EndoVAscular treatment and ThRombolysis for Ischemic Stroke Patients (EVA-TRISP) registry: basis and methodology of a pan-European prospective ischaemic stroke revascularisation treatment registry.

PURPOSE The Thrombolysis in Ischemic Stroke Patients (TRISP) collaboration was a concerted effort initiated in 2010 with the purpose to address relevant research questions about the effectiveness and safety of intravenous thrombolysis (IVT). The collaboration also aims to prospectively collect data on patients undergoing endovascular treatment (EVT) and hence the name of the collaboration was changed from TRISP to EVA-TRISP. The methodology of the former TRISP registry for patients treated with IVT has already been published. This paper focuses on describing the EVT part of the registry. PARTICIPANTS All centres committed to collecting predefined variables on consecutive patients prospectively. We aim for accuracy and completeness of the data and to adapt local databases to investigate novel research questions. Herein, we introduce the methodology of a recently constructed academic investigator-initiated open collaboration EVT registry built as an extension of an existing IVT registry in patients with acute ischaemic stroke (AIS). FINDINGS TO DATE Currently, the EVA-TRISP network includes 20 stroke centres with considerable expertise in EVT and maintenance of high-quality hospital-based registries. Following several successful randomised controlled trials (RCTs), many important clinical questions remain unanswered in the (EVT) field and some of them will unlikely be investigated in future RCTs. Prospective registries with high-quality data on EVT-treated patients may help answering some of these unanswered issues, especially on safety and efficacy of EVT in specific patient subgroups. FUTURE PLANS This collaborative effort aims at addressing clinically important questions on safety and efficacy of EVT in conditions not covered by RCTs. The TRISP registry generated substantial novel data supporting stroke physicians in their daily decision making considering IVT candidate patients. While providing observational data on EVT in daily clinical practice, our future findings may likewise be hypothesis generating for future research as well as for quality improvement (on EVT). The collaboration welcomes participation of further centres willing to fulfill the commitment and the outlined requirements

E-064 Differential response of atrial fibrillation associated stroke with thrombolysis and mechanical thrombectomy

IntroductionAtrial fibrillation (AF) associated stroke is associated with worse functional outcomes, less effective recanalization, and increased rates of hemorrhagic complications after intravenous thrombolysis (IVT). It remains unclear whether recanalization efficacy, procedural speed, and hemorrhagic complications differ in AF associated stroke treated with mechanical thrombectomy (MT).MethodsIn a retrospective multicenter study of 4,232 patients who underwent MT, 3,385 patients had anterior circulation large vessel occlusions (LVO). 1,210 (35.7%) patients had comorbid AF, diagnosed either before or on presentation. Baseline characteristics, procedural outcomes, and clinical outcomes were reported and compared.ResultsAF was associated with faster procedural time (51.5 vs. 58.2 minutes, p=0.007), higher rates of first pass success (42% vs. 35%, p=0.001), and comparable angiographic outcomes. In multivariate analysis, AF was an independent predictor of both procedural speed and first pass success. AF patients had worse functional outcomes, attributable to increased age and stroke severity at presentation. In contrast to IVT associated sICH in AF patients, there was no additive risk of sICH after MT (aOR 0.95, 0.65–1.38, p=0.791). When patients who received IVT-MT were dichotomized by reperfusion status, only patients with poor reperfusion trended towards increased rates of sICH (aOR=2.69, 0.96 – 7.53, p=0.06).ConclusionsMT in AF patients is associated with increased rates of rapid reperfusion without added risk of sICH when reperfusion is achieved. Even when combined with IVT, MT in AF patients does not carry an added risk of sICH if successful recanalization is achieved. Given the historically low recanalization efficacy of IVT for AF associated stroke, it is unclear whether IVT is additive in the setting of AF associated LVO undergoing MT, particularly given the trend towards increased sICH if combined IVT-MT therapy ends with poor reperfusion. Randomized studies are warranted to evaluate whether AF patients with acute LVO may represent a subgroup of patients who may benefit from MT alone versus combined IVT-MT in thrombectomy capable centers.Disclosures F. Akbik: None. A. Alawieh: None. C. Cawley: None. B. Howard: None. F. Tong: None. F. Nahab: None. O. Samuels: None. I. Maier: None. W. Feng: None. N. Goyal: None. R. Starke: None. A. Rai: None. K. Fargen: None. M. Anadani: None. M. Psychogios: None. R. De Leacy: None. S. Keyrouz: None. T. Dumont: None. P. Kan: None. J. Lena: None. J. Liman: None. A. Arthur: None. L. Elijovich: None. D. Mccarthy: None. V. Saini: None. S. Wolfe: None. J. Mocco: None. J. T Fifi: None. F. Nascimento: None. J. Giles: None. R. Crosa: None. W. Fox: None. B. Gory: None. A. Spiotta: None. J. Grossberg: None

Importance of First Pass Reperfusion in Endovascular Stroke Care ‐ Insights From Thrombectomy and Aneurysm Registry (STAR)

Background Mechanical thrombectomy has become the first‐line treatment strategy for patients with large‐vessel occlusion strokes. Often >1 thrombectomy maneuver is necessary to achieve reperfusion. A first‐pass (FP) effect with improved functional outcomes after mechanical thrombectomy has been described. Aim of the present study is to investigate the FP effect in a large, international, multicenter stroke database. Methods Patients who underwent mechanical thrombectomy for large‐vessel occlusion stroke in the anterior cerebral circulation between January 2014 and January 2021 and achieved complete reperfusion were identified from the STAR (Stroke Thrombectomy and Aneurysm Registry). We compared functional outcomes of patients with FP (defined as modified treatment in cerebral ischemia score 3 after a single thrombectomy maneuver) versus multiple‐pass complete reperfusion (defined as modified treatment in cerebral ischemia 3 after ≥1 thrombectomy maneuver). Results A total of 1481 patients with anterior circulation large‐vessel occlusion stroke and successful recanalization were included in the analysis. FP complete recanalization was achieved in 778 patients versus 703 patients with multiple‐pass complete reperfusion. Patients with FP complete recanalization had higher Alberta Stroke Programme Early CT [Computed Tomography] Score at baseline (9 [7–10] versus 8 [7–10]; P=0.002), were less likely to be men (47% versus 51%; P=0.078) and to have intracranial internal carotid artery occlusions (14% versus 27%), as well as more likely to have M1/M2 occlusions (86% versus 73%; P<0.001), diabetes (28% versus 24%; P=0.076), and atrial fibrillation (37% versus 32%; P=0.064). FP complete recanalization (odds ratio [OR], 1.49; P=0.026), lower age (OR, 0.966; P<0.010), lower prestroke modified Rankin scale score (OR, 0.601; P<0.001), diabetes (OR, 0.612; P=0.014), and higher Alberta Stroke Programme Early CT Score (OR, 1.183; P<0.001) were independent predictors of favorable functional outcome (defined as modified Rankin scale score ≤2). In a subgroup analysis, the effect of FP complete reperfusion on favorable outcome was only detectable in patients with M1 occlusions (OR, 1.667; P=0.045). Predictors for FP reperfusion success were lower National Institutes of Health Stroke Scale score at baseline (OR, 0.980; P=0.020) and M1 occlusions (OR, 1.990; P<0.001). Conclusions This analysis of a large, multicenter stroke database confirms the importance of FP reperfusion in endovascular stroke care

Thrombectomy Technique Predicts Outcome in Posterior Circulation Stroke—Insights from the STAR Collaboration

International audienceAbstract BACKGROUND Randomized controlled trials evaluating mechanical thrombectomy (MT) for acute ischemic stroke predominantly studied anterior circulation patients. Both procedural and clinical predictors of outcome in posterior circulation patients have not been evaluated in large cohort studies. OBJECTIVE To investigate technical and clinical predictors of functional independence after posterior circulation MT while comparing different frontline thrombectomy techniques. METHODS In a retrospective multicenter international study of 3045 patients undergoing MT for stroke between 06/2014 and 12/2018, 345 patients had posterior circulation strokes. MT was performed using aspiration, stent retriever, or combined approach. Functional outcomes were assessed using the 90-d modified Rankin score dichotomized into good (0-2) and poor outcomes (3-6). RESULTS We included 2700 patients with anterior circulation and 345 patients with posterior circulation strokes. Posterior patients (age: 60 ± 14, 46% females) presented with mainly basilar occlusion (80%) and were treated using contact aspiration or ADAPT (39%), stent retriever (31%) or combined approach (19%). Compared to anterior strokes, posterior strokes had delayed treatment (500 vs 340 min, P &lt; .001), higher national institute of health stroke scale (NIHSS) (17.1 vs 15.7, P &lt; .01) and lower rates of good outcomes (31% vs 43%, P &lt; .01). In posterior MT, diabetes (OR = 0.28, 95%CI: 0.12-0.65), admission NIHSS (OR = 0.9, 95%CI: 0.86-0.94), and use of stent retriever (OR = 0.26, 95%CI: 0.11-0.62) or combined approach (OR = 0.35, 95%CI: 0.12-1.01) vs ADAPT were associated with lower odds of good outcome. Stent retriever use was associated with lower odds of good outcomes compared to ADAPT even when including patients with only basilar occlusion or with successful recanalization only. CONCLUSION Despite similar safety profiles, use of ADAPT is associated with higher rates of functional independence after posterior circulation thrombectomy compared to stent retriever or combined approach in large “real-world” retrospective study

EndoVAscular treatment and ThRombolysis for Ischemic Stroke Patients (EVA-TRISP) registry: Basis and methodology of a pan-European prospective ischaemic stroke revascularisation treatment registry

Purpose The Thrombolysis in Ischemic Stroke Patients (TRISP) collaboration was a concerted effort initiated in 2010 with the purpose to address relevant research questions about the effectiveness and safety of intravenous thrombolysis (IVT). The collaboration also aims to prospectively collect data on patients undergoing endovascular treatment (EVT) and hence the name of the collaboration was changed from TRISP to EVA-TRISP. The methodology of the former TRISP registry for patients treated with IVT has already been published. This paper focuses on describing the EVT part of the registry. Participants All centres committed to collecting predefined variables on consecutive patients prospectively. We aim for accuracy and completeness of the data and to adapt local databases to investigate novel research questions. Herein, we introduce the methodology of a recently constructed academic investigator-initiated open collaboration EVT registry built as an extension of an existing IVT registry in patients with acute ischaemic stroke (AIS). Findings to date Currently, the EVA-TRISP network includes 20 stroke centres with considerable expertise in EVT and maintenance of high-quality hospital-based registries. Following several successful randomised controlled trials (RCTs), many important clinical questions remain unanswered in the (EVT) field and some of them will unlikely be investigated in future RCTs. Prospective registries with high-quality data on EVT-treated patients may help answering some of these unanswered issues, especially on safety and efficacy of EVT in specific patient subgroups. Future plans This collaborative effort aims at addressing clinically important questions on safety and efficacy of EVT in conditions not covered by RCTs. The TRISP registry generated substantial novel data supporting stroke physicians in their daily decision making considering IVT candidate patients. While providing observational data on EVT in daily clinical practice, our future findings may likewise be hypothesis generating for future research as well as for quality improvement (on EVT). The collaboration welcomes participation of further centres willing to fulfill the commitment and the outlined requirements