From the Department of Neurosurgery and Neurology (A.S., V.M.S., Y.S., J.N.J., J.-K.B., P.K.), Baylor College of Medicine, Houston, Texas.
Department of Neurosurgery (R.M.S., E.C.P., D.R.Y.), University of Miami Miller School of Medicine, Miami, Florida.
AJNR Am J Neuroradiol. 2021 May;42(5):904-909. doi: 10.3174/ajnr.A7067. Epub 2021 Mar 11.
EmboTrap II is a novel stent retriever with a dual-layer design and distal mesh designed for acute ischemic stroke emergent large-vessel occlusions. We present the first postmarket prospective multicenter experience with the EmboTrap II stent retriever.
A prospective registry of patients treated with EmboTrap II at 7 centers following FDA approval was maintained with baseline patient characteristics, treatment details, and clinical/radiographic follow-up.
Seventy patients were treated with EmboTrap II (mean age, 69.9 years; 48.6% women). Intravenous thrombolysis was given in 34.3%, and emergent large-vessel occlusions were located in the ICA ( = 18), M1 ( = 38), M2 or M3 ( = 13), and basilar artery ( = 1). The 5 × 33 mm device was used in 88% of cases. TICI ≥ 2b recanalization was achieved in 95.7% (82.3% in EmboTrap II-only cases), and first-pass efficacy was achieved in 35.7%. The NIHSS score improved from a preoperative average of 16.3 to 12.1 postprocedure and to 10.5 at discharge. An average of 2.5 [SD, 1.8] passes was recorded per treatment, including non-EmboTrap attempts. Definitive treatment was performed with an alternative device (aspiration or stent retriever) in 9 cases (12.9%). Some hemorrhagic conversion was noted in 22.9% of cases, of which 4.3% were symptomatic. There were no device-related complications.
Initial postmarket results with the EmboTrap II stent retriever are favorable and comparable with those of other commercially available stent retrievers. Compared with EmboTrap II, the first-generation EmboTrap may have a higher first-pass efficacy; however, data are limited by retrospective case analysis, incomplete clinical follow-up, and small sample size, necessitating future trials.
EmboTrap II 是一种新型支架取栓器,具有双层设计和远端网孔,适用于急性缺血性脑卒中的大血管闭塞急症治疗。我们首次报道了 EmboTrap II 支架取栓器在获得美国食品药品监督管理局批准后的多中心前瞻性上市后经验。
在获得美国食品药品监督管理局批准后,7 家中心对接受 EmboTrap II 治疗的患者进行前瞻性登记,记录患者基线特征、治疗细节以及临床/影像学随访情况。
70 例患者接受 EmboTrap II 治疗(平均年龄 69.9 岁,48.6%为女性)。34.3%的患者接受了静脉溶栓治疗,紧急大血管闭塞位于颈内动脉(ICA,18 例)、M1 段(38 例)、M2 或 M3 段(13 例)和基底动脉(1 例)。5×33mm 装置的使用率为 88%。95.7%(单纯使用 EmboTrap II 组为 82.3%)的患者达到 TICI≥2b 再通,首次通过效果为 35.7%。NIHSS 评分从术前平均 16.3 分改善至术后的 12.1 分和出院时的 10.5 分。平均每例患者治疗时进行 2.5(SD,1.8)次尝试,包括非 EmboTrap 尝试。9 例(12.9%)患者需要使用替代器械(抽吸或支架取栓器)进行确定性治疗。22.9%的患者出现某种程度的出血性转化,其中 4.3%为症状性。无器械相关并发症。
EmboTrap II 支架取栓器的初步上市后结果是有利的,与其他市售支架取栓器相当。与第一代 EmboTrap 相比,第二代 EmboTrap 的首次通过效果可能更高;然而,由于回顾性病例分析、临床随访不完整和样本量小,数据有限,需要进一步的试验。