WP7 – Thrombus vEssel tReatmenT InterAction RegistrY (TERTIARY)

WP leaders

Bart van der Worp (UMCU) & Bart Emmers (AUMC)

The workpackage

Procedural success of EVT is based on optimal interaction between vascular anatomy (extracranial and intracranial), and thrombus characteristics on the one hand and endovascular approach (devices, technique) on the other hand. Extracranial vascular anatomy includes geometry, stenosis and tortuosity which will dictate which interventional material is needed to reach the target occlusion. Intracranial vascular dimensions and angulations dictates the behavior of stent-retrievers. Thrombus composition influences thrombus mechanics which will dictate the interaction of the thrombus with the aspiration catheter or stent-retriever. We expect that procedural success of EVT can be predicted to guide clinical decision making. A registry of prospectively included consecutive patients with ischemic stroke treated with EVT that consists of detailed information on clinical and imaging findings, devices and EVT techniques used, complications, and radiological and clinical outcomes will add important data to existing knowledge and will inform clinicians on device choice, EVT techniques, and patient eligibility for EVT treatment.

Objectives

Overall objective: To build a highly detailed research database we aim to prospectively collect information on clinical, laboratory, and imaging findings, workflow, devices and EVT techniques used, complications, and outcomes of consecutive patients with ischemic stroke treated with EVT.

This can be split in the following component objectives:

  1. Develop a study protocol.
  2. Obtain ethical approval for the study.
  3. Include 1600 patients in three intervention centers.
  4. Assess the relation between thrombus and vessel characteristics, EVT techniques used, and angiographic and clinical outcomes.
  5. Assess the relation between the number of recanalization attempts and radiological and functional outcomes if first-pass reperfusion is not achieved.
  6. Assess the effect of the use of new-generation devices and the odds of successful reperfusion in difficult cases with resilient thrombus and/or challenging vascular anatomy.
  7. Extend the Registry to additional centers in case additional funding is obtained.