STRATIS Registry Evaluates Real-World Use of Neurothrombectomy Devices for Acute Ischemic Stroke
August 22, 2017—Nils H. Mueller-Kronast, MD, et al published primary results of the STRATIS registry online ahead of print in Stroke. The STRATIS (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) registry aimed to assess whether similar process timelines, technical, and functional outcomes could be achieved in a large, real-world cohort as in the randomized trials on the use of mechanical thrombectomy with stent retrievers for treating patients with acute ischemic stroke caused by large vessel occlusions.
According to the investigators, STRATIS was designed to prospectively enroll patients treated in the United States with the Solitaire revascularization device (Medtronic) and Mindframe Capture low-profile revascularization device (Medtronic) within 8 hours from symptom onset. The STRATIS cohort was compared with the interventional cohort of the previously published SEER patient-level meta-analysis.
As summarized in Stroke, the investigators analyzed a total of 984 patients treated at 55 sites. The mean National Institutes of Health Stroke Scale score was 17.3. Intravenous tissue-type plasminogen activator was administered in 64%. The median times from onset to arrival in the enrolling hospital, from door to puncture, and from puncture to reperfusion were 138, 72, and 36 minutes, respectively. A core lab–adjudicated modified Thrombolysis in Cerebral Infarction ≥ 2b was achieved in 87.9% of patients.
At 90 days, 56.5% achieved a modified Rankin Scale score of 0 to 2, all-cause mortality was 14.4%, and 1.4% suffered a symptomatic intracranial hemorrhage. The median time from emergency medical services scene arrival to puncture was 152 minutes, and each hour delay in this interval was associated with a 5.5% absolute decline in the likelihood of achieving modified Rankin Scale score 0 to 2.
This largest-to-date Solitaire registry documents that the results of the randomized trials can be reproduced in the community and that the decrease of clinical benefit over time warrants optimization of the system of care, concluded the investigators in Stroke.