AUTHOR=Kraehling Hermann , Akkurt Burak Han , Elsharkawy Mohamed , Schwindt Wolfram , Köhler Michael , Werring Nils , Masthoff Max , Cox Anthony , Minks David , Stracke Christian Paul 

TITLE=Evaluation of effectiveness and safety of the large-format pRESET 6-50 thrombectomy stent-retriever in the endovascular treatment of ischemic stroke: real-world experiences from two tertiary comprehensive stroke centers

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1256365

DOI=10.3389/fneur.2023.1256365

ISSN=1664-2295

ABSTRACT=Mechanical thrombectomy (MT) has become the standard treatment in acute ischemic stroke (AIS) with large vessel occlusion (LVO). First-pass (FP) reperfusion of the occluded vessel and fewer passes with stent-retrievers show improvement of functional outcome in stroke patients while higher numbers of passes are associated with higher complication rates and worse outcomes. Studies indicate that a larger size of the stent-retriever is associated with a higher rate of first-pass reperfusion and improved clinical outcome.
In this retrospective study, we investigated the clinical performance of a recently developed and one of the largest stent-retrievers available in the treatment of LVO (pRESET-6-50, phenox GmbH, Bochum).

All consecutive patients with ischemic stroke due to proximal large vessel occlusion treated with MT using the pRESET-6-50-stent-retriever in two tertiary stroke centers between 09/2021–07/2022 were included in this study. The reperfusion rate after MT was quantified by the modified thrombolysis in cerebral infarction (mTICI) score and functional neurological outcome was evaluated with the National Institutes of Health Stroke Scale (NIHSS) score and the major early neurological recovery (mENR) rate after 24 hours. Successful FP reperfusion was defined as mTICI≥2b. Successful and complete reperfusion were defined as mTICI≥2b and mTICI≥2c respectively.

98 patients (46 female, median age 75 (25 – 95)) were included. 70 (72%) patients presented with occlusion of the middle cerebral artery (MCA) in the M1-segment, 6 (6%) patients with occlusion of the M2-segment, 17 (17%) patients with occlusion of the internal carotid artery (ICA) and 5 (5%) patients with obstructed basilar artery (BA).
Successful FP reperfusion was achieved in 58 patients (62%). Successful and complete reperfusion were achieved in 95 (97%) and 82 (83%) patients, respectively. 
Median National Institutes of Health Stroke Scale (NIHSS) in all treated patients improved from 17 to 7.5. Major early neurological recovery (mENR) was observed in 34 patients (35.1%).

MT with the pRESET 6-50 stent-retriever achieves high successful first pass and final reperfusion rates in patients with AIS and LVO. The results of this study support the thesis to use large-format stent-retriever in proximal vessel occlusion MT whenever feasible in order to improve high FP and final reperfusion rate.