Contemporary Results of Mechanical Thrombectomy and Impact of First-Line Technique on Outcome: The INSPIRE-S Global Registry

Abstract

BACKGROUND AND PURPOSE: Three mechanical thrombectomy (MT) techniques are predominantly used for the treatment of acute ischemic stroke (AIS): stent retriever only (SR), aspiration only (ASP), and combination therapy (CT) with a general goal of achieving first-pass reperfusion (FPR; expanded TICI [eTICI] $ 2c). Factors influencing FPR and the relative efficacy and safety of the 3 techniques are loosely understood. MATERIALS AND METHODS: The Innovative Neurovascular Product Surveillance Registry (INSPIRE-S) is a prospective, imaging core-lab–adjudicated, safety clinical events committee–adjudicated, global registry of patients with AIS 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 6 1.3. Among the techniques, the primary end point, good clinical outcome (mRS # 2 or return to prestroke mRS) at 90 days was achieved in 60.5% in SR, 52.8% in ASP, and 56.6% in CT (P . .05 in unadjusted and adjusted analyses). The FPR rates were 48.6% in SR, 39.9% in ASP, and 47.5% in CT (P . .05), and final complete (eTICI $ 2c) reperfusion rates were 77.4% in SR, 70.6% in ASP, and 72.0% in CT (P . .05 in adjusted analyses). In subgroup analyses by occlusion location, ASP had the lowest FPR in the ICA (P ¼ .003), while ASP was more frequently employed than SR for ICA (P ¼ .03). There was no significant difference in FPR among techniques when patients were treated with site-preferred technique. The overall rates of Clinical Events Committee–adjudicated all-cause mortality (14.0%) and symptomatic intracranial hemorrhage (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.