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. 2025 Jun 12:ajnr.A8848.
doi: 10.3174/ajnr.A8848. Online ahead of print.

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

Marc Rodrigo-Gisbert  1 , Marc Ribo  1 , Markus Möhlenbruch  1 , Sanjeev Nayak  1 , Christophe Cognard  1 , Jens Fiehler  1 , Luc Defreyne  1 , Eva González  1 , Pedro Vega  1 , Anderson Tsang  1 , David Orion  1 , Piotr Piasecki  1 , Manuel Ribeiro  1 , Andrés Fernández-Prieto  1 , Jean C Gentric  1 , Oscar Vila  1 , Samer Elsheikh  1 , Charlotte Barbier  1 , Paolo Machi  1 , Luc Stockx  1 , Vincent Costalat  1 , Pedro Lylyk  1 , Alejandro González  1 , Konstantinos Lagios  1 , Olivier Naggara  1 , Laurent Spelle  1 , Jose A Larrea  1 , Omer F Eker  1 , Kyriakos Lobotesis  1 , Riitta Rautio  1 , Pasquale Mordasini  1
Affiliations

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

Marc Rodrigo-Gisbert et al. AJNR Am J Neuroradiol. .

Abstract

Background and purpose: Three mechanical thrombectomy (MT) techniques are predominantly used for the treatment of acute ischemic stroke (AIS): stent retriever (SR) alone, aspiration (ASP) alone, and combination therapy (CT) with a general goal of achieving first-pass reperfusion (FPR: eTICI≥2c). Factors influencing FPR and the relative efficacy and safety of the 3 techniques are loosely understood.

Materials and methods: INSPIRE-S is a prospective, imaging core-lab adjudicated, safety clinical events committee adjudicated, global registry of AIS patients 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±1.3. Among the techniques, the primary endpoint, good clinical outcome (mRS≤ 2 or mRS≤ pre-stroke mRS) at 90 days was achieved in 60.5% in SR, 52.8% in ASP, and 56.6% in CT (p>0.05 in unadjusted and adjusted analyses). The FPR rates were 48.6% in SR, 39.9% in ASP, and 47.5% in CT (p>0.05), and final complete (eTICI≥2c) reperfusion rates were 77.4% in SR, 70.6% in ASP, and 72.0% in CT (p>0.05 in adjusted analyses). In subgroup analyses by occlusion location, ASP had the lowest FPR in the ICA (p=0.003), while ASP was more frequently employed than SR for ICA (p=0.03). There was no significant difference in FPR among techniques when patients were treated with site-preferred technique. The overall rates of CEC-adjudicated all-cause mortality (14.0%) and sICH (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.

Abbreviations: AIS＝ Acute Ischemic Stroke; CT＝ Combined technique; ASP＝ Aspiration alone; LVO＝ Large vessel occlusion; MT＝ Mechanical Thrombectomy; SR＝ Stent Retriever alone.

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Conflict of interest statement

Medtronic Neurovascular Clinical Affairs assisted with data analysis. MR reported receiving personal fees from Anaconda Biomed, AptaTargets, Cerenovus, Medtronic, Methinks, Philips, Sanofi, Stryker, Balt, and Rapid AI outside the submitted work; he has a modest ownership of NoraHealth. CC reports consulting fees from Medtronic. MM reports grants from Balt, Medtronic, MicroVention, and Stryker; consulting fees from Siemens; and support for attending meetings or travel from Europa Group. JF reports funding from the European Commission; personal consulting fees from Acandis, Cerenovus, Medtronic, Microvention, Phenox, Stryker, and Roche; consulting at Philips (no payments); payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Penumbra and Tonbridge; support for attending meetings or travel from Medtronic and Penumbra; stock or stock options from Tegus Medical, Eppdata, and Vastrax; and participation in a Data Safety Monitoring Board or Advisory Board at Phenox (personal fees) and Stryker (personal fees) and is a past president of ESMINT. The other authors report no conflicts of interest. PM reports receipt of research support from Siemens, Cerenovus, iSchmaview, Medtronic, Stryker, the Swiss Heart Foundation and the Swiss National Foundation, and receipt of consultant fees from Medtronic, Cerenovus, Phenox and Microvention during the conduct of the study, unrelated to the submitted work. Medtronic Neurovascular Clinical Affairs funded the INSPIRE-S Registry.

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