Impact of stent retriever size on clinical outcomes in the RECO registry

Yunlong Ding; Xiaoxiao Mao; Lei Bao; Tingting Zhai; Wenjuan Wang; Zhiqun Gu; Yan Liu; Jiali Niu

doi:10.1016/j.heliyon.2024.e28873

Impact of stent retriever size on clinical outcomes in the RECO registry

Heliyon. 2024 Mar 30;10(7):e28873. doi: 10.1016/j.heliyon.2024.e28873. eCollection 2024 Apr 15.

Authors

Yunlong Ding¹, Xiaoxiao Mao², Lei Bao³, Tingting Zhai¹, Wenjuan Wang¹, Zhiqun Gu¹, Yan Liu¹, Jiali Niu⁴

Affiliations

¹ Department of Neurology, Jingjiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, China.
² Department of Imaging, Jingjiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, China.
³ Intensive Care Unit, Jingjiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, China.
⁴ Department of Clinical Pharmacy, Jingjiang People's Hospital, The Seventh Affiliated Hospital of Yangzhou University, China.

Abstract

Objective: In the RECO study, we investigated the impact of the operator's choice of stent retriever size on patients with internal carotid artery (ICA) occlusion.

Methods: Data from the RECO Registry, a prospective multicentre study, were utilized. Patients who underwent mechanical thrombectomy (MT) were divided according to the size of the stent into the RECO 4 × 20 group, the RECO 5 × 30 group and the RECO 6 × 30 group. The outcome measures assessed in the study were the 3-month modified Rankin Scale (mRS) score, occurrence of any intracranial haemorrhage (aICH), workflow timing, recanalization success rate, number of attempts, and all-cause mortality within a 3-month period.

Results: Analysis was conducted on a total of 89 patients with ICA occlusion. RECO 4 × 20, 5 × 30, and 6 × 30 stent retrievers were used in 19 (21.3%), 52 (58.4%), and 18 (20.2%) patients, respectively. The demographic and baseline characteristics showed considerable similarity across the three groups. The puncture-to-recanalization time of the RECO 6 × 30 group [56.5 min (IQR, 41.5-80.8)] was significantly shorter than that of the RECO 4 × 20 group [110 min (IQR, 47-135)]. In 10 out of 18 patients (55.6%), the RECO 6 × 30 stent retriever achieved reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI] score 2b-3) after the initial attempt, surpassing the rates of 31.6% in the RECO 4 × 20 group and 32.7% in the RECO 5 × 30 group. In the RECO 4 × 20 group, the median number of passes was 2 (IQR, 1-3); in the RECO 5 × 30 group, it was 2 (IQR, 1-3); and in the RECO 6 × 30 groups, it was 1 (IQR, 1-2.5). There were no statistically significant differences observed among the three groups concerning aICH or good outcomes (mRS score 0-2).

Conclusion: Our study demonstrated the practical implications of stent-retriever size selection in the context of the MT for ICA occlusion. The routine use of a RECO 6 × 30 stent retriever holds the potential for early revascularization in clinical practice. The significant reduction in the puncture-to-reperfusion time and the greater first-pass effect associated with this stent size underscore its efficiency in treating ICA occlusion.

Keywords: Acute ischaemic stroke; Internal carotid artery; Mechanical thrombectomy; Stents.