A multicenter, propensity score-matched analysis of functional outcomes and recanalization success with or without Trevo for Medium and distal vessel occlusion

James E Siegler^{1

2}, Manisha Koneru¹, Hamza Shaikh¹, Hamza Adel Salim^{3

4}, Basel Musmar⁵, Nimer Adeeb⁵, Vivek Yedavalli³, Motaz Daraghma⁴, Kareem El Naamani⁶, Nils Henninger⁷, Sri Hari Sundararajan⁸, Anna Luisa Kühn⁹, Sherief Ghozy¹⁰, Luca Scarcia¹¹, Benjamin Yq Tan^{12

13}, Jeremy J Heit¹⁴, Robert W Regenhardt⁴, Rami Z Morsi², Tareq Kass-Hout², Nicholas Vigilante², Nicole M Cancelliere¹⁵, Joshua D Bernstock¹⁶, Aymeric Rouchaud¹⁷, Jens Fiehler^{9

18}, Sunil A Sheth¹⁹, Muhammed Amir Essibayi²⁰, Ajit S Puri⁹, Christian Dyzmann²¹, Marco Colasurdo²², Xavier Barreau²³, Leonardo Renieri²⁴, João Pedro Filipe²⁵, Pablo Harker²⁶, Răzvan Alexandru Radu²⁷, Thomas R Marotta¹⁵, Julian Spears¹⁵, Takahiro Ota²⁸, Ashkan Mowla²⁹, Pascal Jabbour⁶, Arundhati Biswas³⁰, Frédéric Clarençon³¹, Piers Klein³², Mohamad Abdalkader³², Thanh N Nguyen³², Ricardo Varela³³, Amanda Baker²⁰, David Altschul²⁰, Nestor R Gonzalez³⁴, Markus A Möhlenbruch³⁵, Vincent Costalat²⁷, Benjamin Gory^{36

37}, Christian Paul Stracke³⁸, Constantin Hecker³⁹, Christoph J Griessenauer³⁹, David S Liebeskind⁴⁰, Alessandro Pedicelli⁴¹, Andrea M Alexandre⁴¹, Illario Tancredi⁴², Tobias D Faizy⁴³, Erwah Kalsoum¹¹, Boris Lubicz⁴⁴, Aman B Patel⁴, Vitor Mendes Pereira¹⁵, Jane Khalife¹, Ankit Rana¹, Adrien Guenego⁴⁴, Adam A Dmytriw^{4

15}; MAD MT Investigators

Affiliations

¹ Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA.
² Department of Neurology, University of Chicago, Chicago, IL, USA.
³ Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA.
⁴ Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁵ Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Baton Rouge, LA, USA.
⁶ Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
⁷ Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA.
⁸ Department of Endovascular Neurosurgery and Neuroradiology NJMS, Newark, NJ, USA.
⁹ Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA.
¹⁰ Departments of Neurological Surgery & Radiology, Mayo Clinic, Rochester, MN, USA.
¹¹ Department of Neuroradiology, Henri Mondor Hospital, Creteil, France.
¹² Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
¹³ Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore.
¹⁴ Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA.
¹⁵ Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael Hospital, University of Toronto, Toronto, ON, Canada.
¹⁶ Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
¹⁷ University Hospital of Limoges, Neuroradiology Department, Université de Limoges, XLIM CNRS, Dupuytren, UMR, France.
¹⁸ Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁹ Department of Neurology, UTHealth McGovern Medical School, Houston, TX, USA.
²⁰ Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
²¹ Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Germany.
²² Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA.
²³ Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France.
²⁴ Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy.
²⁵ Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
²⁶ Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA.
²⁷ Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.
²⁸ Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
²⁹ Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA.
³⁰ Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.
³¹ Department of Neuroradiology, Pitié-Salpêtrière Hospital, GRC BioFast. Sorbonne University, Paris VI, France.
³² Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.
³³ Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
³⁴ Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, USA.
³⁵ Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany.
³⁶ Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France.
³⁷ CHRU-Nancy, INSERM U1254, Université de Lorraine, CIC, Innovations Technologiques, Nancy, France.
³⁸ Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Munster, Germany.
³⁹ Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria.
⁴⁰ UCLA Stroke Center and Department of Neurology Department, UCLA, Los Angeles, California, USA.
⁴¹ UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
⁴² Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium.
⁴³ Department of Radiology, Neuroendovascular Program, University Medical Center, Münster, Germany.
⁴⁴ Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium.

PMID: 40398470
PMCID: PMC12095220
DOI: 10.1177/15910199251341603

A multicenter, propensity score-matched analysis of functional outcomes and recanalization success with or without Trevo for Medium and distal vessel occlusion

James E Siegler et al. Interv Neuroradiol. 2025.

. 2025 May 21:15910199251341603.

doi: 10.1177/15910199251341603. Online ahead of print.

Authors

Affiliations

¹ Cooper Neurological Institute, Cooper University Hospital, Cooper Medical School of Rowen University, Camden, NJ, USA.
² Department of Neurology, University of Chicago, Chicago, IL, USA.
³ Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA.
⁴ Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁵ Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, Baton Rouge, LA, USA.
⁶ Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA.
⁷ Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA.
⁸ Department of Endovascular Neurosurgery and Neuroradiology NJMS, Newark, NJ, USA.
⁹ Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, MA, USA.
¹⁰ Departments of Neurological Surgery & Radiology, Mayo Clinic, Rochester, MN, USA.
¹¹ Department of Neuroradiology, Henri Mondor Hospital, Creteil, France.
¹² Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
¹³ Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore.
¹⁴ Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA.
¹⁵ Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael Hospital, University of Toronto, Toronto, ON, Canada.
¹⁶ Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
¹⁷ University Hospital of Limoges, Neuroradiology Department, Université de Limoges, XLIM CNRS, Dupuytren, UMR, France.
¹⁸ Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁹ Department of Neurology, UTHealth McGovern Medical School, Houston, TX, USA.
²⁰ Department of Neurological Surgery and Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
²¹ Neuroradiology Department, Sana Kliniken, Lübeck GmbH, Lübeck, Germany.
²² Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA.
²³ Interventional Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France.
²⁴ Interventistica Neurovascolare, Ospedale Careggi di Firenze, Florence, Italy.
²⁵ Department of Diagnostic and Interventional Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
²⁶ Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH, USA.
²⁷ Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.
²⁸ Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
²⁹ Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA.
³⁰ Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY, USA.
³¹ Department of Neuroradiology, Pitié-Salpêtrière Hospital, GRC BioFast. Sorbonne University, Paris VI, France.
³² Departments of Radiology & Neurology, Boston Medical Center, Boston, MA, USA.
³³ Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
³⁴ Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, USA.
³⁵ Sektion Vaskuläre und Interventionelle Neuroradiologie, Universitätsklinikum Heidelberg, Heidelberg, Germany.
³⁶ Department of Interventional Neuroradiology, Nancy University Hospital, Nancy, France.
³⁷ CHRU-Nancy, INSERM U1254, Université de Lorraine, CIC, Innovations Technologiques, Nancy, France.
³⁸ Department of Radiology, Interventional Neuroradiology Section, University Medical Center Münster, Munster, Germany.
³⁹ Departments of Neurology & Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria.
⁴⁰ UCLA Stroke Center and Department of Neurology Department, UCLA, Los Angeles, California, USA.
⁴¹ UOSA Neuroradiologia Interventistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
⁴² Department of Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium.
⁴³ Department of Radiology, Neuroendovascular Program, University Medical Center, Münster, Germany.
⁴⁴ Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium.

PMID: 40398470
PMCID: PMC12095220
DOI: 10.1177/15910199251341603

Abstract

BackgroundEndovascular therapy (EVT) for stroke due to distal or medium vessel occlusion (DMVO) is safe. Due to the distinct anatomical characteristics of DMVOs, further evaluation of EVT is crucial to determine which devices may yield better outcomes.MethodsA retrospective analysis of adults with DMVO treated in 37 centers (11 countries) was queried. The primary outcome of favorable shift in 90-day modified Rankin Scale (mRS) was compared between patients treated with Trevo versus other devices on first pass using 1:1 propensity score matching (PSM) with multivariable adjustment. Secondary outcomes included the number of pass attempts, final thrombolysis in cerebral infarction (TICI) score 2b-3, symptomatic intracranial hemorrhage (sICH), improvement in National Institutes of Health Stroke Scale (NIHSS) at 24h, and 90-day mortality.ResultsOf the 1115 included patients, 264 (24%) were treated with Trevo (PSM cohort of 261 per group). Trevo use was not associated with a favorable 90-day mRS shift (proportional odds ratio [OR] 1.10, 95% confidence interval [CI] 0.80-1.51). Trevo was associated with fewer passes (adjusted β=-0.25, 95% CI -0.48 - -0.03), higher odds of TICI 2b-3 (adjusted OR 1.97, 95% CI 1.11-3.49), and a greater 24h NIHSS improvement (adjusted β= -1.74, 95% CI -3.11 - -0.36), with no difference in sICH or mortality (p>0.05). Results were similar in sensitivity analyses.ConclusionsWe observed no safety concerns with Trevo as compared to other EVT devices for DMVO recanalization. There was a signal of better technical efficacy and early clinical improvement.

Keywords: Endovascular thrombectomy; Trevo stent-retriever; acute ischemic stroke; distal vessel occlusion; medium vessel occlusion.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

**Figure 1.**
Inclusion flow chart. MAD-MT denotes Multicenter Analysis of primary distal, medium vessel occlusions–Effect of Mechanical Thrombectomy, and mRS modified Rankin Scale.

**Figure 2.**
Distribution of 90-day mRS according to treatment. mRS denotes modified Rankin Scale.

**Figure 3.**
Distribution in change in NIHSS by 24 h. Violin plot illustrating difference between 24-h and pre-intervention mRS according to device, with negative numbers indicating a reduction (improvement) in NIHSS (p < 0.01 for difference). Open circles represent the median change, with horizontal lines connecting the interquartile ranges of the two groups and vertical spikes reflecting upper- and lower-adjacent values (upper quartile + 1.5 the interquartile range and lower quartile - 1.5 the interquartile range). A red horizontal reference line at 0 indicates no improvement in NIHSS. NIHSS denotes the National Institutes of Health Stroke Scale.

See this image and copyright information in PMC

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A multicenter, propensity score-matched analysis of functional outcomes and recanalization success with or without Trevo for Medium and distal vessel occlusion

Affiliations

A multicenter, propensity score-matched analysis of functional outcomes and recanalization success with or without Trevo for Medium and distal vessel occlusion

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Grants and funding

LinkOut - more resources

Full Text Sources

Miscellaneous