You are here

  • Home
  • Online First
  • Impact of atherosclerotic etiology on technical and clinical outcomes of mechanical thrombectomy with a stent retriever: subanalysis of the Japan Trevo Registry

Article Text

Article menu
Download PDFPDF
Ischemic stroke
Original research
Impact of atherosclerotic etiology on technical and clinical outcomes of mechanical thrombectomy with a stent retriever: subanalysis of the Japan Trevo Registry
  1. Shuntaro Kuwahara1,
  2. Kazutaka Uchida1,
  3. Nobuyuki Sakai2,
  4. Hiroshi Yamagami3,
  5. Hirotoshi Imamura4,
  6. Masataka Takeuchi5,
  7. Manabu Shirakawa1,
  8. Fumihiro Sakakibara1,
  9. Koichi Haraguchi6,
  10. Naoto Kimura7,
  11. Kentaro Suzuki8,
  12. Shinichi Yoshimura1
  1. 1Neurosurgery, Hyogo Medical University, Nishinomiya, Hyogo, Japan
  2. 2Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
  3. 3Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Osaka, Japan
  4. 4Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
  5. 5Neurosurgery, Seisho Hospital, Odawara, Kanagawa, Japan
  6. 6Neurosurgery, Hakodate Shintoshi Hospital, Hakodate, Japan
  7. 7Neurosurgery, Iwate Prefectural Central Hospital, Morioka, Iwate, Japan
  8. 8Neurology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
  1. Correspondence to Dr Kazutaka Uchida, Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan; kuchidans{at}gmail.com

Abstract

Background The safety and effectiveness of stent retriever use for patients with acute large vessel occlusion (LVO) due to intracranial atherosclerotic disease (ICAD) is not well established. We investigated the differences in clinical outcomes in patients with and without ICAD.

Methods We analyzed the Japan Trevo Registry, a nationwide registry which enrolled patients with acute LVO who underwent endovascular therapy (EVT) using the Trevo retriever alone or in combination with an aspiration catheter. We compared the technical and clinical outcomes of EVT between the ICAD and No-ICAD groups. The primary outcome was effective reperfusion and the secondary outcome was modified Rankin scale (mRS) score 0–2 at 90 days. Safety outcomes were worsening of neurologic symptoms within 24 hours, any intracranial hemorrhage within 24 hours, vessel dissection/vessel perforation related to using the Trevo retriever and mortality at 90 days.

Results A total of 835 patients (45 in the ICAD group and 790 in the No-ICAD group) were analyzed. In the ICAD group, more men (68.9% vs 50.8%, P=0.02) and a lower median National Institutes of Health Stroke Scale score at admission (11 vs 18, P<0.0001) were observed. The primary outcome was significantly more common in the No-ICAD group (92.5%) than in the ICAD group (80.0%) (adjusted odds ratio (aOR) 0.21, 95% CI 0.09 to 0.50). The proportion of patients with mRS score 0–2 at 90 days was significantly lower in the ICAD group (44.4% vs 42.4%, aOR 0.49, 95% CI 0.23 to 1.00, P=0.0496). Other secondary and safety outcomes were not significantly different between the two groups.

Conclusions Patients with LVO with ICAD had a lower rate of effective reperfusion than those with No-ICAD.

  • Thrombectomy
  • Atherosclerosis

Data availability statement

Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. Not applicable.

https://doi.org/10.1136/jnis-2023-021192

Statistics from Altmetric.com

    Request Permissions

    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.

    Data availability statement

    Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. Not applicable.

    View Full Text

    Footnotes

    • Contributors KU had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: SK, KU and SY. Acquisition of data: SK, KU, HI, MT, MS, FS, KH, NK and KS. Statistical analysis: KU. Funding: S N. Administrative, technical, or material support: NS and HY. Study supervision: NS, HY, HI, MT, MS, FS, KH, NK and KS. KU is responsible for the overall content as guarantor.

    • Funding Clinical research was funded by Stryker Neurovascular. Although the funder was involved in the conception of the research design and data collection, the data analysis, interpretation, content of this manuscript, and decision to submit it for publication were made by the authors independently.

    • Competing interests SK has no conflicts of interest to report. KU reports lecturer’s fees from Daiichi Sankyo, Bristol-Myers Squibb, Stryker and Medtronic. NS reports a research grant from Biomedical Solutions, Medtronic, Terumo and TG Medical; lecturer’s fees from Asahi-Intec, Biomedical Solutions, Kaneka, Medtronic, and Terumo; membership of the advisory boards for Johnson & Johnson, Medtronic and Terumo. HY discloses research grants from Bristol-Myers Squibb; lecturer’s fees from Stryker, Medtronic, Terumo, Johnson & Johnson and Medico's Hirata. HI reports lecturer’s fees from Medtronic, Daiichi Sankyo, Johnson & Johnson, Stryker, Terumo and Asahi Intecc. MT reports lecturer’s fees from Stryker, Daiichi-Sankyo and Johnson & Johnson. MS reports lecturer’s fees from Stryker, Terumo, Johnson & Johnson and Medtronic. FS reports a manuscript fee from Medicus Shuppan. KH reports lecturer’s fees from Stryker, Medtronic, Kaneka, Asahi intec, Cerenovus and Daiichi Sankyo. NK reports lecturer’s fees from Stryker, Terumo, Medtronic, Kaneka, Asahi intec, Cerenovus, Daiichi Sankyo, Nipro, Siemens, Bayer, Nestle Japan, Lifeline and Pfizer. KS has no conflicts of interest to report. SY reports research grants from Medico’s Hirata, Medtronic, and Terumo; and lecturer fees from Medtronic, Kaneka, Stryker, Daiichi Sankyo, Bristol-Meyers Squibb, and Johnson & Johnson.

    • Provenance and peer review Not commissioned; externally peer reviewed.