Stent retriever size and outcomes after anterior circulation occlusion thrombectomy (2025)

Stent retriever size and outcomes after anterior circulation occlusion thrombectomy (1)

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Ischemic stroke

Original research

Stent retriever size and outcomes after anterior circulation occlusion thrombectomy

  1. http://orcid.org/0000-0001-8424-4464Benjamin Gory1,2,
  2. http://orcid.org/0000-0002-0286-8781Sven Poli3,4,
  3. Bertrand Lapergue5,
  4. http://orcid.org/0000-0003-2140-7881Stephanos Finitsis6,
  5. http://orcid.org/0000-0002-0108-9161Joshua Mbroh3,4,
  6. Xinchen Hui3,4,
  7. Florian Hennersdorf7,
  8. Ulrike Ernemann7,
  9. http://orcid.org/0000-0002-7813-2949Mohammad Anadani8
  10. on behalf of the ETIS and GSR Registry Investigators
    1. 1Diagnostic and Therapeutic Neuroradiology, CHRU-Nancy, Nancy, France
    2. 2IADI, INSERM U1254, Université de Lorraine, Nancy, France
    3. 3Neurology & Stroke, Tübingen University, Tübingen, Germany
    4. 4Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
    5. 5Neurology, Stroke Unit, Hospital Foch, Suresnes, France
    6. 6Neuroradiology, Ahepa Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
    7. 7Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Tübingen, Germany
    8. 8Department of Neurosciences, Intent Medical Group, NorthShore University HealthSystem, Arlington Heights, Illinois, USA
    1. Correspondence to Professor Benjamin Gory; benjagory{at}gmail.com; Dr Sven Poli; sven.poli{at}uni-tuebingen.de

    Abstract

    Background The impact of stent retriever size on mechanical thrombectomy (MT) outcomes remains uncertain. We aim to clarify the influence of stent retriever size on MT outcomes by analyzing data from two national prospective registries.

    Methods A retrospective analysis was performed on data from the French and German MT registries including consecutive patients with anterior circulation large vessel occlusion who underwent Solitaire stent retriever MT with or without additional aspiration. Efficacy outcomes were successful reperfusion and complete reperfusion. Safety outcomes included any intracerebral hemorrhage (ICH) and symptomatic intracerebral hemorrhage (sICH).

    Results Complete reperfusion was lower in the 4×20 mm stent retriever group than in the 4×40 mm stent retriever group (47% vs 53%; OR 0.61, P=0.0039). Successful reperfusion did not differ between the 4×20 mm and 4×40 mm stent retriever groups (89% vs 93%; OR 0.69, P=0.25). There was no difference between the 6×30/6×40 mm and 4×20 mm stents, and there was no difference in functional outcomes between the groups. In terms of safety, any ICH was lower in the 4×20 mm group than in the 4×40 mm group (20% vs 36%; OR 0.60, P=0.0095). Symptomatic ICH was lower in the 4×20 mm group than in the 4×40 mm group (5% vs 10%; OR 0.58, P=0.086), but the difference did not reach statistical significance. Mortality was lower in the 4×20 mm than in the 6×40 mm group (26% vs 33%; OR 0.70, P=0.044). When compared according to occlusion location, the results were overall similar.

    Conclusion This study suggests that longer and larger stent retrievers lead to a higher reperfusion rate but also a higher rate of hemorrhagic complications. Overall, the size of the stent did not affect functional outcomes.

    • Stroke
    • Thrombectomy
    • Complication

    Data availability statement

    Data are available upon reasonable request to the corresponding author and after approval by the local ethics committees.

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      • Stroke
      • Thrombectomy
      • Complication

      Data availability statement

      Data are available upon reasonable request to the corresponding author and after approval by the local ethics committees.

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      Footnotes

      • X @MoAnadani

      • Collaborators ETIS Investigators: Foch: Bertrand Lapergue, Adrien Wand, Arturo Consoli, Oguzhan Coskun, Federico Di Maria, Silvia Pizzuto, Alessandro Sgreccia, Charline Benoit, Lucas Gorza, David Weisenburger-Lile, Waliyde Jabeur, M Tchikviladze, Serge Evrard, Georges Rodeschfor, Raphaël Blanc, Michel Obadia, Jean-Philippe Desilles, Michel Piotin, Pierre Seners, Stanislas Smajda, Simon Escalard, Benjamin Maier, Candice Sabben, Hocine Redjem, Mikael Mazhigi, Grace Adwane, François Delvoye, Amira Al Raaisi, William Boisseau, Adnan Altayeb, Erwan Robichon. Lyon: Omer Eker, Tae-Hee Cho, Laurent Derex, Julia Fontaine, Laura Mechtouff, Norbert Nighoghossian, Elodie Ong, Lucie Rascle, Roberto Riva, Françis Turjman, Morgane Laubacher, Mehdi Beyragued, Yves Berthezene, Marc Hermier, Ameli Roxanna, Alexandre Bani-Sadr, Andrea Filip, Matteo Cappucci, Laurent Derex, Pierre Pernot, Paul Clottes. Nantes: Romain Bourcier, Benjamin Daumas Duport, Pierre Louis Alexandre, Hubert Desal, Solene De Gaalon, Benoît Guillon, Cécile Preterre, Guillaume Tessier, Arthur Lionnet. Nancy: Benjamin Gory, Lisa Humbert Jean-Selton, René Anxionnat, Anne-Laure Derelle, Liang Liao, Emmanuelle Schmitt, Sophie Planel, Sébastien Richard, Gioia Mione, Jean-Christophe Lacour, Marian Dourainou, Emilien Micard, Bailiang Chen, Gérard Audibert, Agnès Masson, Lionel Alb, Marine Beaumont, Adriana Tabarna, Marcela Voicu, Grégoire Barthel, Iona Podar, Madalina Brezeanu, Marie Reitter, François Zhu, René Anxionnat. Bordeaux: Gaultier Marnat, Jean-Sébastien Liegey, Pierre Briau, Victoire Lyon, Igor Sibon, Xavier Barreau, Jean Papaxanthos, Jerome Berge, Sabrina E Bruxelles, Stéphane Olindo, Mathilde Poli, Pauline Renou, Sharmila Sagnier, Thomas Tourdias, Thomas Courret, Malgorzata Milnerowicz, François Rouanet, Benoit Legghe, Aurelie Boyer, Tristan Kerdraon, Lisa Saleille, Laurine Bastardo. Montpellier: Cyril Dargazanli, Vincent Costalat, Federico Cagnazzo, Pierre-Henri Lefevre, Grégory Gascou, Quentin Varnier, François Louis Collemiche, Isabelle Mourand, Caroline Arquizan, Lucas Corti, Adrien Ter Schiphorst, Imad Derraz. Kremlin Bicêtre: Laurent Spelle, Jildaz Caroff, Christian Denier, Vanessa Chalumeau, Cristian Mihalea, Nicolas Legris, Augustin Ozanne, Leon Ikka, Olivier Chassin, Sophie Gallas, Laura Venditti, Mariana Sarov, Jonathan Cortese. Rennes: Jean-Christophe Ferre, Stephane Vannier, Maria Veronica Lassalle, Jean-Yves Gauvrit, Clément Tracol, Cécile Malrain, Edouard Beaufreton, Quentin Alias, Julien Hissier, Maud Guillen, François Eugene, Julien Boucherit. Amiens: Cyril Chivot, Audrey Courselle, Sandrine Canaple, Chantal Lamy, Kevin Delaforge, Manuel Fernandez, Jérémie Vial, Quentin Laferte, Xavier Desdoit. Brest: Serge Timsit, Aurore Jourdain, Jean-Christophe Gentric, Julien Ognard, Mourad Cheddad El Aouni, Irina Viakhireva, Jordan Coris, François-Mathias Merrien, Denis Marechal, Marie Bruguet, Philippe Goas. Caen: Marion Boulanger, Emmanuel Touze, Charlotte Barbier, Romain Schneckenburger, Julien Cogez, Sophie Guettier, Estelle La Porte, Jean Bouchart, Mohammad Ismail. Limoges: Charbel Mounayer, Aymeric Rouchaud, Suzana Saleme, Géraud Forestier. Pitié-Salpêtrière: Sonia Alamowitch, Charlotte Rosso, Sara Leder, Flore Baronnet, Sophie Crozier, Anne Leger, Laure Bottin, Sam Ghazanfari, Marion Yger, Stephen Delorme, Aymeric Wittwer, Christine Vassilev, Gaparad Gerschenfeld, Clémence Blanc, Antonio Rainone, Frédéric Clarencon, Kevin Premat, Eimad Shotar, Stéphanie Lenck, Nader Sourour, Julien Allard, Pierre Chiaroni. Marie Saint-Anne: Olivier Naggara, Guillaume Turc, Wagih Ben Hassen, Denis Trystram, Christine Rodriguez-Regent, Finoana Laza-Omenjanahary, Hugo Gortais. Rouen: Ozlem Ozkul-Wermester, Chrysanthi Papagiannaki, Evelyne Massardier, Aude Triquenot, Margaux Lefebvre, Julien Burel, Florian Basille, Adelya Curado.Toulouse: Alain Viguier, Christophe Cognard, Anne Christine Januel, Jean-François Albucher, Lionel Calviere, Jean-Marc Olivot, Nicolas Raposo, Fabrice Bonneville, Guillaume Bellanger, Louis Fontaine, Philippe Tall, Federico Sacchetti. Bayonne: Frédéric Bourdain, Patricia Bernady, Guillaume Ballan, Stephanie Bannier, Emmanuel Ellie, Olivier Flabeau, Julia Potenza, Antoine Soulages, Laurent Lagoarde-Segot, Hélène Cailliez, Louis Veunac, David Higue, Quentin Bourgeois-Beauvais. Vannes: Anthony Lebras, Sarah Adam, Benoit Pegat, Arnaud Le Guen, François Chedeville, Jérémy Jouan, Rémi Allibert, Alexandre Courtois, Lucile Lescot, Dorothée Videt, Thibaut Lapotre. Pau: Johann Sebastian Richter, Bruno Thierry Barroso, Camille Dahan, Alexis Gonnet, Régis Hubrecht, Zoé Lepine, Hélène Castagnet, Raluca Marasescu. Grenoble: Olivier Heck, Pauline Cuisenier, Olivier Detante, Isabelle Favre Wiki, Clémentine Bonaz, Katia Garambois, Loic Legris, Adrian Kastler, Kamel Boubagra, Corentin Berthet, Stéphane Charara, Florent Lepilliet. Poitiers: Victor Dumas, Jean Philippe Neau, Stéphane Velasco, Nathalie Nasr. Strasbourg: Valérie Wolff, Raoul Pop, Véronique Quenardelle, Valérie Lauer, Irène Pierre-Paul, Roxana Gheoca, Leonard Lorant. Reims: Solène Moulin, Vi Tuan Hua, Paolo Pagano, Alexandre Doucet, Christophe Gelmini, Pierre-François Manceau, Laurenti Paiusan, Isabelle Serre, Sébastien Soize, Thi Ngoc Phuong Nguyen, Maher Sahnoun, Nathalie Caucheteux. Colmar: Pablo Lebedinsky, Federico Bolognini, Francis Vuillemet. Clermont-Ferrand: Anna Ferrier, Abderrahim Zerroug, Ricardo Moreno, Emmanuel Chabart, Elie Lteif, Pauline Paris, Nathalie Bourgois, Marie Raquin. Angers: Anne Pasco-Papon, Jean Baptiste Girot, Alderic Lecluse, Sophie Godard, Vincent L’Allinec, Alice Corfu. Tours: Kevin Janot, Richard Bibi, Marie Gaudron, Arnaud Bretonniere, Mariam Annan, Héloïse Ifergan, Grégoire Boulouis, Marco Pasi, Séverine Debiais, Elisabeth Molinier, Denis Herbreteau, Fouzi Bala, Clémence Hoche. Bar le Duc: Anthony Wietrich, Valérie Ruche, Karine Lavandier, Hakim Amara. Dijon: Yannick Bejot, Brivael Lemogne, Frédéric Ricolfi, Laura Baptiste, Pierre Thouant, Gaulthier Duloquin, Pierre Olivier Comby, Christelle Blanc-Labarre, Simon Amaral, Angélique Bernard, Adrien Chavent, Alan Rhamani, Corinne Chevalier. Besançon: Guillaume Charbonnier, Louise Bonnet, Nicolas Raybaud, Benjamin Bouamra, Thierry Moulin, Alessandra Biondi. Versailles: Fernando Pico, Benjamin Dano, Carmen Patcas, Dhouha Chaari, Daniela Stanciu, Duc Long Duong, Intissar Hmida, Marie-Laure Chadenat. Marseille: Laurent Suissa, Emilie Doche, Jean-François Hak, Anthony Reyre, Xavier Carle, Nadia Laksiri,

        Phélie Osmano, Roxane Peres, Emmanuelle Robinet-Borgmano, Cécile Dulau, Basile Kerleroux, Caroline Rey, Hervé Brunel, Phillipe Dory-Lautrec, Jean-François Hak, Pierre Lehmann, Sivadji Vingadalassalom. Bastia: Basile Kerleroux, Jérôme Berge, Federico Sacchetti. Annecy: Fabrice Bing, Mathieu Bonnerot, Isabelle Berger, Nathalie Morel, Gilles Rodier, Wilfried Vadot. GSR-ET Steering Committee: RWTH Aachen University: Arno Reich (Department of Neurology), Omid Nikoubashman (Department of Neuroradiology). Charité – Universitätsmedizin Berlin: Christian Nolte (Department of Neurology), Eberhard Siebert (Department of Neuroradiology). University Hospital Bonn: Gabor Petzold (Department of Vascular Neurology), Franziska Dorn (Department of Neuroradiology). University Hospital Frankfurt: Jan Hendrik SCHÄFER (Department of Neurology), Fee Keil (Department of Neuroradiology). University Medical Center Göttingen: Ilko L Maier (Department of Neurology), Marielle S Ernst (Department of Neuroradiology). Bezirkskrankenhaus Günzburg: Gerhard F Hamann (Department of Neurology), Michael Braun (Department of Neuroradiology). Asklepios Klinik Hamburg Altona: Anna Alegiani (Department of Neurology), Joachim Rother (Department of Neurology), Bernd Eckert (Department of Neuroradiology). University Medical Center Hamburg-Eppendorf: Maximilian Schell (Department of Neurology), Götz Thomalla (Department of Neurology), Fabian Flottmann (Department of Neuroradiology), Jens Fiehler (Department of Neuroradiology). Klinikum Hanau: Mario Abruscato (Department of Neurology), Sven Thonke (Department of Neurology). Klinikum Nordstadt Hannover: Arman Gregor (Department of Neurology), Evdokia Evangelidou (Department of Neuroradiology). University Medical Center Mainz: Timo Uphaus (Department of Neurology), Klaus Gröschel (Department of Neurology). Johannes Wesling Klinikum Minden: Peter Schellinger (Department of Neurology), Jan Borggrefe (Department of Radiology). Ludwig Maximilian University Munich: Lars Kellert (Department of Neurology), Hanna Zimmermann (Department of Neuroradiology), Steffen Tiedt (Institute for Stroke and Dementia Research). Klinikum rechts der Isar, Technical University of Munich: Silke Wunderlich (Department of Neurology), Tobias Boeckh-Behrens (Department of Neuroradiology). Klinikum Osnabrück: Martina Petersen (Department of Neurology), Lars Krause (Department of Neurology). University Hospital Tübingen: Sven Poli (Department of Neurology), Ulrike Ernemann (Department of Neuroradiology).

      • Contributors All authors have made significant contributions to the conception, design, execution, and interpretation of this study. BG and SP contributed equally to the study’s conceptualization, methodology, and overall supervision. SNF was involved in data analysis. JM, XH, FH, BL, and UE contributed to the acquisition and validation of clinical data. AM performed manuscript preparation, study design, and final review process. Guarantors: AM and BG. Proofread the manuscript.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

      • Competing interests SP: Steering Committee member of the German Stroke Registry. Outside of the submitted work: research support from BMS/Pfizer, Boehringer Ingelheim, Daiichi Sankyo, German Federal Joint Committee Innovation Fund, and German Federal Ministry of Education and Research, Helena Laboratories and Werfen as well as speakers’ honoraria/consulting fees from Alexion, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb/Pfizer, Daiichi Sankyo, Portola, and Werfen. UE: Steering Committee member of the German Stroke Registry.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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      Stent retriever size and outcomes after anterior circulation occlusion thrombectomy (2025)

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