title: Stentrievers versus other endovascular treatment methods for acute stroke: comparison of procedural results and their relationship to outcomes.
abstract: OBJECTIVE
  The use of stentrievers (ST) is rapidly growing due to several potential benefits over other available treatments. ST potentially restore flow before clot retrieval and reduce procedural time. We aimed to study the impact of these potential benefits.
  
  
  METHODS
  Patients with acute stroke treated with endovascular procedures in two stroke centers were studied. According to device availability, patients were treated either with intra-arterial tissue plasminogen activator (IAT), Merci or ST. We defined time to initial flow restoration as time from symptom onset to first pass of contrast to previously occluded arteries either through the deployed device or after recanalization. Complete recanalization (Thrombolysis In Cerebral Infarction >2b), day 5 National Institute of Health Stroke Scale (NIHSS) score and favorable outcome at 3 months (modified Rankin Scale score≤2) were recorded.
  
  
  RESULTS
  A total of 315 patients were studied: 127 IAT, 119 Merci, 69 ST (26 Trevo, 43 Solitaire). No major differences were observed in baseline characteristics between the treatment groups. The rate of complete recanalization was higher with ST (67.2%) than with IAT (50.8%) or Merci (57.3%) (p=0.05). Time from groin puncture to final recanalization was lower with ST (88±46 min) than with IAT (103±70 min) or Merci (128±62 min) (p<0.01) and time from groin puncture to initial flow restoration was shorter with ST (36±18 min) than with IAT (92±67 min) or Merci (114±57 min) (p<0.01). Discharge NIHSS was lower in the ST group (7, IQR 1-26) than in the IAT (14, 2-30) or Merci (12, 5-30) groups (p=0.05) and the rate of favorable outcome was higher: ST (52.9%) vs IAT (33.9%) and Merci (40%) (p=0.03). The use of a ST increased the odds of a favorable outcome (OR 1.9, 95% CI 1.04 to 3.39; p=0.037).
  
  
  CONCLUSIONS
  In acute endovascular treatment of stroke, the use of ST may increase recanalization and reduce time to flow restoration leading to improved outcomes.
authors.affiliation: Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Marc
authors.initials: M
authors.lastname: Ribo
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Molina
authors.forename: Brian
authors.initials: B
authors.lastname: Jankowitz
authors.forename: Alejandro
authors.initials: A
authors.lastname: Tomasello
authors.forename: Syed
authors.initials: S
authors.lastname: Zaidi
authors.forename: Mouhammad
authors.initials: M
authors.lastname: Jumaa
authors.forename: Pilar
authors.initials: P
authors.lastname: Coscojuela
authors.forename: Jennifer
authors.initials: J
authors.lastname: Oakley
authors.forename: José
authors.initials: J
authors.lastname: Alvarez-Sabín
authors.forename: Tudor
authors.initials: T
authors.lastname: Jovin
mesh_terms: D000208:Acute Disease; D000368:Aged; D002533:Cerebral Angiography; D057510:Endovascular Procedures / Q000379:methods*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Angiography; Blood Flow; Stent; Stroke; Thrombectomy