Trevo 3 Mm and/or AXS Catalyst 5 for the Treatment of Medium Distal Vessel Occlusion Stroke-results from the ASSIST Registry

Nikolaos Ntoulias¹, Alex Brehm¹, Salvador Miralbés², Bharath Naravetla^{3

4}, Alejandro Spiotta⁵, Christian Loehr⁶, Mario Martínez-Galdámez⁷, Ryan McTaggart⁸, Luc Defreyne⁹, Pedro Vega¹⁰, Osama O Zaidat¹¹, Lori Lyn Price¹², David S Liebeskind¹³, Markus Möhlenbruch¹⁴, Rishi Gupta¹⁵, Marios-Nikos Psychogios^{16

17}; ASSIST Investigator

Affiliations

¹ Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland.
² Neuroradiology, Hospital Son Espases, Mallorca, Spain.
³ Interventional Neurology, McLaren Regional Medical Center, Flint, MI, USA.
⁴ Interventional Neurology, McLaren Regional Medical Center, Macomb, MI, USA.
⁵ Neurosurgery, Medical University of South Carolina, Charleston, SC, USA.
⁶ Radiology and Neuroradiology, Klinikum Vest Recklinghausen, Recklinghausen, Germany.
⁷ Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
⁸ Interventional Neuroradiology, Rhode Island Hospital, Providence, RI, USA.
⁹ Vascular and Interventional Radiology, Ghent University Hospital, Ghent, Belgium.
¹⁰ Radiology, Hospital Universitario Central de Asturias-HUCA, Oviedo, Spain.
¹¹ euroscience Department, Bon Secours Mercy Health St. Vincent Medical Center, Toledo, OH, USA.
¹² Stryker Neurovascular, Fremont, CA, USA.
¹³ Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
¹⁴ Neuroradiology, Uniklinik Heidelberg, Heidelberg, Germany.
¹⁵ Wellstar Medical Group, Neurosurgery, WellStar Health System, Marietta, GA, USA.
¹⁶ Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland. Marios.psychogios@usb.ch.
¹⁷ Department of Neuroradiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland. Marios.psychogios@usb.ch.

PMID: 39179880
PMCID: PMC11832688
DOI: 10.1007/s00062-024-01450-y

Multicenter Study

Trevo 3 Mm and/or AXS Catalyst 5 for the Treatment of Medium Distal Vessel Occlusion Stroke-results from the ASSIST Registry

Nikolaos Ntoulias et al. Clin Neuroradiol. 2025 Mar.

. 2025 Mar;35(1):51-57.

doi: 10.1007/s00062-024-01450-y. Epub 2024 Aug 23.

Authors

Affiliations

¹ Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland.
² Neuroradiology, Hospital Son Espases, Mallorca, Spain.
³ Interventional Neurology, McLaren Regional Medical Center, Flint, MI, USA.
⁴ Interventional Neurology, McLaren Regional Medical Center, Macomb, MI, USA.
⁵ Neurosurgery, Medical University of South Carolina, Charleston, SC, USA.
⁶ Radiology and Neuroradiology, Klinikum Vest Recklinghausen, Recklinghausen, Germany.
⁷ Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
⁸ Interventional Neuroradiology, Rhode Island Hospital, Providence, RI, USA.
⁹ Vascular and Interventional Radiology, Ghent University Hospital, Ghent, Belgium.
¹⁰ Radiology, Hospital Universitario Central de Asturias-HUCA, Oviedo, Spain.
¹¹ euroscience Department, Bon Secours Mercy Health St. Vincent Medical Center, Toledo, OH, USA.
¹² Stryker Neurovascular, Fremont, CA, USA.
¹³ Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
¹⁴ Neuroradiology, Uniklinik Heidelberg, Heidelberg, Germany.
¹⁵ Wellstar Medical Group, Neurosurgery, WellStar Health System, Marietta, GA, USA.
¹⁶ Diagnostic and Interventional Neuroradiology, University Hospital Basel, Basel, Switzerland. Marios.psychogios@usb.ch.
¹⁷ Department of Neuroradiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland. Marios.psychogios@usb.ch.

PMID: 39179880
PMCID: PMC11832688
DOI: 10.1007/s00062-024-01450-y

Abstract

Background: The effect of endovascular therapy (EVT) on the outcome of stroke patients with a medium distal vessel occlusion (MDVO) is unclear. We report the results of MDVO patients treated with the 3 mm Trevo stent retriever (SR) and/or the AXS Catalyst 5 distal access catheter.

Methods: Data was derived from a prospective, multicenter global registry (ASSIST registry) which enrolled patients treated with operator preferred EVT technique at 71 sites from January 2019 to January 2022. Three techniques were assessed: SR classic, direct aspiration, and a combined approach. Additional inclusion criteria were (a) EVT performed with the 3 mm Trevo SR and/or AXS Catalyst 5 distal access catheter on the first pass and (b) an occlusion of the M2 segment or M3 segment of the middle cerebral artery or the A1, A2 or A3 segment of the anterior cerebral artery. The primary outcome was achieving an expanded Thrombolysis in Cerebral Infarction (eTICI) score of 2c or 3 on the first pass, with the primary technique as adjudicated by core lab. The primary clinical outcome measure was a 90-day modified Rankin Scale (mRS) score of 0-2.

Results: A total of 155 patients (10.4% of the ASSIST population) were included. Most patients had an M2 occlusion (93.5%). First pass eTICI reperfusion was achieved in 43.1% of the patients. No modifying effect of the frontline technique was found. The rate of mRS 0-2 (overall 65.0%) did not significantly differ between groups.

Conclusion: The data suggests that the Trevo 3 mm SR and/or the AXS Catalyst 5 may be an option to treat medium distal vessel occlusion, but more data is needed to demonstrate safety and efficacy in this patient cohort. Further improvements are needed regarding materials and techniques to improve reperfusion results in this patient cohort in the future.

Keywords: Distal vessel occlusion; Endovascular therapy; Ischemic stroke; Mechanical thrombectomy; Medium vessel occlusion.

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Conflict of interest statement

Conflict of interest: C. Loehr is a consultant for Penumbra, Phenox, Stryker. L. Defreyne is a consultant for Stryker. L.L. Price is an employee of Stryker and hold Stryker stock. D.S. Liebeskind is a consultant for Cerenovus, Genentech, Medtronic, Rapid Medical, Stryker, and Vesalio. M. Möhlenbruch received research grants from Acandis, Balt, Medtronic, Microvention, Phenox, Stryker* (*industry payments are made to the research fund of the institution), receives payment or honoraria for lectures from Balt, Medtronic, Stryker* (*industry payments are made to the research fund of the institution). R. Gupta serves as Principal Investigator (PI) for the ASSIST Registry (Stryker), PI for the RECCLAIM II Study (Zoll), Clinical Events Committee (CEC) for the MIND Trial (Penumbra), Data Safety Monitoring Board (DSMB) Membrane Study (Cerenovus), ELEVATE Study (Medtronic) consultant and stock options for Vesalio, Rapid Medical. M.‑N. Psychogios: Grants from the Swiss National Science Foundation (SNF) for the DISTAL trial (33IC30_198783), ICARUS (32003B_220118) and TECNO trial (32003B_204977), Grant from Bangerter-Rhyner Stiftung for the DISTAL trial. Unrestricted Grants for the DISTAL trial from Stryker Neurovascular Inc., Phenox GmbH, Penumbra Inc. and Rapid Medical Inc., Sponsor-PI SPINNERS trial (Funded by a Siemens Healthineers AG Grant), Research agreement with Siemens Healthineers AG, Local PI ACT in STROKE, XXXX, EXCELLENT, TENSION, COATING, SELECT‑2, SURF and ESCAPE-NEXT trials. Speaker fees: Stryker Neurovascular Inc., Medtronic Inc., Penumbra Inc., Acandis GmbH, Phenox GmbH, Siemens Healthineers AG. N. Ntoulias, A. Brehm, S. Miralbés, B. Naravetla, A. Spiotta, M. Martínez-Galdámez, R. McTaggart, P. Vega and O.O. Zaidat declare that they have no competing interests.

References

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Trevo 3 Mm and/or AXS Catalyst 5 for the Treatment of Medium Distal Vessel Occlusion Stroke-results from the ASSIST Registry

Affiliations

Trevo 3 Mm and/or AXS Catalyst 5 for the Treatment of Medium Distal Vessel Occlusion Stroke-results from the ASSIST Registry

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Research Materials

Miscellaneous