ROSSETTI: Towards a more personalized treatment of stroke

Leading Spanish neuroradiologists presented a unique multicentre registry to boost stroke treatment at the 12th Triángulo Radiológico leadership meeting in January in Barcelona.

By Mélisande Rouger

The boom in interventional radiology procedures has enabled great strides in ischemic stroke management. But while a myriad of techniques are available, the challenge remains in choosing the most appropriate thrombectomy treatment on the spot, according to Dr Jordi Blasco Andaluz, a neuroradiologist at Hospital Clinic Barcelona. ‘We use multiple techniques in our daily practice, for example balloon guiding catheters, stent retrievers, direct aspiration or combined techniques,’ he told Spanish radiology leaders gathered in the Catalan capital. ‘When we consider which treatments work and which don’t, each one of us tends to have their own vision, which is sometimes highly biased.’

Comparing clinical outcomes

To back up the choice of treatment with scientific evidence, Blasco and a group of Spanish interventional neuroradiologists developed the multicentre Registry of cOmbined vs. SinglE Thromectomy Techniques (ROSSETTI), to provide an open database for every centre involved. ‘We tried to get together to draw conclusions, so that instead of treating 200 patients a year, we treat 2,000,’ he said. ‘It seemed very utopic at the time, and we thought we need to make it as simple as possible.’

Each patient presents with different vessels and characteristics, and we need to be able to make recommendations according to patient types
Jordi Blasco

The initiative started in 2019 to compare revascularization and clinical outcomes in patients with acute ischemic stroke with large anterior circulation vessel occlusion treated by thrombectomy techniques with subsequent analysis of combined versus standard techniques. The project started without funding and including 750 patients from 14 stroke centres. ‘We wanted to know which of the techniques we used worked best,’ Blasco said. ‘Now we have 5,500 patients, and a detailed description of each treatment approach, to analyse how they have been devised and how revascularization was adjudicated at each centre.’

Today, ROSSETTI includes 19 stroke centres in Spain and one in Turkey. International participation is expected to grow in the near future.

An overarching goal of the project is to promote personalized medicine. ‘Each patient presents with different vessels and characteristics, and we need to be able to make recommendations according to patient types,’ Blasco explained.

Data analysis is performed by the department of Computer Science, Applied Mathematics and Statistics of the University of Girona, using a portfolio platform and a tool provided by an industry partner. ‘We want to know how to open this vessel, and have the probability of results with this approach or another,’ he said.

News • Research, diagnostics, therapies

Focus on stroke

Strokes are among the most common cause of death worldwide and one of the most common causes of disability. Mortality rates are decreasing due to improving care. Nevertheless, experts expect the absolute number of cases to rise in view of the ageing population. Read more about current research and treatment options here.

A collaborative image database for research

Each centre that shares data with ROSSETTI can access its patient database along with all the medical images that are uploaded before, during and after the procedure. With funding, significant advances could be made in this area as well, Blasco believes. ‘The difficulty lies in many cases in uploading images to the cloud from the different hospitals, mainly due to technical problems or lack of staff available to carry out this task,’ he said. ‘In the future, funding can help us to have the entire image bank of all the patients included in ROSSETTI.’

When centres take part in a research project, they can send a request to the ROSSETTI executive committee to use the project’s database and obtain follow-up, as well as research and statistical support.

To this day, the ROSSETTI database has been used in seven published works, including not only the data collected in clinical practice, but also imaging biomarkers data, to anticipate what may happen with vessels in a quantifiable way.

As such, it is a unique repository in the world, Josep Puig, a partaking neuroradiologist from Josep Trueta Hospital in Girona, explained. ‘There are only four or five registries with this amount of imaging biomarker data, and these characteristics of having 3,000 or 4,000 patients with different types coming in the ward and followed up to three months after the procedure.’

In the future, ROSSETTI will focus on incorporating more national and international centres, feeding the clinical database, expanding the image library, and carrying out image and biomarkers analysis.

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Dr Jordi Blasco is a member of the Spanish Society of Interventional Neuroradiology (SENR), and care coordinator for interventional neuroradiology at the Hospital Clínic de Barcelona and the Children's Hospital Sant Joan de Déu in Spain. Blasco has more than 20 years of experience in cerebrovascular pathology. He graduated in medicine at the University of Barcelona, and holds the European diploma of the European Board of Neuroradiologists. He has published more than 100 articles, and has spoken at numerous conferences worldwide.

26.02.2025