Real-world stent retriever thrombectomy for acute ischemic stroke beyond 6 hours of onset: analysis of the NASA and TRACK registries

Mokin, Maxim; Aböu-Chebl, Alex; Castonguay, Alicia C.; Nogueira, Raul G; English, Joey; Farid, Hamed; Gupta, Rishi; Martin, Coleman; Holloway, W; Haussen, Diogo C; Mueller‐Kronast, Nils; Zaidat, Osama O.

doi:10.1136/neurintsurg-2018-014272

Cited by 45 publications

(41 citation statements)

References 12 publications

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“…The SICH rate in this study was 12% (95% CI 8% to 17%). This is similar to recent real world published rates of SICH in stent retriever registries47 but higher than that seen in the randomized trials, which was of the order of 0–8% 1–10. Many patients were treated with thrombolytics prior to stent deployment which may have increased the bleeding rate.…”

Section: Discussionsupporting

confidence: 88%

A systematic review and meta-analysis of observational evidence for the use of bailout self-expandable stents following failed anterior circulation stroke thrombectomy

Wareham

Flood

Phan³

et al. 2018

J NeuroIntervent Surg

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BackgroundThe crucial role of thrombectomy in the management of emergent large vessel occlusive stroke is not disputed but there is a technical failure rate in a significant minority of patients whose outcomes are often poor. Our objective was to perform a systematic review and meta-analysis to assess the safety and efficacy of permanent self-expandable stent deployment as a bailout procedure in cases of failed anterior circulation thrombectomy.MethodsTwo independent reviewers searched the Pubmed (Medline) database for studies reporting outcomes following failed endovascular thrombectomy with subsequent rescue therapy employing self-expandable stents.ResultsEight studies (one prospective, seven retrospective) originating from Europe, Asia, and America comprising 160 patients met the inclusion criteria. Estimated baseline National Institutes of Health Stroke Scale score was 17.1 (95% CI 15.7 to 18.4). Following failed thrombetcomy and stent deployment, the rate of favorable outcome (modified Rankin Scale score 0–2) was 43% (95% CI 34% to 53%). Pooled mortality was 21% (95% CI 13% to 33%). Successful recanalization (Thrombolysis in Cerebral Infarction (TICI) 2b–3 or Thrombolysis in Myocardial Infarction (TIMI) 2–3) was 71% (95% CI 63% to 77%). Symptomatic intracerebral hemorrhage was seen in 12% (95% CI 7% to 18%). The Solitaire stent (Medtronic) was the most commonly deployed stent following failed thrombectomy attempts (66%; 95% CI 31% to 89%). Pre- or post-stent angioplasty was performed in 39%of patients (95% CI 29% to 48%). Glycoprotein IIb/IIIa inhibitors were used in 89% (95% CI 71% to 97%). 95% of patients received postprocedural antiplatelet therapy.ConclusionA rescue stent procedure seems reasonable as a last resort following failed thrombectomy but currently the level of evidence is limited. Prospective registries may aid in guiding future recommendations.

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Section: Discussionsupporting

confidence: 88%

A systematic review and meta-analysis of observational evidence for the use of bailout self-expandable stents following failed anterior circulation stroke thrombectomy

Wareham

Flood

Phan³

et al. 2018

J NeuroIntervent Surg

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“…Using the mTICI 2c/3 definition of FPE, the rate of reperfusion with EmboTrap was 40%. Furthermore, in ARISE II, thrombectomy was limited to patients presenting with 8 h of symptom onset whereas in NASA and TRACK patients were treated within a longer time window, including wake-up strokes (8). The current and prior studies strongly advocated toward further innovation in thrombectomy devices, since more than half of patients treated with stent retrievers currently do not achieve FPE.…”

Section: Discussionmentioning

confidence: 99%

First Pass Effect in Patients Treated With the Trevo Stent-Retriever: A TRACK Registry Study Analysis

et al. 2020

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Results: The rate of FPE in TRACK was 23% (140/609). There was no association between patient demographics and FPE, including age (p = 0.36), sex (p = 0.50), race (p = 0.50), location of occlusion (p = 0.26), baseline NIHSS (p = 0.62), or past medical history. There was no difference in the use of a balloon-guide catheter or general anesthesia (49 and 57% with FPE vs. 47 and 64%, p = 0.63 and p = 0.14, respectively). Clinical outcomes were significantly associated with FPE; 63 vs. 44% in non-FPE patients achieved mRS 0-2 at 90 days (p = 0.0004). Conclusion: Our study showed that achieving complete recanalization with a single thrombectomy pass using the Trevo device was highly beneficial. The most common clinical factors that are used to determine eligibility for endovascular therapy, such as NIHSS severity, location of occlusion or patient age were not predictive of the ability to achieve FPE.

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“…Both registries showed rates of clinical outcomes comparable to the major RCTs (48% and 42% rates of good clinical outcome in TRACK and NASA, respectively). Combined, 33% of patients from both registries were treated with thrombectomy beyond the first 6 hours, and the safety and efficacy of this treatment was equal to that of treatment performed within 0–6 hours 20. No specific imaging criteria or modalities were required in TRACK and NASA; imaging-based patient selection was left to the discretion of each participating site.…”

Section: Indications For Thrombectomymentioning

confidence: 99%

Indications for thrombectomy in acute ischemic stroke from emergent large vessel occlusion (ELVO): report of the SNIS Standards and Guidelines Committee

Mokin

Ansari

McTaggart

et al. 2019

J NeuroIntervent Surg

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146

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Real-world stent retriever thrombectomy for acute ischemic stroke beyond 6 hours of onset: analysis of the NASA and TRACK registries

Abstract: Real-world experience with patients with anterior circulation AIS treated with the Solitaire and Trevo thrombectomy devices beyond the first 6 hours of symptom onset proved to be equally safe and effective as for patients with symptom onset within the first 6 hours.

Cited by 45 publications

References 12 publications

A systematic review and meta-analysis of observational evidence for the use of bailout self-expandable stents following failed anterior circulation stroke thrombectomy

A systematic review and meta-analysis of observational evidence for the use of bailout self-expandable stents following failed anterior circulation stroke thrombectomy

First Pass Effect in Patients Treated With the Trevo Stent-Retriever: A TRACK Registry Study Analysis

Indications for thrombectomy in acute ischemic stroke from emergent large vessel occlusion (ELVO): report of the SNIS Standards and Guidelines Committee

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