Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke: Primary Results of the STRATIS Registry.

Stroke

From the Advanced Neuroscience Network/Tenet South Florida (N.H.M.-K., R.K.); St Vincent Mercy Hospital, Toledo, OH (O.O.Z.); Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.); University of California Los Angeles (R.J., J.L.S., D.S.L., S. Starkman); Brigham and Women's Hospital, Boston, MA (M.A.A.-S.); Methodist Hospital, Houston, TX (R.P.K.); Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.); University of Miami Miller School of Medicine/Jackson Memorial Hospital, FL (D.R.Y., E.C.P.); Norton Neuroscience Institute, Norton Healthcare, Louisville, KY (T.L.Y., S.R.D.); University of Pittsburgh Medical Center, PA (A.P.J.); WellStar Neurosciences Network, WellStar Kennestone Regional Medical Center, Marietta, GA (R.G.); Valley Baptist Medical Center, Harlingen, TX (A.E.H.); St Luke's Hospital of Kansas City, MO (C.O.M.); Oregon Health and Science University Hospital, Portland, OR (H.B.); Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA (R.G.N., D.C.H.); Baptist Health Lexington/Central Baptist, KY (C.A.G.); South Broward Hospital, Hollywood, FL (B.P.M.); Providence St Vincent Medical Center, Portland, OR (V.D.); Baptist Hospital of Miami, FL (I.L.); St Dominic's-Jackson Memorial Hospital, MS (S.H.M.); University of Tennessee Medical Center, Knoxville (P.K.); Advocate Christ Medical Center, Oak Lawn, IL (T.J.G.); Cleveland Clinic, OH (M.S.H.); Baylor University Medical Center, Dallas, TX (I.T.); OhioHealth Riverside Methodist Hospital, Columbus (N.V.); Memorial Hermann Texas Medical Center, Houston (P.R.C.); Swedish Medical Center First Hill Campus, Seattle, WA (S.J.M.); Maine Medical Center, Portland (R.D.E.); Geisinger Clinic, Danville, PA (C.M.S.); Baptist Medical Center-Jacksonville, FL (E.S.); Baptist Hospital Louisville, KY (A.A.-C.); Barnes Jewish Hospital, St Louis, MO (C.P.D.); Mercy San Juan Medical Center and Mercy General, Carmichael, CA (L.M.); Presence St Joseph Medical Center, Joliet, IL (A. Badruddin); Buffalo General Medical Center, NY (A.H.S.); University of Arizona Medical Center, Tucson (T.M.D.); University of Kentucky Hospital, Lexington (A.A.); Los Robles Medical Center, Thousand Oaks, CA (M.A.T.); Aurora Hospital, Milwaukee, WI (K.A.); West Virginia University/Ruby Memorial Hospital, Morgantown, WV (J.C.); Albany Medical Center, NY (A. Boulos); University of Maryland Medical Center, Baltimore (G.J.); University of Massachusetts Memorial Medical Center, Worcester (A.S.P.); Crouse Hospital, Syracuse, NY (E.M.D.); Virginia Mason Medical Center, Seattle, WA (D.H.R.); Mayo Clinic-Rochester, MN (D.F.K.); Erlanger Medical Center, Chattanooga, TN (B.W.B.); ProMedica Toledo Hospital, OH (M.A.J.); Banner University Medical Center, Phoenix, AZ (P.S.); McLaren Flint, MI (A.M.); California Pacific Medical Center, San Francisco (J.D.E.); University of California, Irvine, Orange (S. Suzuki); St John Providence Hospital, Detroit, MI (R.D.F.); Abbott Northwestern Hospital, Minneapolis, MN (J.E.D.A.); and Carolinas Medical Center, Charlotte, NC (J.C.M.).

Published: October 2017

Mechanical thrombectomy with stent retrievers is now standard for treating acute ischemic stroke due to large vessel occlusion, as shown by the STRATIS registry which aimed to evaluate real-world treatment outcomes compared to randomized trials.
The study involved 984 patients treated within 8 hours of symptom onset at 55 sites in the U.S., finding key metrics such as a median arrival-to-puncture time of 138 minutes and an 87.9% success rate in achieving sufficient blood flow restoration.
At 90 days post-treatment, 56.5% of patients had a favorable recovery, but delays in treatment increased the risk of worse outcomes, highlighting the need for improved care systems to enhance patient results.

Background And Purpose: Mechanical thrombectomy with stent retrievers has become standard of care for treatment of acute ischemic stroke patients because of large vessel occlusion. The STRATIS registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) aimed to assess whether similar process timelines, technical, and functional outcomes could be achieved in a large real world cohort as in the randomized trials.

Methods: STRATIS was designed to prospectively enroll patients treated in the United States with a Solitaire Revascularization Device and Mindframe Capture Low Profile Revascularization Device within 8 hours from symptom onset. The STRATIS cohort was compared with the interventional cohort of a previously published SEER patient-level meta-analysis.

Results: A total of 984 patients treated at 55 sites were analyzed. The mean National Institutes of Health Stroke Scale score was 17.3. Intravenous tissue-type plasminogen activator was administered in 64.0%. The median time from onset to arrival in the enrolling hospital, door to puncture, and puncture to reperfusion were 138, 72, and 36 minutes, respectively. The Core lab-adjudicated modified Thrombolysis in Cerebral Infarction ≥2b was achieved in 87.9% of patients. At 90 days, 56.5% achieved a modified Rankin Scale score of 0 to 2, all-cause mortality was 14.4%, and 1.4% suffered a symptomatic intracranial hemorrhage. The median time from emergency medical services scene arrival to puncture was 152 minutes, and each hour delay in this interval was associated with a 5.5% absolute decline in the likelihood of achieving modified Rankin Scale score 0 to 2.

Conclusions: This largest-to-date Solitaire registry documents that the results of the randomized trials can be reproduced in the community. The decrease of clinical benefit over time warrants optimization of the system of care.

Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02239640.

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http://dx.doi.org/10.1161/STROKEAHA.117.016456	DOI Listing

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