Randomized Study Comparing First-Line Dual Versus Single-Stent Retriever Technique : TWIN2WIN
Tomasello, Alejandro (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Moreu, Manuel (Hospital Clínico San Carlos (Madrid))
Terceño, Mikel (Hospital Universitari de Girona Doctor Josep Trueta)
Dinia, Lavinia (Institut de Recerca Sant Pau)
Barrena Caballo, Maria Rosario (Hospital Universitario Miguel Servet (Saragossa))
Requena, Manuel (Hospital Universitari Vall d'Hebron)
Jablonska, Magda (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Cendrero Correa, Judith (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Flores, Alan (Hospital Universitari Joan XXIII de Tarragona)
Ortega-Gutierrez, Santiago (University of Iowa)
Diana, Francesco (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Hernández Morales, David (Hospital Universitari Vall d'Hebron. Institut de Recerca)
De Dios Lascuevas, Marta (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Rubiera Del Fueyo, Marta A (Hospital Universitari Vall d'Hebron. Institut de Recerca)
García-Tornel, Álvaro (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Rizzo, Federica (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Olivé-Gadea, Marta (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Pérez-García, Carlos (Hospital Clínico San Carlos (Madrid))
Trejo Gallego, Carmen (Hospital Clínico San Carlos (Madrid))
Carmona Fuentes, Tomás (Hospital San Pablo (Coquimbo, Xile))
Rodrigo-Gisbert, Marc (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Molina, Carlos A (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Ribo, Marc (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Universitat Autònoma de Barcelona

Date:	2025
Abstract:	BACKGROUND: The double-stent retriever (SR) technique has been described as an effective rescue technique when single-SR fails to induce recanalization. We aimed to assess the safety and efficacy of first-line double-SR in patients with stroke undergoing thrombectomy. METHODS: This was a multicenter, randomized, controlled, blinded adjudicated primary outcome study. Patients with a large vessel occlusion stroke within 24 hours after onset and undergoing thrombectomy were included. Upon confirmation of large vessel occlusion on initial angiogram, patients were randomly allocated to receive a first-line strategy: single-SR versus double-SR technique. Investigators could use their technique of choice if further passes were needed. The primary objective was to evaluate the efficacy of double-SR defined as first-pass complete recanalization (expanded Treatment in Cerebral Infarction grade 2c-3) compared with single-SR. First-pass recanalization and final successful recanalization (expanded Treatment in Cerebral Infarction grade 2b50-3) were centrally assessed by a blinded investigator. The safety outcome was the occurrence of a symptomatic intracerebral hemorrhage. The data safety monitoring board stopped the recruitment after a preplanned interim analysis because a predefined efficacy boundary was reached. RESULTS: From April 2022 to October 2023, 108 patients were included: 50 (46%) in the single-SR group and 58 (54%) in the double-SR group. First-pass recanalization was achieved in 12 of 50 patients (24%) allocated to single-SR and 27 of 58 patients (46%) allocated to double-SR (adjusted odds ratio, 2. 72 [95% CI, 1. 19-6. 46]). Substantial reperfusion within 3 attempts was obtained in 42 patients (84%) allocated to single-SR and in 52 patients (89%) allocated to double-SR (adjusted odds ratio, 1. 74 [95% CI, 0. 5-5. 76]). The mean number of passes was 2±1. 3 with single-SR and 1. 7±1 with double-SR (mean difference, -0. 37 [95% CI, -0. 9 to 0. 06]). A symptomatic intracerebral hemorrhage occurred in 3 patients (6%) allocated to single-SR and in 6 patients (10%) allocated to double-SR (adjusted odds ratio, 1. 66 [95% CI, 0. 40-8. 35]). CONCLUSIONS: In patients with stroke undergoing thrombectomy, first-line double-SR is safe and superior to single-SR in achieving first-pass recanalization but not final recanalization. Implications on clinical outcomes should be studied in specifically designed trials.
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Language:	Anglès
Document:	Article ; recerca ; Versió acceptada per publicar
Published in:	Stroke, Vol. 56, Núm. 2 (February 2025) , p. 326-334, ISSN 1524-4628

DOI: 10.1161/STROKEAHA.124.048496

Postprint 16 p, 471.4 KB

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