New Stent Retriever Technology Versus Standard Devices for Anterior Large Vessel Thrombectomy: A Multicenter Study

Abstract

BACKGROUND AND PURPOSE: Guidelines recommend stent retrievers (SRs) for treating large vessel occlusion (LVO) stroke. We assessed noninferiority of the iNtercept (iVascular) SR with a self-expanding basket on a pusher wire versus contemporary SRs (CSRs) using propensity score (PS) matching analysis. METHODS: We analyzed data from the ROSSETTI multicenter registry of patients with anterior circulation LVO to compare procedural (recanalization rates according to the modified Thrombolysis In Cerebral Infarction (mTICI) score and procedural complications), clinical (modified Rankin Scale at 90 days), and safety (symptomatic intracranial hemorrhage, mortality at 90 days) outcomes of patients treated with iNtercept or CSRs (Solitaire, Trevo, and EmboTrap) as a first-line strategy, with or without balloon-guide catheter (BGC + SR, BCG - SR) after PS matching. Non-inferiority of iNtercept was established if the prespecified lower bound of the 95% confidence interval was over -10%. RESULTS: A total of 164 and 132 patients treated first-line by iNtercept were matched to 656 and 132 patients treated first-line by CSR + BGC and CSR - BGC, respectively. After matching, successful reperfusion (mTICI2b/3) after first-line strategy was achieved in 53.7% and 54.8% in the iNtercept versus CSR + BGC groups, respectively (absolute difference, -0.1%), and 53.8% and 51.3% in the iNtercept versus CSR - BGC, respectively (2.6%). Final reperfusion rates and favorable 90-day outcomes were similar. iNtercept had fewer sICH, procedural complications, and emboli in a new territory than CSR + BGC, and fewer procedural complications than CSR - BGC. CONCLUSIONS: This multicenter registry with PS matching demonstrated the non-inferiority of iNtercept to approved CSRs for successful reperfusion in LVO acute ischemic stroke.