Association of first-line thrombectomy technique and outcome in late-window large vessel occlusion strokes: A post hoc analysis of the MR CLEAN-LATE trial

Robrecht Rmm Knapen; Susanne Gh Olthuis; Adriaan Cgm van Es; Bart J Emmer; Wouter J Schonewille; Christiaan van der Leij; Wim H van Zwam; Robert J van Oostenbrugge

doi:10.1177/17474930241268303

Association of first-line thrombectomy technique and outcome in late-window large vessel occlusion strokes: A post hoc analysis of the MR CLEAN-LATE trial

Int J Stroke. 2024 Dec;19(10):1113-1122. doi: 10.1177/17474930241268303. Epub 2024 Jul 31.

Authors

Robrecht Rmm Knapen¹, Susanne Gh Olthuis², Adriaan Cgm van Es³, Bart J Emmer⁴, Wouter J Schonewille⁵, Christiaan van der Leij⁶, Wim H van Zwam¹, Robert J van Oostenbrugge²

Affiliations

¹ Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+ and School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands.
² Department of Neurology, Maastricht University Medical Center+ and School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands.
³ Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
⁴ Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands.
⁵ Department of Neurology, St. Antonius Nieuwegein, Nieuwegein, The Netherlands.
⁶ Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.

Abstract

Background: This study aimed to compare direct aspiration, stent retriever, and the combined thrombectomy technique on clinical, safety, and technical outcomes in late-window stroke patients included in the MR CLEAN-LATE trial.

Methods: This post hoc analysis of the MR CLEAN-LATE trial included patients treated with direct aspiration, stent retriever, or combined thrombectomy technique as first-line approach. Primary outcome was the modified Rankin Scale (mRS) score at 90 days follow-up, and compared between the three groups with ordinal logistic regression analysis. Secondary outcomes included mortality at 90 days, total technique switches, procedure time, recanalization rate measured with the expanded thrombolysis in cerebral infarction (eTICI) score, and symptomatic intracranial hemorrhage (sICH). Predefined variables were used for adjustments.

Results: In the MR CLEAN-LATE trial, 258 patients underwent endovascular treatment and 232 were included in our analyses. The mRS at 90 days did not differ (stent retriever vs. direct aspiration: adjusted common odds ratio (acOR) = 1.35, 95% confidence interval (CI) = 0.73 to 2.50; stent retriever vs. combined: acOR = 1.13, 95% CI = 0.64 to 2.00; direct aspiration vs. combined: acOR = 1.19, 95% CI = 0.64 to 2.21). Direct aspiration thrombectomy was accompanied with more switches to another technique compared to the stent retriever (adjusted odds ratio (aOR) = 6.50, 95% CI = 2.52 to 16.8) or combined group (aOR = 4.67, 95% CI = 1.80 to 12.1) and with higher sICH rates compared to the combined technique (13% vs. 2.5%; aOR = 8.19, 95% CI = 1.49 to 45.1). Mortality, procedure time, and eTICI did not differ.

Conclusion: Stent retriever, direct aspiration, or the combined thrombectomy technique as first-line approach showed no differences in clinical outcome in late-window stroke patients. Direct aspiration was accompanied with higher sICH rates and more switcher to another technique compared to the combined group.

Keywords: Stroke; first-line technique; intra-arterial thrombectomy; late-window.

Publication types

Randomized Controlled Trial

MeSH terms

Aged
Endovascular Procedures* / methods
Female
Humans
Male
Middle Aged
Stents
Stroke / surgery
Thrombectomy* / methods
Treatment Outcome