The real-life use of the EmboTrap device (Neuravi/Cerenovus) has provided “very good outcomes” when compared to that observed in large mechanical thrombectomy trials which included a highly-selective patient population.
Patrick Brouwer (Karolinska Hospital, Stockholm, Sweden) presented his centre’s experience using the EmboTrap to treat 166 acute ischaemic stroke patients at the Society of NeuroInterventional Surgery 14th Annual Meeting (SNIS; 24–27 July, Colorado Springs, USA).
Brouwer described “real-life” as no pre-defined selection criteria, where patients are treated according to a case-based clinical judgement. “In our experience we have treated posterior circulation and tandem lesions and the operators were at various levels (some were even fellows),” he explained.
According to Brouwer, the treatment strategy at Karolinska changed a little over time, for example, the positioning of the device and the decision not to wait the four-minute period after the deployment of the device were changes made by the operators. Further, he explained, they no longer do runs after opening the device and stent retriever is combined with dual aspiration in a large number of cases.
All of the data are assessed by a core lab and an independent neurologist, who sees the patient but does not know the treatment, scores the clinical data.
In the Karolinska experience of 166 patients, 77% of patients were transferred from another hospital and IV t-PA was given in 45% of the cases. In terms of clot location, the majority of occlusions were in the MCA, but 16% were located in the posterior circulation and 17.5% were tandem lesions.
The median time from symptom onset to imaging was 90 minutes, the median time from first imaging to imaging in the treatment hospital was 100 minutes, reflecting the high number of transferred patients, and the median time from first imaging to groin puncture was 120 minutes—the minimum time was 15 minutes and the maximum time was 26 hours and 10 minutes.
In terms of procedure times, Brouwer reported that the median time from groin puncture to device in place was 18 minutes, and the median time from groin puncture to end result was 55 minutes. The TICI 2b–3 score was 84.2% and the average number of passes was 2.4. The number of patients with an mRS score of 6 was 11% and 25 cases are missing data because the patients have not yet reached the three month follow-up period.
“mRS 0–2 is 57.6%, but we have to break that down because 15 patients had a pre-stroke mRS of 2, 11 patients had a pre-stroke mRS of 3 and one patient had an mRS 5 before we started treating. If we correct for this, we will get a compensated mRS 0–2 of 69.8%,” Brouwer explained.
“The conclusion is that the EmboTrap has proved to be an effective and easy to use device in our centre, even being used by operators of varying degrees of experience. These results of a real-life analysis show a very good outcome in comparison with large studies with a highly-selective patient population, which we did not have,” Brouwer added.