STRIDE Study Subgroup Analyses: Using Mechanical Aspiration Thrombectomy for In-stent Thrombosis Versus Native-vessel Thrombosis Yields Similar Outcomes

Sunday, March 30, 2025

3:45 PM – 3:54 PM CT

Location: Music City Center, 205 BC

Presenting Author(s)

Alex Powell, MD, FSIR

Attending Physician
MCVI, United States

Author/Co-author(s)

HW

Heiko Wenforff, MD

Vascular Surgeon
Klinikum rechts der Isar, Munich, Germany, Germany
JR

Jarrad Rowse, MD

Vascular Surgeon
University of Alabama at Birmingham, United States
KN

Khanjan H. Nagarsheth, MD

Associate Professor
University of Maryland, United States
DD

David J. Dexter, II, MD, RPVI

Vascular Surgeon
Sentara Vascular Specialists, United States
AD

Alan Dietzek, MD

Vascular Surgeon
Danbury Hospital, United States
PM

Patrick Muck, MD

Chief of Vascular Surgery & Program Director Vascular Fellowship & Integrated Residency
TriHealth – Good Samaritan Hospital, United States
FA

Frank Arko, MD

Vascular Surgeon
Sanger Heart and Vascular Institute, United States
Jayer Chung, MD (he/him/his)

Associate Professor of Surgery
Baylor College of Medicine, United States
TM

Thomas Maldonado, MD

Professor of Surgery
NYU Langone Medical Center, United States

Purpose: Lower-extremity acute limb ischemia (LE-ALI) is a form of peripheral arterial disease associated with high rates of morbidity and mortality. Patients with thrombus in previously placed stents may comprise a challenging treatment population. In these STRIDE study subgroup analyses, we compare outcomes for LE-ALI patients with in-stent vs. native vessel thrombosis treated with mechanical aspiration thrombectomy.

Materials and Methods: STRIDE, a prospective, single-arm study, enrolled 119 adult patients across 16 sites in the US and Europe who were treated first-line using the Indigo Aspiration System (Penumbra, Alameda, CA). The primary outcome was target limb salvage (TLS) 30 days post-procedure. Secondary outcomes included device-related serious adverse events (SAEs), technical success (post-procedure TIMI flow grades 2/3), and patency at 30 days. Outcomes between in-stent vs. native-vessel thrombosis subgroups (n=100) were compared.

Results:

Of the 100 STRIDE patients included, 29 had in-stent thrombosis and 71 had native-vessel thrombosis. Both subgroups were balanced on demographics (mean age 66.4 ± 13.8 years, 48.0% female) and baseline vascular medical history except for chronic limb ischemia (in-stent 72.4% vs. native 25.4% difference [95% CI] = 47.1% [23.5%, 64.4%]). The in-stent subgroup had longer median target thrombus length (135.0 vs. 56.5mm, P=0.0007) and a higher proportion of superficial femoral artery involvement (82.8% vs. 42.3%; difference [95% CI] = 40.5% [17.9%, 56.9%]). There was no difference between subgroups regarding the use of adjunctive thrombolytics (P=0.6402). Results show no difference in TLS between in-stent and native-vessel subgroups (P=0.5031). Similarly, there were no significant differences between subgroups for all secondary outcomes. In a multivariate cox proportional hazards model, when adjusted for age and sex, in-stent thrombosis was associated with time to patency failure at 30 days (P=0.0489).

Conclusion: Although LE-ALI with in-stent thrombosis may be more challenging to treat, both the in-stent and native-vessel patient subgroups showed high rates of technical success and TLS at 30 days, and low rates of device-related SAEs. In-stent thrombosis may represent an increased risk in patency failure, furthering the need for investigations into clinical predictors of outcomes. These STRIDE subgroup analyses show that first-line mechanical aspiration thrombectomy using Indigo is safe and effective for LE-ALI patients with thrombosis in stents and native vessels alike.