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; Floor Pinckaers; Susanne G.H. Olthuis; Rabia Deniz; Nadinda A.M. van der Ende; Agnetha A.E. Bruggeman; Anne F.A.V. Pirson; Nikki Boodt; Lucas A. Ramos; Nerea Arrarte-Terreros; Haryadi Prasetya; Praneeta R. Konduri; Natalie E. LeCouffe; Adrien E.D. Groot; Sabine L. Collette; Lieve M. Schupp; Eva J.H.F. Voogd; Eleonora L.F. Kirkels; Annick J. Weterings; Heitor Alves; P. F.C. Groot; Anouk de Jong; Michelle Simons; Rob H. Lo; H. Bart van der Worp; Jeanette Bakker; Sjoert Pegge; Rob H. Lo; Reinoud P.H. Bokkers; Pieter Jan van Doormaal; J. de Vries; Ewoud J. van Dijk; Pieter Jan van Doormaal; Lotte van den Heuvel; Wouter H. Hinsenveld; Robert Jan B. Goldhoorn

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

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
, Floor Pinckaers
, Susanne G.H. Olthuis
, Rabia Deniz
, Nadinda A.M. van der Ende
, Agnetha A.E. Bruggeman

Anne F.A.V. Pirson, Nikki Boodt, Lucas A. Ramos, Nerea Arrarte-Terreros, Haryadi Prasetya, Praneeta R. Konduri, Natalie E. LeCouffe, Adrien E.D. Groot, Sabine L. Collette, Lieve M. Schupp, Eva J.H.F. Voogd, Eleonora L.F. Kirkels, Annick J. Weterings, Heitor Alves, P. F.C. Groot, Anouk de Jong, Michelle Simons, Rob H. Lo, H. Bart van der Worp, Jeanette Bakker, Sjoert Pegge, Rob H. Lo, Reinoud P.H. Bokkers, Pieter Jan van Doormaal, J. de Vries, Ewoud J. van Dijk, Pieter Jan van Doormaal, Lotte van den Heuvel, Wouter H. Hinsenveld, Robert Jan B. Goldhoorn,

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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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.

Original language	English
Pages (from-to)	1126–1139
Number of pages	14
Journal	Cardiovascular and Interventional Radiology
Volume	48
Issue number	8
DOIs	https://doi.org/10.1007/s00270-025-04048-0
Publication status	Published - 2025

Keywords

Endovascular treatment (EVT)
Stent retriever (SR)
Stroke
Thrombectomy

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Knapen, R. R. M. M., Goldhoorn, R. J. B., Vos, J. A., Emmer, B. J., Uyttenboogaart, M., Hofmeijer, J., Schonewille, W. J., Majoie, C. B., Roos, Y. B. W. E. M., van der Lugt, A., van Dippel, D. W. J., Lingsma, H. F., van der Leij, C., van Oostenbrugge, R. J., van Zwam, W. H., Pinckaers, F., Olthuis, S. G. H., Deniz, R., van der Ende, N. A. M. (2025). Outcomes After Thrombectomy for Acute Ischemic Stroke Related to Type of Stent Retriever; a MR CLEAN Registry Study. Cardiovascular and Interventional Radiology, 48(8), 1126–1139. https://doi.org/10.1007/s00270-025-04048-0

@article{a4f9fa21485e438a8fb9563f08dd8fa9,

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

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",

author = "Knapen, \{Robrecht R.M.M.\} and Goldhoorn, \{Robert Jan B.\} and Vos, \{Jan Albert\} and Emmer, \{Bart J.\} and Maarten Uyttenboogaart and Jeannette Hofmeijer and Schonewille, \{Wouter J.\} and Majoie, \{Charles B.\} and Roos, \{Yvo B.W.E.M.\} and \{van der Lugt\}, Aad and \{van Dippel\}, \{Diederik W.J.\} and Lingsma, \{Hester F.\} and \{van der Leij\}, Christiaan and \{van Oostenbrugge\}, \{Robert J.\} and \{van Zwam\}, \{Wim H.\} and Floor Pinckaers and Olthuis, \{Susanne G.H.\} and Rabia Deniz and \{van der Ende\}, \{Nadinda A.M.\} and Bruggeman, \{Agnetha A.E.\} and Pirson, \{Anne F.A.V.\} and Nikki Boodt and Ramos, \{Lucas A.\} and Nerea Arrarte-Terreros and Haryadi Prasetya and Konduri, \{Praneeta R.\} and LeCouffe, \{Natalie E.\} and Groot, \{Adrien E.D.\} and Collette, \{Sabine L.\} and Schupp, \{Lieve M.\} and Voogd, \{Eva J.H.F.\} and Kirkels, \{Eleonora L.F.\} and Weterings, \{Annick J.\} and Heitor Alves and Groot, \{P. F.C.\} and \{de Jong\}, Anouk and Michelle Simons and Lo, \{Rob H.\} and \{van der Worp\}, \{H. Bart\} and Jeanette Bakker and Sjoert Pegge and Lo, \{Rob H.\} and Bokkers, \{Reinoud P.H.\} and \{van Doormaal\}, \{Pieter Jan\} and \{de Vries\}, J. and \{van Dijk\}, \{Ewoud J.\} and \{van Doormaal\}, \{Pieter Jan\} and \{van den Heuvel\}, Lotte and Hinsenveld, \{Wouter H.\} and Goldhoorn, \{Robert Jan B.\}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2025.",

year = "2025",

doi = "10.1007/s00270-025-04048-0",

language = "English",

volume = "48",

pages = "1126–1139",

journal = "Cardiovascular and Interventional Radiology",

issn = "0174-1551",

publisher = "Springer",

number = "8",

}

Knapen, RRMM, Goldhoorn, RJB, Vos, JA, Emmer, BJ, Uyttenboogaart, M, Hofmeijer, J, Schonewille, WJ, Majoie, CB, Roos, YBWEM, van der Lugt, A, van Dippel, DWJ, Lingsma, HF, van der Leij, C, van Oostenbrugge, RJ, van Zwam, WH, Pinckaers, F, Olthuis, SGH, Deniz, R, van der Ende, NAM, Bruggeman, AAE, Pirson, AFAV, Boodt, N, Ramos, LA, Arrarte-Terreros, N, Prasetya, H, Konduri, PR, LeCouffe, NE, Groot, AED, Collette, SL, Schupp, LM, Voogd, EJHF, Kirkels, ELF, Weterings, AJ, Alves, H, Groot, PFC, de Jong, A, Simons, M, Lo, RH, van der Worp, HB, Bakker, J, Pegge, S, Lo, RH, Bokkers, RPH, van Doormaal, PJ, de Vries, J, van Dijk, EJ, van Doormaal, PJ, van den Heuvel, L, Hinsenveld, WH, Goldhoorn, RJB 2025, 'Outcomes After Thrombectomy for Acute Ischemic Stroke Related to Type of Stent Retriever; a MR CLEAN Registry Study', Cardiovascular and Interventional Radiology, vol. 48, no. 8, pp. 1126–1139. https://doi.org/10.1007/s00270-025-04048-0

TY - JOUR

T1 - Outcomes After Thrombectomy for Acute Ischemic Stroke Related to Type of Stent Retriever; a MR CLEAN Registry Study

AU - Knapen, Robrecht R.M.M.

AU - Goldhoorn, Robert Jan B.

AU - Vos, Jan Albert

AU - Emmer, Bart J.

AU - Uyttenboogaart, Maarten

AU - Hofmeijer, Jeannette

AU - Schonewille, Wouter J.

AU - Majoie, Charles B.

AU - Roos, Yvo B.W.E.M.

AU - van der Lugt, Aad

AU - van Dippel, Diederik W.J.

AU - Lingsma, Hester F.

AU - van der Leij, Christiaan

AU - van Oostenbrugge, Robert J.

AU - van Zwam, Wim H.

AU - Pinckaers, Floor

AU - Olthuis, Susanne G.H.

AU - Deniz, Rabia

AU - van der Ende, Nadinda A.M.

AU - Bruggeman, Agnetha A.E.

AU - Pirson, Anne F.A.V.

AU - Boodt, Nikki

AU - Ramos, Lucas A.

AU - Arrarte-Terreros, Nerea

AU - Prasetya, Haryadi

AU - Konduri, Praneeta R.

AU - LeCouffe, Natalie E.

AU - Groot, Adrien E.D.

AU - Collette, Sabine L.

AU - Schupp, Lieve M.

AU - Voogd, Eva J.H.F.

AU - Kirkels, Eleonora L.F.

AU - Weterings, Annick J.

AU - Alves, Heitor

AU - Groot, P. F.C.

AU - de Jong, Anouk

AU - Simons, Michelle

AU - Lo, Rob H.

AU - van der Worp, H. Bart

AU - Bakker, Jeanette

AU - Pegge, Sjoert

AU - Lo, Rob H.

AU - Bokkers, Reinoud P.H.

AU - van Doormaal, Pieter Jan

AU - de Vries, J.

AU - van Dijk, Ewoud J.

AU - van Doormaal, Pieter Jan

AU - van den Heuvel, Lotte

AU - Hinsenveld, Wouter H.

AU - Goldhoorn, Robert Jan B.

PY - 2025

Y1 - 2025

N2 - 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.

AB - 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.

KW - Endovascular treatment (EVT)

KW - Stent retriever (SR)

KW - Stroke

KW - Thrombectomy

UR - https://www.scopus.com/pages/publications/105008544629

U2 - 10.1007/s00270-025-04048-0

DO - 10.1007/s00270-025-04048-0

M3 - Article

AN - SCOPUS:105008544629

SN - 0174-1551

VL - 48

SP - 1126

EP - 1139

JO - Cardiovascular and Interventional Radiology

JF - Cardiovascular and Interventional Radiology

IS - 8

ER -

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

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