Osama O. Zaidat1,2, Alicia C. Castonguay3,1, Diogo C Haussen4,5, Joey English6,7, H Farid8,9, Erol Veznedaroglu10,11, Mandy J. Binning10,12, Ajit S Puri13,14, S Hou15,16, Vallabh Janardhan17,18, N Vora19,20, R Budzik21,20, Amer Alshekhlee22,23, Michael Abraham24,25, Randall C. Edgell26,27, Asif Taqi28,29, Eugene Lin30,31, Ramy El Khoury32,33, Maxim Mokin34,35, Aniel Majjhoo36,37, M Kabbani38,39, M.T. Froehler40,41, Ira J. Finch42,43, Shyam Prabhakaran44,45, Robin Novakovic46,47, Truc My Nguyen48,49, Sumeru Mehta50,27, Syed A. Quadri51,29, Pankajavalli Ramakrishnan5,52, Raul G Nogueira5,53
1Med College of Wisconsin, Milwaukee, WI
2O O Zaidat
3A Castonguay
4D Haussen
5Emory, Atlanta, GA
6California Pacific Med Cntr, SF, CA
7J English
8H Farid
9St Jude Med, Chicago, IL
10Capital Health, Pennington, NJ
11E Veznedaroglu
12M Binning
13A S Puri
14U Mass, Boston, MA
15S Y Hou
16U Mass, Boston, NJ
17Texas Stroke Institute, Dallas, TX
18V Janardhan
19N Vora
20Riverside Radiology, Columbus, OH
21R F Budzik
22A Alshekhlee
23SSM Neuroscience Institute, St Louis, MO
24M G Abraham
25Univ of Kansas, Kansas, KS
26R Edgell
27St Louis Univ, St Louis, MO
28A Taqi
29SNC, LA, CA
30E Lin
31St Vincent Mercy Hosp, Toledo, OH
32R Khoury
33Tulane Univ, New Orleans, LA
34M Mokin
35Univ of S Florida, Tampa, FL
36A Q Majjhoo
37Wayne State, Detroit, MI
38Gunderson, La Cross, WI
39M R Kabbani
40M T Froehler
41Vanderbilt, Nashville, TN
42I Finch
43John Muir Med Cntr, Walnut Creek, CA
44Northwestern, Chicago, IL
45S Prabhakaran
46R Novakovic
47UT Southwestern, Dallas, TX
48Boston Med Cntr, Boston, MA
49T Nguyen
50S Mehta
51S A Quadri
52P Ramakrishnan
53R G Nogueira
Tóm tắt
Background and Purpose:
Recent randomized clinical trial (RCTs) demonstrated efficacy of mechanical thrombectomy using stent-retrievers in acute ischemic stroke (AIS) patients. The main purpose of TRevo ACute Ischemic StroKe (TRACK) stent-retriever thrombectomy multicenter registry is to demonstrate safety and efficacy in real life clinical practice.
Methods:
The investigator-initiated TRACK multicenter registry recruited 24 sites in north America to submit demographic, clinical, site-adjudicated angiographic, and outcome data on consecutive AIS patients treated with Trevo stent-retriever device as the first treatment option. Standard clinical safety (symptomatic intracranial hemorrhage (sICH), and mortality) and efficacy (revascularization and disability) outcomes and predictors of clinical outcome were analyzed.
Results:
624 patients were enrolled in the TRACK registry. Median age was 68 years (range 16-94, 118 (18.1%) >80), male gender was 51.4%, and 67.7% were white. The median National Institutes of Health Stroke Severity Scale (NIHSS) was 17 (IQR 13-22). Transfer cases were 50.6% with IV-rtPA use in 318 cases (51.3%). Median onset to groin puncture (OTG) time was 283 min (IQR 198.5-443), and groin puncture to revascularization was 66 min (IQR 37.5-103). Anterior circulation occlusion was 86.2% (MCA/M2 in 55.2% followed by ICA in 15.9% and M2 in 12.7%). Use of GA was in 389 cases (62.3%), number of passes were ≤ 3 in 92% of the cases (1: 45.2%, 2:28%, and 3:18.7%), 291 (46.7%) had BGC use. Rescue use was seen in 21.7%. Revascularization of ≥ TIMI 2 was 81.8% and ≥ TICI 2b was 70%. The primary outcome of mRS of ≥ 2 was 48.3% in the full cohort, and 50.6% in TREVO-2 like group. sICH and mortality were 7.2%, and 20.1% in the full cohort vs 6.9% and 17.5% in the TREVO-2 like group, respectively. The independent predictors of clinical outcome were lower baseline NIHSS, younger age, use of BGC, successful recanalization, and no general anesthesia (GA).
Conclusions:
The real life clinical practice Trevo registry demonstrated good clinical outcome and high rate of recanalization. Younger age, lower baseline NIHSS, use of balloon guide catheter, successful recanalization, and avoiding endotrachaeal GA independent predictors of good clinical outcome.
