Knapen Robrecht R M M, Goldhoorn Robert-Jan B, Vos Jan Albert, Emmer Bart J, Uyttenboogaart Maarten, Hofmeijer Jeannette, Schonewille Wouter J, Majoie Charles B, Roos Yvo B W E M, van der Lugt Aad, van Dippel Diederik W J, Lingsma Hester F, van der Leij Christiaan, van Oostenbrugge Robert J, van Zwam Wim H
Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
School for Cardiovascular Diseases Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
Cardiovasc Intervent Radiol. 2025 Jun 9. doi: 10.1007/s00270-025-04048-0.
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.
对于因大血管闭塞导致的急性缺血性卒中患者，使用取栓支架进行血管内治疗（EVT）已知是有效且安全的。我们旨在比较在全国范围内接受EVT治疗的卒中患者登记处（MR CLEAN登记处）中最常用的取栓支架。
纳入在MR CLEAN登记处中因大血管闭塞导致缺血性卒中且以取栓支架血栓切除术（每种取栓支架至少进行100例EVT）作为一线技术进行治疗的患者。主要结局是90天随访时的改良Rankin量表（mRS）评分。次要结局包括再灌注（扩展的脑梗死治疗 [eTICI]）、90天死亡率、有症状的颅内出血、EVT后24至48小时的美国国立卫生研究院卒中量表（NIHSS）评分以及手术时间。通过多变量回归分析，我们计算优势比（OR）和β估计值，以比较最常用的取栓支架之间的结局，并对预定义变量进行调整。一项亚组分析聚焦于取栓支架对M1段闭塞患者结局的影响。
Trevo（史赛克公司）是最常用的取栓支架（n = 1541，占70%）。其他类型包括Solitaire（n = 301，占14%）（美敦力公司）、Embotrap（n = 255，占11%）（Cerenovus公司；强生公司）和Revive（n = 103，占5.2%）（Cerenovus公司；强生公司）。与Trevo取栓支架相比，Solitaire的90天mRS评分略高但具有统计学意义（调整后的共同 [ac]OR：0.75，95%CI：0.57 - 0.99），死亡率更高（aOR：1.77，95%CI：1.16 - 2.68），Revive支架的手术时间更长（平均：67.6分钟对58.9分钟；调整后的β估计值：11.6，95%CI：2.69 - 20.6）。在M1亚组分析中没有结局差异。
Trevo、Solitaire、Embotrap和Revive取栓支架在EVT后的临床、技术和安全结局方面存在差异——尽管具有统计学意义，但差异较小。治疗医生应使用他们熟悉的取栓支架，并且应该进行更严格患者选择的进一步研究以验证这些结果。
