Outcomes After Thrombectomy for Acute Ischemic Stroke Related to Type of Stent Retriever; a MR CLEAN Registry Study

Robrecht R M M Knapen; Robert-Jan B Goldhoorn; Jan Albert Vos; Bart J Emmer; Maarten Uyttenboogaart; Jeannette Hofmeijer; Wouter J Schonewille; Charles B Majoie; Yvo B W E M Roos; Aad van der Lugt; Diederik W J van Dippel; Hester F Lingsma; Christiaan van der Leij; Robert J van Oostenbrugge; Wim H van Zwam; MR CLEAN Registry study

doi:10.1007/s00270-025-04048-0

Outcomes After Thrombectomy for Acute Ischemic Stroke Related to Type of Stent Retriever; a MR CLEAN Registry Study

Cardiovasc Intervent Radiol. 2025 Jun 9. doi: 10.1007/s00270-025-04048-0. Online ahead of print.

Authors

Robrecht R M M Knapen^{1

2}, Robert-Jan B Goldhoorn³, Jan Albert Vos⁴, Bart J Emmer⁵, Maarten Uyttenboogaart⁶, Jeannette Hofmeijer⁷, Wouter J Schonewille⁸, Charles B Majoie⁵, Yvo B W E M Roos⁹, Aad van der Lugt¹⁰, Diederik W J van Dippel¹¹, Hester F Lingsma¹², Christiaan van der Leij¹³, Robert J van Oostenbrugge^{14

15}, Wim H van Zwam^{13

14}; MR CLEAN Registry study

Collaborators

MR CLEAN Registry study:
Diederik W J Dippel, Aad van der Lugt, Charles B L M Majoie, Yvo B W E M Roos, Robert J van Oostenbrugge, Wim H van Zwam, Jelis Boiten, Jan Albert Vos, Ivo G H Jansen, Maxim J H L Mulder, Robert- Jan B Goldhoorn, Kars C J Compagne, Manon Kappelhof, Josje Brouwer, Sanne J den Hartog, Wouter H Hinsenveld, Lotte van den Heuvel, Diederik W J Dippel, Bob Roozenbeek, Aad van der Lugt, Pieter Jan van Doormaal, Charles B L M Majoie, Yvo B W E M Roos, Bart J Emmer, Jonathan M Coutinho, Wouter J Schonewille, Jan Albert Vos, Marieke J H Wermer, Marianne A A van Walderveen, Adriaan C G M van Es, Julie Staals, Robert J van Oostenbrugge, Wim H van Zwam, Jeannette Hofmeijer, Jasper M Martens, Geert J Lycklama À Nijeholt, Jelis Boiten, Sebastiaan F de Bruijn, Lukas C van Dijk, H Bart van der Worp, Rob H Lo, Ewoud J van Dijk, Hieronymus D Boogaarts, J de Vries, Paul L M de Kort, Julia van Tuijl, Issam Boukrab, Jo P Peluso, Puck Fransen, Jan S P van den Berg, Heleen M den Hertog, Boudewijn A A M van Hasselt, Leo A M Aerden, René J Dallinga, Maarten Uyttenboogaart, Omid Eschgi, Reinoud P H Bokkers, Tobien H C M L Schreuder, Roel J J Heijboer, Koos Keizer, Rob A R Gons, Lonneke S F Yo, Emiel J C Sturm, Tomas Bulut, Paul J A M Brouwers, Anouk D Rozeman, Otto Elgersma, Michel J M Remmers, Thijs E A M de Jong, Charles B L M Majoie, Wim H van Zwam, Aad van der Lugt, Geert J Lycklama À Nijeholt, Marianne A A van Walderveen, Marieke E S Sprengers, Sjoerd F M Jenniskens, René van den Berg, Albert J Yoo, Ludo F M Beenen, Alida A Postma, Stefan D Roosendaal, Bas F W van der Kallen, Ido R van den Wijngaard, Adriaan C G M van Es, Bart J Emmer, Jasper M Martens, Lonneke S F Yo, Jan Albert Vos, Joost Bot, Pieter-Jan van Doormaal, Anton Meijer, Elyas Ghariq, Reinoud P H Bokkers, Marc P van Proosdij, G Menno Krietemeijer, Jo P Peluso, Hieronymus D Boogaarts, Rob Lo, Wouter Dinkelaar, Auke P A Appelman, Bas Hammer, Sjoert Pegge, Anouk van der Hoorn, Saman Vinke, Sandra Cornelissen, Christiaan van der Leij, Rutger Brans, Jeanette Bakker, Maarten Uyttenboogaart, Miou Koopman, Lucas Smagge, Olvert A Berkhemer, Jeroen Markenstein, Eef Hendriks, Patrick Brouwer, Dick Gerrits, Diederik W J Dippel, Aad van der Lugt, Charles B L M Majoie, Yvo B W E M Roos, Robert J van Oostenbrugge, Wim H van Zwam, Geert J Lycklama À Nijeholt, Jelis Boiten, Jan Albert Vos, Wouter J Schonewille, Jeannette Hofmeijer, Jasper M Martens, H Bart van der Worp, Rob H Lo, Robert J van Oostenbrugge, Jeannette Hofmeijer, H Zwenneke Flach, Hester F Lingsma, Naziha El Ghannouti, Martin Sterrenberg, Wilma Pellikaan, Rita Sprengers, Marjan Elfrink, Michelle Simons, Marjolein Vossers, Joke de Meris, Tamara Vermeulen, Annet Geerlings, Gina van Vemde, Tiny Simons, Gert Messchendorp, Nynke Nicolaij, Hester Bongenaar, Karin Bodde, Sandra Kleijn, Jasmijn Lodico, Hanneke Droste, Maureen Wollaert, Sabrina Verheesen, D Jeurrissen, Erna Bos, Yvonne Drabbe, Michelle Sandiman, Nicoline Aaldering, Berber Zweedijk, Jocova Vervoort, Eva Ponjee, Sharon Romviel, Karin Kanselaar, Denn Barning, Laurine van der Steen, Esmee Venema, Vicky Chalos, Ralph R Geuskens, Tim van Straaten, Saliha Ergezen, Roger R M Harmsma, Daan Muijres, Anouk de Jong, Olvert A Berkhemer, Anna M M Boers, J Huguet, P F C Groot, Marieke A Mens, Katinka R van Kranendonk, Kilian M Treurniet, Manon L Tolhuisen, Heitor Alves, Annick J Weterings, Eleonora L F Kirkels, Eva J H F Voogd, Lieve M Schupp, Sabine L Collette, Adrien E D Groot, Natalie E LeCouffe, Praneeta R Konduri, Haryadi Prasetya, Nerea Arrarte-Terreros, Lucas A Ramos, Nikki Boodt, Anne F A V Pirson, Agnetha A E Bruggeman, Nadinda A M van der Ende, Rabia Deniz, Susanne G H Olthuis, Floor Pinckaers

Affiliations

¹ Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands. Robrecht.knapen@mumc.nl.
² School for Cardiovascular Diseases Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands. Robrecht.knapen@mumc.nl.
³ Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands.
⁴ Department of Radiology, Sint Antonius Hospital, Nieuwegein, The Netherlands.
⁵ Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands.
⁶ Department of Neurology and Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁷ Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands.
⁸ Department of Neurology, Sint Antonius Hospital, Nieuwegein, The Netherlands.
⁹ Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
¹⁰ Department of Radiology and Nuclear Medicine, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands.
¹¹ Department of Neurology, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands.
¹² Department of Medical Decision Making, Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands.
¹³ Department of Radiology & Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
¹⁴ School for Cardiovascular Diseases Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
¹⁵ Department of Neurology, Maastricht University Medical Center+, Maastricht, The Netherlands.

PMID: 40490624
DOI: 10.1007/s00270-025-04048-0

Abstract

Purpose: Endovascular treatment (EVT) with a stent retriever is known to be effective and safe in patients with acute ischemic stroke due to large vessel occlusion. We aimed to compare the most used stent retrievers in a nationwide registry of EVT-treated stroke patients (MR CLEAN Registry).

Methods: Patients with ischemic stroke due to large vessel occlusion, treated with stent retriever thrombectomy (each stent retriever with at least 100 EVTs) as first-line technique in the MR CLEAN Registry, were included. The primary outcome was the modified Rankin Scale (mRS) score at 90-day follow-up. Secondary outcomes included reperfusion (expanded Treatment In Cerebral Infarction [eTICI]), mortality at 90 days, symptomatic intracranial hemorrhage, National Institutes of Health Stroke Scale (NIHSS) score between 24 and 48 h post-EVT, and procedure time. With multivariable regression analyses, we calculated odds ratios (OR) and β-estimates to compare outcomes between the most frequently used stent retrievers, with adjustments for predefined variables. One subgroup analysis focused on the effect of the stent retriever on outcomes in M1 occlusions.

Results: Trevo (Stryker) was the most frequently used stent retriever (n = 1541, 70%). Other types were Solitaire (n = 301, 14%) (Medtronic), Embotrap (n = 255, 11%) (Cerenovus; Johnson&Johnson), and Revive (n = 103, 5.2%) (Cerenovus; Johnson&Johnson). There was a slightly, but statistically significant, higher 90-day mRS score (adjusted common [ac]OR: 0.75, 95%CI: 0.57-0.99) and mortality rate (aOR: 1.77, 95%CI: 1.16-2.68) for the Solitaire and longer procedure times for the Revive stent (mean: 67.6 versus 58.9 min; adjusted β-estimate: 11.6, 95%CI: 2.69-20.6) compared to the Trevo retriever. There were no outcome differences in the M1 subgroup analyses.

Conclusion: Differences in clinical, technical, and safety outcomes after EVT between the Trevo, Solitaire, Embotrap, and Revive stent retrievers were-although statistically significant-small. Treating physicians should use the stent retriever they are used to, and further studies with more strict patient selection should be conducted to validate these results.

Keywords: Endovascular treatment (EVT); Stent retriever (SR); Stroke; Thrombectomy.