Document resource
Introduction/Purpose Despite major advances in mechanical thrombectomy, important gaps remain regarding geographic and racial differences in practice patterns and outcomes. Additionally, the influence of clot characteristics on demographic, procedural, and clinical features remains incompletely understood. This analysis evaluates angiographic and clinical outcomes and clot composition by mechanical thrombectomy techniques across geographical regions.Materials and Methods The EXCELLENT Registry ( NCT03685578) is a prospective, global, multicenter, single-arm, post-market observational study evaluating endovascular stroke treatment using Johnson&Johnson MedTech Neurovascular devices as first-line therapy in a real-world setting. Broad inclusion criteria were applied. The registry collected granular per-pass procedural data and incorporated a core imaging laboratory, a centralized clot histology laboratory blinded to clinical data, independent 90-day modified Rankin Scale (mRS) assessment, and a Clinical Events Committee. Enrollment occurred across three continents with a focus on systematic thrombus collection and analysis.Results From September 2018 to November 2024, 2,000 patients were enrolled at 65 sites: 29 U.S. (n=1,134), 20 Europe (n=590), and 16 Asian sites in China and Japan (n=276). First-line treatment consisted of stent retriever (n=1,637) and direct aspiration (n=363). This distribution was partly influenced by the study protocol where stent retriever (EmboTrap) was required as the first-line technique for the initial 1,000 patients while in the second half of the study, either stent retriever or direct aspiration (Cereglide71 or Large Bore Catheter/ EmboVac) was permitted as the first-line approach and therefore may not fully reflect real world trends in technique use. Across regions, stent retriever was used as the front-line technique in 84.3% (956/1134) of cases in the U.S., 82.5% (487/590) in Europe, and 70.3% (194/276) in Asia, whereas first-line direct aspiration was used in 15.7% (178/1134), 17.5% (103/590), and 29.7% (82/276) of cases in the U.S., Europe, and Asia, respectively. Of all participants, 15.0% (300/2000) changed technique from the first-line approach throughout the course of the thrombectomy, with similar rates in each of the three regions. Clot analyses are complete and the database is locked. Revascularization rates, functional independence and histological clot analyses stratified by mechanical thrombectomy technique and region will be presented at the conference.Conclusion The EXCELLENT Registry provides comprehensive, real-world, global data on thrombectomy practices and outcomes, offering unique insights into geographic variability, mechanical thrombectomy techniques and the relationship between clot composition, baseline characteristics, and clinical outcomes in a racially and ethnically diverse population.Disclosures A. Siddiqui: 1; C; Brain Aneurysm Foundation, National Institutes of Health, National Institute of Neurological Disorders and Stroke. 2; C; Amnis Therapeutics, Apellis Pharmaceuticals, Boston Scientific, Canon Medical Systems, Cardinal Health 200, Cerebrotech, Cerevatech, Cordis Neurovascular, Corindus, Endostream, Imperative Care, InspireMD, Integra LifeSciences, IRRAS AB, Medtronic, Terumo Neuro, Minnetronix Neuro, Peijia, Penumbra, Q’Apel, Rapid, Serenity, Silk Road, StimMed, Stryker, Three Rivers, VasSol, Viz.ai, W.L. Gore, Hyperfine Operations, Piraeus, Rebound Therapeutics, Abbott Labs, Asahi Intecc, Carotix, CerebrovaKP, Contego, Johnson & Johnson MedTech Neurovascular, Prometheus Therapeutics, ShockWave, Synchron Australia, Tegus, TG Medical, FreeOx Biotech, Hyperfine Operations, Perflow, Vastrax, Vesalio, PerFlow. 4; C; Adona, Amnis Therapeutics, Bend IT Technologies, BlinkTBI, Cerebrotech, Cerevatech, Cognition, CVAID, E8, Endostream, Galaxy Therapeutics, Imperative Care, InspireMD, Instylla, International Medical Distribution Partners, Launch NY, Neurolutions, NeuroRadial Technologies (Sold to Medtronic in 2021), NeuroTechnology Investors, Neurovascular Diagnostics, Peijia, PerFlow, Q’Apel, QAS.ai, Radical Catheter Technologies, Rebound Therapeutics (purchased by Integra LifeSciences), Rist Neurovascular (purchased by Medtronic), Sense Diagnostics, Serenity, Silk Road, Sim & Cure, SongBird Therapy, Spinnaker, StimMed, Synchron, Three Rivers, Truvic, Tulavi Therapeutics, Vastrax, VICIS, Viseon, Buffalo Technology Partners, Cardinal Consultants, 3N Endovascular, Basecampv Vascular SAS, Borvo, CerebrovaKP, Code Zero, Collavidence, Contego, FreeOx Biotech, Hyperion Surgical, Kandu Health, NextGen Biologics, Physician X, Piraeus, Prometheus Therapeutics, ReNiva, STENT’UP, TG Medical, Viz.ai, Whisper Medical, Willow Medtech, IRRAS, AB, Tegus, PUMA Venture Capital Fund I. 5; C; University at Buffalo Neurosurgery and Jacobs Institute. 6; C; Society of NeuroInterventional Surgery (Board Secretary, 2020–2021), AANS/CNS Cerebrovascular Section (Chair, 2020–2021), Johnson & Johnson MedTech Neurovascular (EXCELLENT, NAPA, ARISE II Trials – leadership/steering roles, other services), Medtronic (SWIFT PRIME, VANTAGE, EMBOLISE, SWIFT DIRECT Trials), Terumo Neuro (FRED Trial, CONFIDENCE Study), MUSC (POSITIVE Trial), Penumbra (3D Separator, COMPASS, INVEST, TIGER Trials), MIVI Neuroscience (EVAQ Trial), Rapid Medical (SUCCESS Trial, other services), InspireMD (C-GUARDIANS IDE Pivotal Trial), Terumo Neuro (other services), MIVI (other services), Medical University of South Carolina (other services), Penumbra (other services), InspireMD (C-GUARDIANS IDE Pivotal Trial), Medtronic (other services), Patent holder, Cognition Medical (other services), Launch NY (other services), Neurovascular Diagnostics (other services), PUMA Venture Capital Fund (other services), Vastrax (other services), VICIS (other services), Brain Aneurysm Foundation (mentor), Joint Cerebrovascular Section of the American Association of Neurological Surgeons (past chair), Council of State Neurosurgical Societies, Society of Neurointerventional Surgery Standards and Guidelines Committee, Multispecialty Carotid Alliance, Northwest University–DSMB Chair for HEAT Trial, Patent holder. T. Andersson: 2; C; Anaconda, Johnson & Johnson MedTech Neurovascular, Ceretrieve, Optimize Neurovascular, Rapid Medical, SPRYTE, Cortirio. 4; C; Ceroflo. 6; C; Spryte Medical (ad hoc travel support). A. Yoo: 1; C; Medtronic, Johnson & Johnson MedTech Neurovascular, Penumbra, Stryker, Genentech, Balt. 2; C; Penumbra, Johnson & Johnson MedTech Neurovascular, Philips, Vesalio, NIH/NINDS, Rapid Medical, ZOLL Circulation, Nicolab, Route 92 Medical, Medtronic, Stryker, Genentech, Balt. 4; C; Insera Therapeutics, Galaxy Medical, Gravity Medical, Nicolab. 5; C; HCA Healthcare. 6; C; Nicolab (nonfinancial support for consulting, scientific advisory board), Zoll Circulation (nonfinancial support for consulting), NIH/NINDS (personal fees for serving as endovascular safety and data monitor), American Heart Association (editorial board), inSteps (Scientific Advisor/Advisory Board), HCA Neurovascular Research Advisory Board (Scientific Advisor/Advisory Board), Route 92 (Scientific Advisor/Advisory Board), Associate Editor of Stroke: Vascular and Interventional Neurology Journal, XCath (scientific advisory board). O. Zaidat: 1; C; Stryker, Medtronic, Johnson & Johnson MedTech Neurovascular, Penumbra, Genentech. 2; C; Johnson & Johnson MedTech Neurovascular, Medtronic, Stryker, Penumbra, National Institutes of Health (NIH) StrokeNet. 4; C; Galaxy Therapeutics, Penumbra. 6; C; National Institutes of Health StrokeNet Consortium (endovascular committee co-chair), Surpass and Pipeline embolization devices (proctor), PI for TESLA trial (grants from Medtronic, Stryker, Penumbra, Genentech, Cerenovus Johnson and Johnson), PI for PICASSO trial (received grants from Medtronic, Stryker, Penumbra), Stroke: Vascular and Interventional Neurology (editorial board), Patent holder. R. Hanel: 1; C; NIH, Interline Endowment, Microvention (now Terumo Neuro), Stryker Neurovascular. 2; C; Medtronic, Balt, Stryker, Q’Apel Medical, Johnson & Johnson MedTech Neurovascular, Terumo Neuro, Imperative Care, Phenox, Rapid Medical. 4; C; InNeuroCO, Cerebrotech, eLum, Endostream, Three Rivers, Scientia, Rist, BlinkTBI, Corindus. 6; C; MiVI (advisory board), eLum (advisory board), Three Rivers (advisory board), Shape Medical (advisory board), Corindus (advisory board). W. Hacke: 1; C; Boehringer Ingelheim. 2; C; Johnson & Johnson MedTech Neurovascular. T. Jovin: 1; C; National Institutes of Health, Patient-Centered Outcomes Research Institute, Medtronic, Stryker Neurovascular. 2; C; Johnson & Johnson MedTech Neurovascular, Contego Medical. 4; C; Anaconda, Route 92, Viz.ai, FreeOx, Methinks, Galaxy Therapeutics, AptaTargets, Kandu, Gravity, Luminopia, Carlsmed, StataDx, Vastrax, Let’s Get Proof, Baskin Biosciences. 6; C; Anaconda (advisor role), Route 92 (advisor role), Viz.ai (advisor role), FreeOx (advisor role), Methinks (advisor role), Galaxy Therapeutics (advisor role), AptaTargets (advisor role), Kandu (advisor role), Gravity (advisor role), Luminopia (advisor role), Carlsmed (advisor role), StataDx (advisor role), Vastrax (advisor role), Let’s Get Proof (advisor role), Baskin Biosciences (advisor role), Johnson & Johnson MedTech Neurovascular (DSMB and steering committee - personal fees), Contego Medical (screening committee). J. Fiehler: 1; C; European Commission. 2; C; Acandis, Johnson & Johnson MedTech Neurovascular, Medtronic, Terumo Neuro, Phenox, Stryker, Roche. 4; C; Tegus Medical, Eppdata, Vastrax. 6; C; Philips (consulting – no payments), Penumbra (lectures, presentations, speakers bureaus, article writing, educational events, meeting/travel support), Tonbridge (lectures, presentations, speakers bureaus, article writing, educational events), Medtronic (support for attending meetings or travel), Past president of ESMINT, Phenox (DSMB/Advisory Board – personal fees), Stryker (DSMB/Advisory Board – personal fees). S. De Meyer: 6; C; Johnson & Johnson MedTech Neurovascular (travel support). R. Nogueira: 1; C; Cerenovus, Stryker. 2; C; Anaconda Biomed, Astrocyte, Biogen, Brainomix, Cerebrotech, Johnson & Johnson MedTech Neurovascular, Ceretrieve, Corindus, Genentech, Hybernia, Imperative Care, Medtronic, NeuroVasc Technologies, Perfuze, Phenox, Philips, Prolong Pharmaceuticals, RapidPulse, Shanghai Wallaby, Stryker, Vesalio, Viz.ai. 4; C; Brain4Care, Brainomix, Cerebrotech, Ceretrieve, Corindus, Perfuze, Piraeus, Quantanosis AI, Reist/Q’Apel, Truvic, Vesalio, Viseon, Viz.ai, Tulavi Therapeutics, Vastrax. 6; C; DUSK Trial PI, Synchron (DSMB).