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Updated: Jan 9, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Mechanical thrombectomy for acute ischemic stroke in a low- and middle-income country: primary outcomes from the
Dileep R Yavagal1, Shailesh B Gaikwad2,3, Deepti Vibha4
1Department of Neurology and Neurosurgery, University of Miami, Miami, Florida, USA dyavagal@med.miami.edu sgaikwad_63@yahoo.com.
Background And Aims:
Access to mechanical thrombectomy for acute ischemic stroke secondary to large vessel occlusion (LVO) is severely restricted in resource-constrained environments, largely owing to the prohibitive cost of existing approved devices.
Objective:
The GRASSROOT Trial is the first prospective thrombectomy study in a low- and middle-income country (LMIC) setting assessing the safety and efficacy of the novel Supernova stent retriever-engineered for highest-level performance across diverse patient populations.
Methods:
A prospective, single-arm, multicenter trial conducted in India enrolled patients with AIS due to internal carotid artery terminus, M1/M2 middle cerebral artery, or basilar artery occlusions presenting within 24 hours of symptom onset. Primary safety endpoints were symptomatic intracranial hemorrhage (sICH) within 24 hours and all-cause mortality at 90 days. Primary efficacy endpoint was successful reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) score ≥2b), with a 90-day modified Rankin Scale (mRS) score of 0-2 serving as the secondary efficacy endpoint.
Results:
Thirty-two consecutive eligible patients (mean age 58±16 years; 31% female; median National Institutes of Health Stroke Scale (NIHSS) score 14 (IQR 9-18), Alberta Stroke Program Early CT Score 8 (IQR 7-10)) were enrolled. Successful reperfusion (mTICI≥2b) after 1-3 passes of the Supernova stent retriever (median=1 (1-3)) was achieved in 30 (93.8%) patients without need for adjunctive rescue therapy. At 90 days, mortality was 9.4%, sICH 3.1%, and functional independence (mRS score 0-2) 50%. The median NIHSS score improved from 14 at baseline to 7 at discharge and to 4 at 90 days. First pass recanalization was observed in 22 (68.8%) patients. No device-related complications or deficiencies were observed.
Conclusions:
The GRASSROOT Trial demonstrates excellent safety and efficacy of the Supernova stent retriever in large vessel occlusions. High rate of first pass reperfusion together with value-based pricing could facilitate a significant advancement in acute stroke thrombectomy access in India and other LMICs.
Trial Registration Number:
NCT06249776.
