Search Results for: Utilizzo degli stent-retriever nell’ictus ischemico acuto

Stroke, Volume 56, Issue Suppl_1, Page AWMP94-AWMP94, February 1, 2025. Introduction:Medical therapy and endovascular therapy for intracranial atherosclerotic disease (ICAD) have evolved over the past two decades with improved medical therapy benchmarks, and improved techniques and patient selection for stenting. This study investigated patient co-morbidity trends to determine if these factors have led to better national patient outcomes.Methods:We performed a data search from the U.S. National Inpatient Sample (NIS) database from 2009 to 2020, evaluating patients who presented with stroke from ICAD and were treated with angioplasty and stenting and analyzed presenting co-morbidities and patient outcomes. The sample included patients who presented with stroke due to severe stenosis and underwent elective stenting, and those who presented with large vessel occlusion (LVO) with underlying ICAD who underwent rescue stenting following thrombectomy. We analyzed Elixhauser co-morbidity groups to look for trends and looked at all-cause in-hospital mortality.Results:Data from 2009 to 2020 showed no significant difference in patient mortality over the study period for patients who presented with LVO and underlying ICAD who underwent thrombectomy and rescue stenting, but there was a trend towards increased baseline co-morbidities. There was a significant decrease in mortality over the study period in patients who presented with stroke and severe stenosis who underwent elective angioplasty and stenting alone (p = 0.0103). Interestingly, there was a trend towards increased co-morbidities in patients during this period, despite the improved outcomes. There were significantly higher incidences in uncontrolled hypertension (28.2% vs 7.9%), diabetes (33.6% vs 4.6%), obesity (26.4% vs 10.2%) in the 2020 patient group compared to the 2009 patients. Hypercholesterolemia data is not captured in the Elixhauser co-morbidity analysis.Conclusions:Despite SAMMPRIS aggressive medical therapy guidelines published in 2011, over the study period there was a trend towards worse co-morbidity profiles in both the thrombectomy plus stent and stent only cohorts. While there was no change in mortality in the thrombectomy plus stent group over time, there was a significant trend towards better outcomes with lower mortality in the stenting only cohort, suggesting improved outcomes with best practice techniques and better patient selection criteria for endovascular therapy

Stroke, Volume 56, Issue Suppl_1, Page AWMP91-AWMP91, February 1, 2025. Background and Objective:Carotid artery stenting (CAS) is a procedure that has been established as a safe and effective alternative to carotid endarterectomy in high surgical risk patients. There are procedural questions that remain unanswered, specifically, the safety of pre-stent balloon angioplasty versus post-stent versus both. The objective of our study is to understand the risk and safety of these procedural techniques.Methods:Multicenter retrospective data related to angioplasty balloons, stents, complications due to pre and post-stent angioplasty along with the modified Rankin score (mRS) before and after the procedure were collected from January of 2015 until December of 2022. Statistical analysis was performed to correlate this data with risks of complications and clinical outcomes.Results:A total of 1355 patients were enrolled. We found that patients who underwent pre-stent angioplasty, or both (pre and post-stent angioplasty) had a higher risk of complications compared to those who only had post-stent angioplasty. There were more complications in patients who did not undergo post-stent angioplasty as compared to those who did undergo angioplasty (p=0.018, OR=0.513). Follow-up MRS at 30-90 days was higher if the balloons in both pre-stent angioplasty (p=0.016) and post-stent angioplasty (p=0.020) stent angioplasty were not inflated to nominal pressure. Follow up MRS was statistically higher (p=0.01) in patients with open-cell stents than closed-cell stents. Open-cell stents were more likely to undergo post-stent angioplasty (p

Stroke, Volume 56, Issue Suppl_1, Page ATP249-ATP249, February 1, 2025. Introduction:First pass effect (FPE) in endovascular thrombectomy (EVT) is associated with favorable treatment course and recovery, making it an important prognostic indicator for patients undergoing EVT. Atrial fibrillation (AF) related strokes have been shown to be associated with greater rates of FPE in acute large vessel occlusions; however, the association between AF and FPE in medium vessel occlusions (MeVO) is unknown. We aimed to assess the association between AF and achieving FPE in MeVO.Methods:A prospectively-maintained retrospective registry of adult acute ischemic stroke patients was retrospectively reviewed (10/2019-10/2023). Patients undergoing EVT for a MeVO in a middle cerebral artery segment (M2/M3) were included. Multivariable logistic regressions with 2500 bootstrap iterations for modified FPE (mFPE, defined as modified Treatment in Cerebral Infarction [mTICI] 2B/2C/3) and FPE (mTICI 2C/3) was performed using the following covariables: age, sex, comorbid conditions, anticoagulation/antiplatelet use, premorbid modified Rankin score, admission National Institutes of Health Stroke Scale, Alberta Stroke Program Early Computed Tomography Score, occlusion location and laterality, thrombolytic administration, and EVT approach (either aspiration-only or combination aspiration with stent retriever). Receiver operator characteristics curve analysis was performed to derive area under the curve (AUC) to assess model performance.Results:Of 67 patients included, median age was 70 years (IQR 63-82). Most occlusions were in the distal M2 segment (88.1%). Rate of mFPE was 58.2% (39/67); rate of FPE was 34.3% (23/67). In multivariable regressions, AF (adjusted OR 0.04, 95% CI 0.01-0.49, p=0.01) and lack of antiplatelet/anticoagulant use (adjusted OR 0.05, 95% CI 0.01-0.71, p=0.03) were independently associated with lower likelihood of mFPE. AF was the only covariable significantly associated with lower odds of FPE (adjusted OR 0.08, 95% CI 0.01-0.63, p=0.02). Models for mFPE and FPE had AUCs of 0.86 (95% CI 0.78-0.94) and 0.80 (0.75-0.85), respectively.Conclusion:AF was associated with a significantly lower likelihood of FPE and mFPE in thrombectomy for MeVOs. This may suggest a need to prepare for additional passes and rescue intraprocedural strategies in EVT for MeVO patients with AF. Future studies are needed to further investigate this relationship.

Stroke, Volume 56, Issue Suppl_1, Page ATP248-ATP248, February 1, 2025. Objective:Silent brain infarctions (SBIs), which appear as dot-like lesions on diffusion-weighted imaging (DWI) after endovascular procedures, are associated with an increased risk of subsequent stroke, dementia and cognitive decline. Efforts to reduce SBIs are needed. The objective of our study is to identify factors associated with SBIs following middle cerebral artery (MCA) stenting or balloon angioplasty.Methods:We retrospectively reviewed patients who underwent MCA stenting or balloon angioplasty, including those with symptomatic, atherosclerotic MCA stenosis of ≥ 50%. DWI was performed before and after the procedure, and newly appeared DWI lesions were regarded as SBIs. We compared variables between patients with and without SBIs and investigated the factors associated with the occurrence of SBIs. Additionally, among those with SBIs, we further analyzed the differences based on lesion location (cortex only vs. involving perforator territory).Results:Among 107 patients, 60 (56.1%) exhibited SBIs post-procedure. Factors significantly associated with SBIs included smaller diameter (OR [95% CI] = 0.03[0.003-0.42], p=0.008), and longer stenosis (1.24[1.03-1.50], p=0.024), higher MCA tortuosity (1.25[1.12-1.39], p

Stroke, Volume 56, Issue Suppl_1, Page ATP239-ATP239, February 1, 2025. Background:There are limited therapy options in case of failed reperfusion after stent-retriever and/or aspiration based endovascular treatment (EVT) for acute ischemic stroke. Despite the absence of data supporting its use, rescue angioplasty (RA; with or without stent implantation) is often utilized in such cases. Studies are limited to large vessel occlusions, while the outcomes and complications after RA in medium/distal vessel occlusions (MDVOs) have not been reported. This study aims to report the outcomes of RA in MDVO stroke patients.Methods:We performed a retrospective sub-analysis of the “Blood pressure and Antiplatelet medication management after reScue angioplasty after failed Endovascular treatment in Large and distal vessel occlusions with probable IntraCranial Atherosclerotic Disease” (BASEL ICAD) registry. All MDVO stroke patients were included in the analysis.Results:Out of 718 patients, 92 (12.8%) presented with an MDVO. Sixty-one patients (65.9%) presented with an occlusion of the M2 segment of the middle cerebral artery. Rescue stenting (RS) was performed in 83 patients (90.2%) and balloon angioplasty alone was performed in 9 patients (9.8%). Successful reperfusion (modified thrombolysis in cerebral infarction (mTICI) score ≥ 2b) before RA was achieved in 34 patients (36.9%) and after RA in 76 (82.6%) patients. Symptomatic intracranial hemorrhage (sICH) occurred in 8 patients (9.1%) and post-treatment stent occlusion in 14 patients (16.7%). 90 days mortality was 24.1%. Twenty-nine patients (34.9%) achieved functional independence at 90 days (modified Rankin Scale 0 – 2).Conclusion:Rescue Angioplasty might be a viable treatment option in case of failed reperfusion after conventional EVT in selected MDVO patients. However, safety concerns remain.

Stroke, Volume 56, Issue Suppl_1, Page ADP39-ADP39, February 1, 2025. Background:Patients with atrial fibrillation were excluded from clinical trials evaluating carotid artery stent(CAS) or carotid endarterectomy (CEA).We performed this analysis to identify the prevalence of atrial fibrillation and associated outcomes in symptomatic internal carotid artery stenosis patients undergoing CAS or CEA.Methods:We analyzed the data from the National inpatient sample (NIS) between January 2016 to December 2021. We used the ICD-10 to identify patients hospitalized with diagnosis of stroke, TIA, or retinal ischemia with stenosis of carotid artery who underwent CAS or CEA. We divided patients based on presence or absence of atrial fibrillation. We ascertained the end points of intra-procedural and post-procedural cerebral infarction, hemorrhage, discharge home and death in CAS and CEA patients with atrial fibrillation. We compared the endpoints between patients who underwent CAS and those who underwent CEA after propensity score matching.Results:Atrial fibrillation was present in 3,785 (18.3%) of 20,645 patients underwent either CAS or CEA between 2016 and 2021 [18.0% versus 18.8% for CAS or CEA, respectively, p=0.50]. The proportions of patients who developed acute myocardial infarction, respiratory failure, acute kidney injury, or required blood transfusion was higher in patients with atrial fibrillation in both CAS and CEA groups. There was no difference in odds of post-operative stroke and/or death in patients with atrial fibrillation (compared with those without atrial fibrillation) who were treated with CAS (OR 0.99, 95% CI 0.62-1.60, p=0.98) and those treated with CEA (OR 1.09, 95% CI 0.69-1.73, p=0.72) in the multivariate analysis after adjusting for confounders. The length of stay and hospitalization cost was significantly higher in patients with atrial fibrillation (compared with those without atrial fibrillation who were treated with CAS and those treated with CEA). There was no difference in post-operative stroke and/or death (10.7% versus 8.7%, p=0.41) and discharge home (32.4% versus 26.8%, p=0.13) in atrial fibrillation patients who underwent CEA with compared to those underwent CAS in propensity matched analysis.Conclusion:Approximately 1 in 5 patients with symptomatic internal carotid artery stenosis who undergo CAS or CEA have atrial fibrillation in the United States, we did not identify any higher risk of post-operative stroke and/or death in atrial fibrillation patients irrespective of which procedure was undertaken

Stroke, Volume 56, Issue Suppl_1, Page ADP36-ADP36, February 1, 2025. Objective:To explore the diagnosis of cerebral venous sinus stenosis(CVSS) in idiopathic intracranial hypertension(IIH)，and to evaluate the efficacy and risk of venous sinus stenting treatment for CVSS．Methods:50 patients with refractory IIH complicated with CVSS underwent examination with magnetic resonance venography (MRV)，digital subtraction angiography(DSA) and direct retrograde cerebral venography and manometry to confirm morphologic features of IlH and measure venous pressure．The CSF pressure on lumbar puncture ranged from 250 to 500 mmH2O with normal composition. All patients had headache, and funduscopic examination demonstrated papilledema for all patients. 38 patients who showed severe stenosis of venous sinuses with the pressure gradient across the stenosis >100 mmH2O were treated with venous sinus stenting and were followed-up for more than 12 months．Intrasinus pressures were recorded before and after the procedure and correlated with clinical outcome during the follow-up period.Results:Sinus stenting angioplasty was successful in all 38 patients．In all patients venous sinus stenosis was improved after stenting procedure (the residual stenosis rate

Stroke, Volume 56, Issue Suppl_1, Page ADP37-ADP37, February 1, 2025. Object:The introduction of antiplatelet agents is essential in stent-assisted coil embolization (SACE) for the treatment of intracranial aneurysms, and preoperative drug efficacy assessment is important in reducing the risk of ischemic complications. Light Transmission Aggregometry (LTA) is used in our institution to assess drug efficacy, and we analyzed the association between patient background factors, including preoperative LTA values, and perioperative complications in patients who underwent SACE in a retrospective analysis.Methods:Patients who underwent SACE for unruptured cerebral aneurysms from 1 March 2017 to 30 June 2024 were included. Two antiplatelet drugs (aspirin 100 mg and clopidogrel 75 mg /or prasugrel 3.75 mg) were administered 7 days prior to the procedure, and LTA measurements were performed on the day of surgery. The association of each patient’s background factors with ischemic complications during the hospitalization period (≥1 mRS drop) and DWI and SWI positivity rates on the day after surgery was analyzed. To investigate whether LTA value affect DWI positive rate, propensity score-matched analysis was employed to control for age, sex, alcohol consumption, smoking, family history, medical history, aneurysm shape, multiple aneurysms, symptomatic aneurysms, maximum diameter, neck diameter, aneurysm site, left or right, first treatment or not, stent type, number of stents, clopidogrel or prasugrel.Results:During the observation period, 1021 unruptured cerebral aneurysms received endovascular treatment, of which 548 (453 Neuroform Atlas, 17 Enterprise, 78 LVIS) underwent coil embolization with stenting. The mean LTA value on the day of surgery was 44.2 (20-74). Symptomatic ischemic complications were present in two patients (0.4%), but no associated factors were found. Propensity score matching was successful for pairs of 184 aneurysms in the DWI negative group and 184 aneurysms in the DWI positive group. LTA value was still significantly higher in DWI positive group than in DWI negative group (46.96 vs 42.14, p

Stroke, Volume 56, Issue Suppl_1, Page ATP253-ATP253, February 1, 2025. Background:Angiographic shape of occlusion, like the clot meniscus sign and the claw-sign, have been reported to potentially impact recanalization rate and clinical outcome in patient undergoing mechanical thrombectomy for acute ischemic strokes.Method:Following PRISMA guidelines, a systematic literature search was conducted across PubMed, Scopus, and Web of Science databases. Patients were grouped into clot meniscus/claw sign positive and negative groups based on the definitions obtained from each study. Primary outcomes included technical success, with a meta-analysis performed using a random-effects model to calculate proportions and odds ratios (OR) with 95% confidence intervals (Cl).Results:We included seven studies recruiting 1572 patients. The results indicated that the positive and negative groups had comparable first-pass effect (OR: 1.95; 95%CI: 0.76 – 5.01; P = 0.167) and final recanalization (OR: 1.36; 95%CI: 0.81 – 2.27; P = 0.248) rates. However, the rate of having a favorable functional outcome was significantly higher in the positive than negative sign groups (OR: 1.91; 95%CI: 1.25 – 2.92; P < 0.003). Within the sign-positive population, the use of contact aspiration was associated with a significantly higher rate of recanalization compared to using a stent retriever (OR: 0.18; 95%CI: 0.07 – 0.49; P < 0.001). This result did not translate into a clinical impact, as both stent retriever and contact aspiration showed comparable rates of functional independence at three months (OR: 0.22; 95%CI: 0.02 – 2.33; P = 0.210).Conclusion:The presence of the clot meniscus/claw sign is not associated with recanalization outcomes after thrombectomy. However, it might be a good sign to predict which thrombectomy technique might be associated with better recanalization, although current evidence might need further confirmation.

Stroke, Volume 56, Issue Suppl_1, Page ATP257-ATP257, February 1, 2025. Background:Clinical trial designs have evolved due to changes in therapies, populations, and statistical methods.Objective:We aimed to analyze the designs of acute endovascular therapy trials in ischemic stroke over time, and how mechanical thrombectomy has evolved, particularly in patient selection and statistical methods.Methods:A systematic search was conducted in PubMed, EMBASE, Cochrane, CINAHL, and SCOPUS for phase 3 or 4 randomized clinical trials of endovascular reperfusion therapy for acute ischemic stroke. Trials with functional outcomes measured at 3 months were included. Data extracted included year of publication, estimated and actual sample sizes, observed outcomes, and statistical methods used. The studies were classified in 3 periods by publication date: Period 1: before 2015, pre-stent retriever; Period 2: 2015-2019, early thrombectomy era; and Period 3: 2020-2024, recent period.Results:Of 2693 references, 21 trials met inclusion criteria, 3 in Period 1, 10 in Period 2, 8 in Period 3. Median sample sizes were 150 in Period 1, 206 in Period 2, and 300 in Period 3. Dichotomized Rankin were primary outcomes in 100% in Period 1, 80% in Period 2, and 60% in Period 3, with remainder analyzed by Rankin shift or proportional odds. Early termination occurred in 0% in Period 1, 40% in Period 2, and 0% in Period 3. 7 studies met or almost met their estimated sample size.14 studies did not meet their estimated sample size, due to early terminations (for efficacy or futility), slow recruitment, or positive findings from other trialsConclusion:The trials published during the 2015–2019 period had early terminations and positive results for thrombectomy. More recent trials have larger sample sizes and more commonly used methods to analyze the full range of Rankin categories, such as mRS shift or proportional odds models. This might reflect a shift toward capturing more nuanced outcomes in stroke populations.

Stroke, Volume 56, Issue Suppl_1, Page A128-A128, February 1, 2025. Introduction:Acute infection transiently increases risk for childhood arterial ischemic stroke (AIS). We hypothesize that this paradox of a common exposure linked to a rare outcome could be explained by either (1)unusual infections—uncommon pathogens or combinations of pathogens—or (2) anunusual host responseto infection. While previous studies relied solely on clinical history and targeted laboratory testing as measures of infection, we leveraged metagenomic next-generation sequencing (mNGS) as an unbiased measure of infection to test the first hypothesis.Methods:The Vascular effects of Infection in Pediatric Stroke II(VIPS II) study is a North American and Australian prospective cohort study which enrolled children (28 days – 18 years old) with AIS at 22 sites over a 5-year period. We collected data on preceding infection via parental interview and chart abstraction at time of admission. We performed mNGS of serum and throat swabs collected within 72 hours of stroke ictus. To assess for the background spectrum of pathogens, we enrolled and performed mNGS on unmatched stroke-free well controls (WC) and ill controls (IC).Results:Between 2017 and 2022, VIPS II enrolled 205 cases, 95 WC, and 47 IC(Table 1). Both serum and throat swab mNGS data was available for 190/205 cases, 91/95 WC, and 27/47 IC. Parents reported clinical infection in the 4 weeks prior to stroke in 47/190 (25%) cases. Chart abstraction identified hospital diagnoses of pre-stroke infection in 69/190 (35%) cases. Typical childhood viral pathogens were identified by mNGS in 26/190 (14%) cases, 9/91 WC (10%), and 9/27 (33%) IC; multiple pathogens in a single patient were rare(Table 2).Clinical infection (parental history or chart abstraction) was present in 18/26 (69%) cases with infection detected on mNGS. Overall, infection preceding or coincident with stroke was identified by parental interview, chart abstraction, or mNGS in 46% of cases.Conclusions:Almost half of cases had evidence of infection prior to or coincident with AIS, supporting prior literature. Unbiased pathogen detection with mNGS, performed for the first time in children with AIS, detected a variety of common childhood infections in both cases and controls, suggesting that the paradoxical relationship between infection and AIS is not explained by unusual or multiple pathogens. The alternative hypothesis regarding an unusual host immune response to infection in the pathogenicity in AIS should be further explored.

Stroke, Volume 56, Issue Suppl_1, Page AWP258-AWP258, February 1, 2025. Introduction:Surpass Evolve (SE) is an updated flow diverter stent. While shown to be effective and safe for treating intracranial aneurysms (IA), blood flow analysis is still limited. In this study we constructed IA models with patient-specific internal carotid artery geometry and conducted hemodynamic flow analysis of treatment with implanted SE.Hypothesis:IA neck size affects the flow changes induced by SE.Methods:A model of a patient left internal carotid artery was prepared from the UCLA clinical database. Using computer automated design (CAD) software, two variations of a 4 x 4 mm saccular IA were constructed on the ophthalmic segment: a mid-sized neck (~2 mm) and a wide neck (~5 mm). For each case, a SE device measuring 3.25 mm in diameter and 17 mm in length was added to model treatment, and computational flow dynamic (CFD) simulations of pulsatile blood flow were performed. Post-treatment blood flow was quantitatively compared between IA models, specifically intra-aneurysmal flow velocity, pulsatility index (PI), turbulence, vorticity, and wall shear stress (WSS).Results:Significantly higher flow pulsatility was observed at the neck of the wide neck IA compared to the mid-sized neck IA (PI = 2.96 and 1.66 respectively). Likewise, peak systolic flow velocities were 32.9% and 118% higher at the body and dome respectively in the wide neck case (Fig. 1). Peak systolic WSS values were observed in both cases at the neck facing the direction of blood flow, in which values exceeded 15 Pa for the wide neck case. In the mid-size neck case, WSS in excess of 3 Pa was not observed beyond the neck region, whereas notable propagation of WSS to the body and dome regions were observed in the wide neck case (Fig. 2). Higher flow vorticity was observed in all regions of the IA for the wide-neck case. Flow within the IA of both mid-size and wide neck cases remained mostly laminar with no observable turbulence relative to that in the parent vessel.Conclusion:SE treatment reduced the flow entering the IA at a high curvature area of the ICA. When comparing IA of the same size, increased neck size may reduce the flow reduction effects by 2-fold. We also observed high WSS concentrated at the distal side of the IA neck. As WSS relates to vascular remodeling, following up for distal neck remodeling in post procedure scans could be beneficial to monitor regrowth for SE-treated wide neck IAs.

Stroke, Volume 56, Issue Suppl_1, Page AWP228-AWP228, February 1, 2025. Introduction:Intracerebral hemorrhage (ICH) volume and expansion are important predictors of clinical outcome. Recent results show volumetric thresholds for prediction of poor outcome differ based on the anatomic location (lobar vs deep) of the ICH. In this study we add further atlas-based anatomic detail including lobar and subcortical locations to determine location-specific volume and expansion thresholds for the prediction of poor clinical outcome, hypothesizing that these cut-offs will vary by location.Methods:We analyzed 286 subjects from the MISTIE3 trial that had not undergone surgery prior to imaging analysis. Admission and follow-up CT scans at 24 hours ± 6 hours were analyzed. ICH locations (Basal Ganglia, Thalamus, Frontal, Occipital, Parietal, Temporal) were determined using adjudication and atlas-based methods from day 30 scans. ICH expansion was defined as a 33% or 6ml volume increase. Poor outcome was defined as modified Rankin Scale 4-6. We performed univariate and multivariate analysis using ICH location, age, ICH volumes, time from ictus to scan to identify variables associated with expansion and outcome (P < 0.05). Cutoffs at each location for volume and expansion, and their sensitivity and specificity for predicting outcome were determined using receiver operator characteristic curves.Results:Baseline CT volumes averaged 42.68ml with 41% showing expansion. Multivariate results indicated that the volume in temporal, parietal, occipital and basal ganglia locations and volume expansion in the temporal, parietal, basal ganglia were significant predictors of poor outcome. Volume thresholds for the prediction of poor outcome at the different lobar locations were frontal (46.4ml), temporal (53.7ml), parietal (48.9ml), occipital (57.6ml), basal ganglia (45.0ml). Expansion thresholds for prediction of poor outcome were frontal (13.7ml), temporal (1.20ml), parietal (2.52ml), occipital (6.1ml), basal ganglia (6.20ml). Temporal, parietal and basal ganglia volume and expansion thresholds were significant.Conclusion:Our results add specific lobar locations and their threshold values. Our volumetric expansion associations with outcome suggest that small expansions in the temporal and parietal lobes may be more clinically significant than in other locations. These results indicate that targeting of therapeutic interventions to reduce ICH expansion may have different effects based on specific lobar and deep locations.

Isa-Aii, con Stroke Action Plan for Italy obiettivo 90% nel 2030

Circulation, Ahead of Print. Background: In patients with post-thrombotic syndrome (PTS), stent recanalization of iliofemoral veins or the inferior vena cava can restore venous patency and improve functional outcomes. The risk of stent thrombosis is particularly increased during the first 6 months after intervention. The ARIVA trial tested whether daily aspirin 100 mg plus rivaroxaban 20 mg is superior to rivaroxaban 20 mg alone to prevent stent thrombosis within 6 months after stent placement for PTS.Methods: In this multinational, academic, open-label, independently adjudicated trial, patients with a Villalta score >4 points, a stenosis or occlusion of the inferior vena cava, iliac veins, or common femoral vein, successfully treated with venous stent placement, were randomized in a 1:1 fashion to the study groups. Key exclusion criteria included age 75 years, contraindications to anticoagulant use or acute venous thrombosis