Contemporary Results of Mechanical Thrombectomy and Impact of First-Line Technique on Outcome: The INSPIRE-S Global Registry.
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BORIS DOI
Date of Publication
June 12, 2025
Publication Type
Article
Division/Institute
Author
Rodrigo-Gisbert, Marc | |
Ribo, Marc | |
Möhlenbruch, Markus | |
Nayak, Sanjeev | |
Cognard, Christophe | |
Fiehler, Jens | |
Defreyne, Luc | |
González, Eva | |
Vega, Pedro | |
Tsang, Anderson | |
Orion, David | |
Piasecki, Piotr | |
Ribeiro, Manuel | |
Fernández-Prieto, Andrés | |
Gentric, Jean C | |
Vila, Oscar | |
Elsheikh, Samer | |
Barbier, Charlotte | |
Machi, Paolo | |
Stockx, Luc | |
Costalat, Vincent | |
Lylyk, Pedro | |
González, Alejandro | |
Lagios, Konstantinos | |
Naggara, Olivier | |
Spelle, Laurent | |
Larrea, Jose A | |
Eker, Omer F | |
Lobotesis, Kyriakos | |
Rautio, Riitta |
Subject(s)
Series
American Journal of Neuroradiology
ISSN or ISBN (if monograph)
1936-959X
0195-6108
Publisher
American Society of Neuroradiology
Language
English
Publisher DOI
PubMed ID
40506228
Description
Background And Purpose
Three mechanical thrombectomy (MT) techniques are predominantly used for the treatment of acute ischemic stroke (AIS): stent retriever (SR) alone, aspiration (ASP) alone, and combination therapy (CT) with a general goal of achieving first-pass reperfusion (FPR: eTICI≥2c). Factors influencing FPR and the relative efficacy and safety of the 3 techniques are loosely understood.
Materials And Methods
INSPIRE-S is a prospective, imaging core-lab adjudicated, safety clinical events committee adjudicated, global registry of AIS patients treated with Medtronic Neurovascular devices on the first pass and grouped according to first-pass MT technique.
Results
From May 2020 through December 2022, 802 patients (29 sites, 13 countries) who met eligibility criteria were enrolled in the INSPIRE-S registry and were grouped by first-pass MT technique (259 in SR, 146 in ASP, and 397 in CT). Overall, MCA-M1/M2 occlusions were present in 76.1% of patients, and the mean number of passes was 1.9±1.3. Among the techniques, the primary endpoint, good clinical outcome (mRS≤ 2 or mRS≤ pre-stroke mRS) at 90 days was achieved in 60.5% in SR, 52.8% in ASP, and 56.6% in CT (p>0.05 in unadjusted and adjusted analyses). The FPR rates were 48.6% in SR, 39.9% in ASP, and 47.5% in CT (p>0.05), and final complete (eTICI≥2c) reperfusion rates were 77.4% in SR, 70.6% in ASP, and 72.0% in CT (p>0.05 in adjusted analyses). In subgroup analyses by occlusion location, ASP had the lowest FPR in the ICA (p=0.003), while ASP was more frequently employed than SR for ICA (p=0.03). There was no significant difference in FPR among techniques when patients were treated with site-preferred technique. The overall rates of CEC-adjudicated all-cause mortality (14.0%) and sICH (1.5%) did not significantly differ among the techniques.
Conclusions
The primary results of real-world data from INSPIRE-S showed overall high rates of first pass complete reperfusion and final clinical outcomes that were similar among the 3 MT techniques.
Abbreviations
AIS＝ Acute Ischemic Stroke; CT＝ Combined technique; ASP＝ Aspiration alone; LVO＝ Large vessel occlusion; MT＝ Mechanical Thrombectomy; SR＝ Stent Retriever alone.
Three mechanical thrombectomy (MT) techniques are predominantly used for the treatment of acute ischemic stroke (AIS): stent retriever (SR) alone, aspiration (ASP) alone, and combination therapy (CT) with a general goal of achieving first-pass reperfusion (FPR: eTICI≥2c). Factors influencing FPR and the relative efficacy and safety of the 3 techniques are loosely understood.
Materials And Methods
INSPIRE-S is a prospective, imaging core-lab adjudicated, safety clinical events committee adjudicated, global registry of AIS patients treated with Medtronic Neurovascular devices on the first pass and grouped according to first-pass MT technique.
Results
From May 2020 through December 2022, 802 patients (29 sites, 13 countries) who met eligibility criteria were enrolled in the INSPIRE-S registry and were grouped by first-pass MT technique (259 in SR, 146 in ASP, and 397 in CT). Overall, MCA-M1/M2 occlusions were present in 76.1% of patients, and the mean number of passes was 1.9±1.3. Among the techniques, the primary endpoint, good clinical outcome (mRS≤ 2 or mRS≤ pre-stroke mRS) at 90 days was achieved in 60.5% in SR, 52.8% in ASP, and 56.6% in CT (p>0.05 in unadjusted and adjusted analyses). The FPR rates were 48.6% in SR, 39.9% in ASP, and 47.5% in CT (p>0.05), and final complete (eTICI≥2c) reperfusion rates were 77.4% in SR, 70.6% in ASP, and 72.0% in CT (p>0.05 in adjusted analyses). In subgroup analyses by occlusion location, ASP had the lowest FPR in the ICA (p=0.003), while ASP was more frequently employed than SR for ICA (p=0.03). There was no significant difference in FPR among techniques when patients were treated with site-preferred technique. The overall rates of CEC-adjudicated all-cause mortality (14.0%) and sICH (1.5%) did not significantly differ among the techniques.
Conclusions
The primary results of real-world data from INSPIRE-S showed overall high rates of first pass complete reperfusion and final clinical outcomes that were similar among the 3 MT techniques.
Abbreviations
AIS＝ Acute Ischemic Stroke; CT＝ Combined technique; ASP＝ Aspiration alone; LVO＝ Large vessel occlusion; MT＝ Mechanical Thrombectomy; SR＝ Stent Retriever alone.