgroup analyses.

Differences in clinical, technical, and safety outcomes after EVT between the Trevo, Solitaire, Embotrap, and Revive stent retrievers were-although statistically significant-small. Treating physicians should use the stent retriever they are used to, and further studies with more strict patient selection should be conducted to validate these results.