Introduction/purpose Higher rates of successful revascularization with the least number of passes correlate with improved clinical outcomes in acute stroke endovascular treatment. Different adjunctive technical approaches such as proximal flow arrest using balloon guide catheter (BGC), large bore conventional guide catheter (CGC), or distal large bore catheter (DLBC) with lesional or regional aspiration, are aimed at improving revascularization rates. We present an interim analysis of adjunctive techniques and angiographic outcomes from the STRATIS Registry.
Materials and methods The STRATIS registry is a prospective, multicenter study of patients with large vessel occlusion (LVO) treated with the Solitaire Stentriever ≤8 hours of symptoms onset. Technical approaches were grouped based on the first technique implemented: BGC; CGC; and DLBC. Posterior circulation target vessel occlusion and subjects with combined BGC and DLBC approach were excluded. A Core Lab extrapolated the techniques from the procedural reports. Baseline variables were compared between the three groups. The main angiographic and technical outcomes were: 1) First pass effect (FPE) defined as successful recanalization of ≥TICI2b, 2) True FPE defined as TICI 3 after first pass with Solitaire; 3) Number of passes among the cohorts.
Results 413 anterior circulation subjects were included in this interim analysis. The initial technical approach was 60% BGC, 30% DLBC, and 10% CGC. The groups were well balanced in reference to baseline and demographic factors. The rates of FPE were: 62%, 51%, and 45% (P = 0.0336), while the true FPE rates were: 44% vs. 37% vs. 28% (P = 0.0996) with BGC, DLBC, and CGC, respectively. The mean number of passes were: 1.7 ± 1.09, 2.1 ± 1.42, and 2.2 ± 1.76 (P = 0.0085), with BGC, DLBC, and CGC, respectively. The rates of successful recanalization of ≥TICI2b after all passes were 91.9% BGC, 88.8% DLBC, and 87.5% CGC (P = 0.4945).
Conclusion The STRATIS registry interim analysis demonstrated a higher use of BGC as first approach (60%) compared to previous reports. Consistent with published data, BGC is associated with higher rates of successful revascularization and a trend toward higher rates of complete revascularization from the first pass. Moreover, a lower number of passes is associated with BGC use compared to CGC and DLBC. DLBC with lesional and regional aspiration appears to be superior to CGC only. These results are preliminary, and further analysis with final planned sample size and correlation with central blinded core lab imaging data will provide further evidence on technical and angiographic outcomes with different adjunctive approaches.
Disclosures O. Zaidat: 2; C; Medtronic Neurovascular. D. Liebeskind: 1; C; NIH-NINDS. 2; C; Medtronic Neurovascular, Stryker. R. Jahan: 1; C; Medtronic Neurovascular. 2; C; Medtronic Neurovascular. M. Froehler: 2; C; Medtronic Neurovascular. 6; C; Site PI (Large, Liberty, SCENT, Feat, Barrel, Atlas, Rhapsody, Positive, Sep 3D) payment to institution. M. Aziz-Sultan: 2; C; Medtronic Neurovascular. 6; C; Expert Witness - BMC. R. Klucznik: 3; C; Medtronic Neurovascular. J. Saver: 2; C; Medtronic Neurovascular, Stryker, Neuravia, Cognition Medical, Boehringer Ingelheim (prevention only). D. Yavagal: 2; C; Medtronic Neurovascular. 6; C; ESCAPE trial DSCMB member. N. Mueller-Kronast: 2; C; Medtronic Neurovascular.
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work noncommercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.