Abstract Background and aims Despite major advances in mechanical thrombectomy, gaps remain regarding geographic and racial differences in practice patterns and outcomes, as well as the influence of clot characteristics on demographic, procedural, and clinical features. Methods The EXCELLENT Registry (NCT03685578) is a prospective, global, multicenter, single-arm, post-market observational study evaluating endovascular stroke treatment using Cerenovus 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 Between September 2018 and November 2024, 2,000 patients were enrolled across 65 sites: 29 U.S. sites (n=1,134), 20 European sites (n=590), and 16 Asian sites in China and Japan (n=276). First-line treatment included Embotrap in 1,637 patients and direct aspiration using large-bore catheters in 363 patients. Per-pass clot samples were collected in 1,291 patients. Final successful revascularization (mTICI 2b–3) was achieved in 95.2% of patients, with 48.0% achieving functional independence (mRS 0–2) or no worsening from prestroke mRS at 90 days. Clot analyses are complete and the database is locked. Full results will be presented at the conference. Conclusions The EXCELLENT Registry provides comprehensive, real-world, global data on thrombectomy practices and outcomes, offering unique insights into geographic variability and the relationship between clot composition, baseline characteristics, and clinical outcomes in a racially and ethnically diverse population. Conflict of interest Raul Nogueira: consultant for Anaconda Biomed, Astocyte, Biogen, Brainomix, Cerebrotech, Cerenovus, Ceretrieve, Corindus, Genentech, Hybernia, Imperative Care, Medtronic USA, NeuroVasc Technologies, Perfuze, Phenox, Philips, Prolong Pharmaceuticals, RapidPulse, Shanghai Wallaby, Stryker Corporation, Vesalio, Viz-AI; ownership/investment interest in Brain4Care, Brainomix, Cerebrotech, Ceretrieve, Corindus, Perfuze, Piraeus Medical, Quantanosis AI, Reist/Q'Apel Medical, Truvic, Vesalio, Viseon, Viz-AI; grant/contract from Cerenovus, Stryker; Data and Safety Monitoring for Synchron. Adnan Siddiqui: consulting fees from Amnis Therapeutics, Apellis Pharmaceuticals, Boston Scientific, Canon Medical Systems USA, Cardinal Health 200, Cerebrotech Medical Systems, Cerenovus, Cerevatech Medical, Cordis, Corindus, Endostream Medical, Imperative Care, InspireMD, Integra LifeSciences, IRRAS AB, Medtronic, MicroVention, Minnetronix Neuro, Peijia Medical, Penumbra, Q’Apel Medical, Rapid Medical, Serenity Medical, Silk Road Medical, StimMed, Stryker Neurovascular, Three Rivers Medical, VasSol, Viz.ai, W.L. Gore, Hyperfine Operations, Piraeus, and Johnson stock or stock options in Adona Medical, Amnis Therapeutics, Bend IT Technologies, BlinkTBI, Cerebrotech Medical, Cerevatech Medical, Cognition Medical, CVAID, E8, Endostream Medical, Galaxy Therapeutics, Imperative Care, InspireMD, Instylla, International Medical Distribution Partners, Launch NY, Neurolutions, NeuroRadial Technologies, NeuroTechnology Investors, Neurovascular Diagnostics, Peijia Medical, PerFlow Medical, Q’Apel, QAS.ai, Radical Catheter Technologies, Rebound Therapeutics (purchased by Integra Lifesciences), Rist Neurovascular (purchased by Medtronic), Sense Diagnostics, Serenity Medical, Silk Road Medical, Sim grants from the Brain Aneurysm Foundation and NIH; leadership roles have included Secretary of the Board of the Society of NeuroInterventional Surgery (2020–2021) and Chair of the Cerebrovascular Section of the AANS/CNS (2020–2021); has served as National PI or on steering committees for trials including the Cerenovus EXCELLENT and ARISE II Trials; Medtronic SWIFT PRIME, VANTAGE, EMBOLISE, and SWIFT DIRECT Trials; MicroVention FRED Trial and CONFIDENCE Study; MUSC POSITIVE Trial; Penumbra 3D Separator, COMPASS, and INVEST Trials; MIVI Neuroscience EVAQ Trial; Rapid Medical SUCCESS Trial; and InspireMD C-GUARDIANS IDE Pivotal Trial; has provided other services for Rapid Medical, MicroVention, MIVI, Medical University of South Carolina, Penumbra, Cerenovus, InspireMD, and Medtronic; employment with University at Buffalo Neurosurgery and Jacobs Institute; patent holder. Albert Yoo: personal fees for serving as a consultant for Penumbra, Cerenovus, Philips, Vesalio, and the National Institute of Neurological Disorders and Stroke; nonfinancial support for serving as a consultant for Nicolab and Zoll Circulation outside the submitted work; equity interest in Insera Therapeutics, Galaxy Medical, Gravity Medical, and Nicolab. Osama Zaidat: consulting for Johnson serves in an advisory capacity for Cerenovus and Contego Medical; research support from the National Institutes of Health, Patient-Centered Outcomes Research Institute, Medtronic, and Stryker. Jens Fiehler: funding from the European Commission; personal consulting fees from Acandis, Cerenovus, Medtronic, Microvention, Phenox, Stryker, and Roche; consulting at Philips (no payments); payment or honoraria for lectures, presentations, speakers bureaus, article writing or educational events from Penumbra and Tonbridge; support for attending meetings or travel from Medtronic and Penumbra; stock or stock options from Tegus Medical, Eppdata, and Vastrax; and participation in a Data Safety Monitoring Board or Advisory Board at Phenox (personal fees) and Stryker (personal fees) and is a past president of ESMINT. Simon De Meyer: travel support from Johnson Founder/shareholder of Ceroflo.
Nogueira et al. (2026) studied this question.