A93 The EXCELLENT 2000 global registry: angiographic, clinical and thrombus composition by technique

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Background/Introduction Despite advances in mechanical thrombectomy (MT), gaps remain regarding geographic and racial differences in practice patterns and outcomes; and the influence of clot characteristics on procedural and clinical features is not fully understood. Objective/Purpose This analysis evaluates angiographic and clinical outcomes and clot composition by MT techniques across geographical regions. Methods/Case Description The EXCELLENT Registry (NCT03685578) is a global all-comer, prospective, single-arm, post-market study evaluating endovascular stroke treatment using Johnson&Johnson MedTech devices as first-line therapy (stent-retriever [SR] required in the initial 1000 patients and SR or direct aspiration [DA] permitted thereafter). The registry collected per-pass procedural data and included a core imaging laboratory, centralized clot histology lab, independent 90-day mRS assessments, and Clinical Events Committee. Results/Findings From September 2018-November 2024, 2,000 patients were enrolled at 65 sites across three continents: 29 U.S. (n=1,134), 20 Europe (n=590), and 16 Asian sites in China/Japan (n=276). First-line treatment consisted of stent retriever (n=1,637) and direct aspiration (n=363). By region, first-line SR was used in 84.3% (U.S.), 82.5% (Europe), and 70.3% (Asia), while DA was used in 15.7%, 17.5%, and 29.7%, respectively. Overall, technique changed from the first-line approach in 15.0% (300/2000) of cases, with similar rates across regions. Revascularization rates, functional independence and clot analyses stratified by MT technique and region will be presented at the conference. Discussion/Conclusions/Learning Points EXCELLENT provides comprehensive, real-world, data on thrombectomy practices and outcomes, offering insights into geographic variability, MT techniques and the relationship between clot composition, baseline characteristics, and clinical outcomes in a diverse population.

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