Background and purpose Given the promising performance of the new Embolus Retriever with Interlinked Cages (ERIC) in smaller case series, we sought to assess the efficacy and safety of mechanical thrombectomy (MT) with ERIC compared with other stent retrievers (SRs) in acute ischemic stroke due to large vessel occlusion (LVO).
Methods We reviewed the databases of two comprehensive stroke centers in in Germany and Switzerland for MT due to LVO in the anterior circulation with either ERIC or another SR as a first device. Co-primary outcome was defined as successful recanalization (Thrombolysis in Cerebral Infarction 2b/3) after the first device and favorable outcome (modified Rankin Scale score 0–2) at 90 days' follow-up. Multiple logistic regression analysis was applied to adjust for potential confounders.
Results 183 consecutive patients with stroke were treated with either ERIC (49%) or a SR (51%) as the first device and successful recanalization was seen in 82% and 57%, respectively (P<0.001). Adding SR to futile ERIC recanalization or vice versa increased final recanalization rates (ERIC: 87%, SR: 79%). The use of ERIC as a first device resulted in favorable clinical outcome in 50% compared with 35% when a SR was used (P=0.038), an effect driven by age, stroke severity, presence of carotid-T-occlusion, and general anesthesia and not by the device deployed.
Conclusion The use of ERIC as a first device appeared to be associated with higher rates of successful recanalization and resulted in better functional outcome. However, favorable outcome was not attributable to ERIC. Most importantly, both device types complemented one another and improved final recanalization rates when used successively.
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LR and TK contributed equally.
Contributors PG, LR and TK: substantial contributions to the conception or design of the work or the acquisition, analysis or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SZ, CG-E, JB, JA, MD, KN, FF, and JF: the acquisition, analysis or interpretation of data for the work; revising it critically for important intellectual content; final approval of the version to be published and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests JF receives research support from the German Ministry of Science and Education (BMBF), German Ministry of Economy and Innovation (BMWi), German Research Foundation (DFG), European Union (EU), Hamburgische Investitions- und Förderbank (IFB), Medtronic, Microvention, Philips, Stryker. He is a consultant for Acandis, Cerenovus, Covidien, Medtronic, Microvention, Penumbra, Route92 and Stryker.
Ethics approval Ethikkommission Nordwest- und Zentralschweiz.
Provenance and peer review Not commissioned; externally peer reviewed.