Real-World Data Show Positive Outcomes of Mechanical Thrombectomy for Stroke
In the international Embotrap extraction and clot evaluation and lesion evaluation for neurothrombectomy (EXCELLENT; NCT03685578) registry study, endovascular thrombectomy (EVT) reduced post-stroke disability in nearly half of those treated.
These data support previous showing EVT resulted in less disability after 3 months. Prior trials were performed in carefully selected centers, employing strict clinical and imaging inclusion criteria. In this real-world, prospective, observational trial, most people treated with EVT for ischemic stroke required only 1 attempt to remove a blood clot.
In nearly half of those treated, EVT resulted in modified Rankin scale (mRS) scores of 2 or lower, indicating slight/minimal disability, defined as being able to look after own affairs without assistance or no worsening from their pre-stroke condition at 90 days.
“This study shows how much stroke thrombectomy has advanced,” said Raul G. Nogueira, MD, director, University of Pittsburgh Medical Center Stroke Institute. “We saw a wide range of cases, including patients who, not too long ago, would not be considered good candidates for thrombectomy based on older age, pre-existing disability, or large size of the stroke on presentation. Our findings in this study expand thrombectomy to be considered for more stroke patients. The results may have potential implications for technique and device selection when removing clots and the development of better blood-clot removal strategies.”
To examine the effectiveness of blood-clot removal across a wide range of stroke patients seen in routine daily care (outside of a clinical trial), the trial enrolled 1,000 adult ischemic stroke patients (average age 70; 52% female) at 36 sites from September 2018 to March 2021.
The sites were a mix of thrombectomy-capable and comprehensive stroke centers. Patients were treated with a specific mechanical thrombectomy device called EmboTrap in an unlimited time frame.
The study was designed to collect real-world treatment data and did not exclude patients based on prestroke independence level, severity of stroke, location of the occlusion, or time between onset of stroke and treatment. Only 10% of patients whose clots had a higher composition of red blood cell count and a lower composition of platelets died within 90 days, compared with 24% of patients whose clots had a lower composition of red blood cells and platelets. Among patients with higher red blood cell content, 63% with lower platelet content had either slight or no disability, compared to 51% with higher platelet content.
The results were presented at the American Stroke Association International Stroke Conference 2022, which was held in person in New Orleans and virtually, Feb. 9-11, 2022