Background With the presentation of the MR CLEAN, EXTEND IA, ESCAPE and SWIFT PRIME trials at ISC 2015, treatment of proximal large vessel occlusion with stent retrievers within of 6–12 hrs of stroke onset has become standard of care. The results of these trials greatly depended on their efficient triage and safe technique and there is only limited data on how these results may be replicated in the community.
Method STRATIS is the first prospective registry to track patients treated with a Solitaire™ stent retriever as first modality. The registry has three unique design aspects that distinguish it from other studies. The registry has independent core lab validation of imaging outcomes, and as a first, documents the impact of 6 forms of interventional techniques as well as type of anesthesia on the 90 day outcome. Moreover, the potential for large cohort of physiological perfusion images use for triage will be available from STRATIS Registry. Furthermore, it tracks the well-needed system of care data including transfer distances, referral patterns, times and location of stroke onset to ultimate interventional treatment. STRATIS will be the largest registry to date with this level of granular detail with intent to enroll 1000 patients within 8 hrs from onset to groin puncture in 60 sites, 27 of which will be former SWIFT PRIME sites.
Results 124 subjects have been enrolled at 23 centers, with a mean age of 68.4 (19, 100) and median baseline NIHSS 16.6 (8, 30). 54% received IV tPA at a mean time of 119 min from onset. Mean onset to groin time was 266 mins. Distribution of occlusions with 16% combined extra- and intra-cranial ICA, 63% M1 and 18% M2 emboli was similar to the SWIFT PRIME. 50% underwent advanced imaging with CTP. Site-reported successful reperfusion (mTICI 2b-3) was achieved in 81.4%. sICH occurred in only 0.8% (1/124) of patients.
Conclusion In a limited cohort that is similar to the population as descried in the published trials, STRATIS is documenting achievement of equivalent reperfusion and safety endpoints. However, despite similar onset to IV tPA time, onset to groin puncture time was significantly longer in the community setting. The detailed system of care analysis of STRATIS should allow sites to identify gaps to improve triage strategies. The detailed procedural documentation should, for the first time, be able to delineate the impact of anesthesia and different interventional techniques on patient outcomes.
Disclosures N. Mueller-Kronast: 2; C; Covidien Neurovascular. A. Aziz-Sultan: 2; C; Covidien Neurovascular. R. Jahan: 2; C; Covidien Neurovascular. R. Klucznik: 2; C; Covidien Neurovascular. O. Zaidat: 2; C; Covidien Neurovascular.
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