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E-055 analysis of a mr clean-like group in the multicenter track registry
  1. A Castonguay1,
  2. O Zaidat1,
  3. R Nogueira2,
  4. P Ramakrishnan3,
  5. D Haussen2,
  6. A Lima2,
  7. J English4,
  8. H Farid5,
  9. E Veznedaroglu6,
  10. M Binning6,
  11. A Puri7,
  12. S Hou7,
  13. V Janardhan8,
  14. N Vora9,
  15. R Budzik9,
  16. A Alshekhlee10,
  17. M Abraham11,
  18. R Edgell12,
  19. M Taqi13,
  20. E Lin14,
  21. R Khoury15,
  22. M Mokin16,
  23. A Majjhoo17,
  24. M Kabbani18,
  25. M Froehler19,
  26. I Finch20,
  27. S Prabhakaran21,
  28. R Novakovic22,
  29. T Nguyen23
  1. 1Medical College of Wisconsin, Milwaukee, WI, USA
  2. 2Emory University School of Medicine, Atlanta, GA, USA
  3. 3Emory Univeristy School of Medicine, Atlanta, GA, USA
  4. 4California Pacific Medical Center, San Francisco, CA, USA
  5. 5St. Jude Medical Center, Chicago, IL, USA
  6. 6Capital Health Institute for Neurosciences, Pennington, NJ, USA
  7. 7University of Massachusetts Medical School, Worcester, MA, USA
  8. 8Texas Stroke Institute, Plano, TX
  9. 9Riverside Radiology, Columbus, OH, USA
  10. 10SSM Neuroscience Institutes, DePaul Health, St. Louis, MO, USA
  11. 11University of Kansas, Kansas City, KS, USA
  12. 12St. Louis University Hospital, St. Louis, MO, USA
  13. 13Desert Regional Medical Center, Palm Springs, CA, USA
  14. 14Baptist Cardiac and Vascular Institute, Miami, FL, USA
  15. 15Tulane Univeristy School of Medicine, New Orleans, LA, USA
  16. 16University of South Florida, Tampa, FL, USA
  17. 17Wayne State University School of Medicine, Detroit, MI, USA
  18. 18Gundersen Lutheran Medical Foundation, Inc., La Crosse, WI, USA
  19. 19Vanderbilt University Medical Center, Nashville, TN, USA
  20. 20John Muir Medical Center, Walnut Creek, CA, USA
  21. 21Northwestern University, Evanston, IL, USA
  22. 22University of Texas Southwestern Medical Center, Dallas, TX, USA
  23. 23Boston Medical Center, Boston, MA, USA

Abstract

Background The MR CLEAN multicenter randomized clinical trial demonstrated the safety and effectiveness of intra-arterial treatment within 6 h after stroke onset in patients with acute ischemic stroke (AIS) caused by proximal intracranial occlusion in the anterior circulation.

Objective To present the clinical and angiographic outcomes of a MR CLEAN-like population within the real-world multicenter TREVO Stent-Retriever Acute Stroke (TRACK) Post-marketing Registry and assess its performance relative to the MR CLEAN population.

Design/methods The investigator-initiated TRACK Registry recruited sites within North America to submit retrospective data on consecutive patients treated with the TREVO device. A TRACK sub-cohort matched to the MR CLEAN interventional population (based on the following criteria: anterior circulation occlusion, time of onset to groin puncture ≤6 hrs, NIHSS ≥2) was identified (TRACK-MRCL) and compared to the MR CLEAN interventional and control (MRC-I, MRI-C) group of 233 and 267 patients, respectively. The groups were evaluated for differences in the clinical (mRS at 3 months, mortality, and sICH) and angiographic outcomes (TICI revascularization grades).

Results 409 patients underwent treatment using the TREVO device in 18 centers. Of those patients, 250 patients were included in the TRACK-MRCL group. Demographics of the TRACK-MRCL, MRC-I, and MRC-C groups (respectively): median age (IQR) 69 (55–78) versus 65.8 (54.5–76.0), and 65.7 (55.5–76.4); median NIHSS (IQR) 18 (14–22) versus 17 (14–21), and 18 (14–22); male 49.2% vs. 57.9%, and 58.8%, p = 0.12; ICA occlusion 20.4% vs. 25.3%, and 28.2%, p = 0.19; M1 occlusion 59.2% vs. 66.1%, and 62%, p = 0.13; IV-tPA use 67.2% vs. 87.1%, 90.6%, p = 0.0001; general anesthesia use 65.5% vs. 37.5%, p = 0.0001; median time of onset to groin puncture (min) (IQR) 215 (169.8–268.5) versus 260 (210–313). TICI ≥ 2a and TICI ≥ 2b revascularization rates were 92.8% vs. 80.6% (p = 0.0002) and 83.6% vs. 58.7% (p = 0.0001) in the TRACK-MRCL and MRC-I groups, respectively. sICH was noted in 8.5% of TRACK-MRCL patients compared to 7.7% and 6.4% in the MRC-I and

MRC-C groups, respectively (p = 0.87). In TRACK-MRCL patients with available 90-day outcomes, 47.3% (113/239) had achieved a good clinical outcome (mRS 0–2) versus 32.6% (76/233) and 13.1% (35/267) in the MRC-I and MRC-C groups, respectively (p = 0.0014). Mortality was 14.2% (34/239) in the TRACK-MRCL cohort versus 9.0% (21/233) and 8.2% (22/267) in the MRC-I and MRC-C groups, respectively (p = 0.09).

Conclusion Although not directly comparable, this sub-analysis of a real-world TREVO stent-retriever registry patient matched to MR CLEAN population demonstrated consistent higher rates of good clinical and revascularization outcomes than the MR CLEAN control group.

Disclosures A. Castonguay: None. O. Zaidat: None. R. Nogueira: None. P. Ramakrishnan: None. D. Haussen: None. A. Lima: None. J. English: None. H. Farid: None. E. Veznedaroglu: None. M. Binning: None. A. Puri: None. S. Hou: None. V. Janardhan: None. N. Vora: None. R. Budzik: None. A. Alshekhlee: None. M. Abraham: None. R. Edgell: None. M. Taqi: None. E. Lin: None. R. Khoury: None. M. Mokin: None. A. Majjhoo: None. M. Kabbani: None. M. Froehler: None. I. Finch: None. S. Prabhakaran: None. R. Novakovic: None. T. Nguyen: None.

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