Ntoulias Nikolaos, Brehm Alex, Miralbés Salvador, Naravetla Bharath, Spiotta Alejandro, Loehr Christian, Martínez-Galdámez Mario, McTaggart Ryan, Defreyne Luc, Vega Pedro, Zaidat Osama O, Price Lori Lyn, Liebeskind David S, Möhlenbruch Markus, Gupta Rishi, Psychogios Marios-Nikos
Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland.
Neuroradiology, Hospital Son Espases, Mallorca, Spain.
Clin Neuroradiol. 2025 Mar;35(1):51-57. doi: 10.1007/s00062-024-01450-y. Epub 2024 Aug 23.
The effect of endovascular therapy (EVT) on the outcome of stroke patients with a medium distal vessel occlusion (MDVO) is unclear. We report the results of MDVO patients treated with the 3 mm Trevo stent retriever (SR) and/or the AXS Catalyst 5 distal access catheter.
Data was derived from a prospective, multicenter global registry (ASSIST registry) which enrolled patients treated with operator preferred EVT technique at 71 sites from January 2019 to January 2022. Three techniques were assessed: SR classic, direct aspiration, and a combined approach. Additional inclusion criteria were (a) EVT performed with the 3 mm Trevo SR and/or AXS Catalyst 5 distal access catheter on the first pass and (b) an occlusion of the M2 segment or M3 segment of the middle cerebral artery or the A1, A2 or A3 segment of the anterior cerebral artery. The primary outcome was achieving an expanded Thrombolysis in Cerebral Infarction (eTICI) score of 2c or 3 on the first pass, with the primary technique as adjudicated by core lab. The primary clinical outcome measure was a 90-day modified Rankin Scale (mRS) score of 0-2.
A total of 155 patients (10.4% of the ASSIST population) were included. Most patients had an M2 occlusion (93.5%). First pass eTICI reperfusion was achieved in 43.1% of the patients. No modifying effect of the frontline technique was found. The rate of mRS 0-2 (overall 65.0%) did not significantly differ between groups.
The data suggests that the Trevo 3 mm SR and/or the AXS Catalyst 5 may be an option to treat medium distal vessel occlusion, but more data is needed to demonstrate safety and efficacy in this patient cohort. Further improvements are needed regarding materials and techniques to improve reperfusion results in this patient cohort in the future.
血管内治疗（EVT）对伴有中远端血管闭塞（MDVO）的中风患者预后的影响尚不清楚。我们报告了使用3毫米Trevo取栓支架（SR）和/或AXS Catalyst 5远端通路导管治疗MDVO患者的结果。
数据来自一项前瞻性、多中心全球注册研究（ASSIST注册研究），该研究纳入了2019年1月至2022年1月在71个地点接受术者首选EVT技术治疗的患者。评估了三种技术：经典SR、直接抽吸和联合方法。其他纳入标准为：（a）首次使用3毫米Trevo SR和/或AXS Catalyst 5远端通路导管进行EVT，（b）大脑中动脉M2段或M3段或大脑前动脉A1、A2或A3段闭塞。主要结局是首次通过时达到脑梗死扩展溶栓（eTICI）2c或3级评分，主要技术由核心实验室判定。主要临床结局指标是90天改良Rankin量表（mRS）评分为0 - 2分。
共纳入155例患者（占ASSIST研究人群的10.4%）。大多数患者为M2段闭塞（93.5%）。43.1%的患者首次通过时实现了eTICI再灌注。未发现一线技术的改良效果。mRS 0 - 2级的比例（总体为65.0%）在各组之间无显著差异。
数据表明，Trevo 3毫米SR和/或AXS Catalyst 5可能是治疗中远端血管闭塞的一种选择，但需要更多数据来证明该患者群体的安全性和有效性。未来需要在材料和技术方面进一步改进，以改善该患者群体的再灌注结果。
