Acute Ischemic Stroke2BE3-PhaseIINCT07533253
Rescue Distal Thrombectomy in Treatment for Persistent Distal Occlusions
A study testing Proximal mechanical thrombectomy, Rescue distal mechanical thrombectomy and Conservative management in people with Acute Ischemic Stroke, run by Centre hospitalier de l'Université de Montréal (CHUM) at 1 site in Canada.
Trial summary
The goal of this clinical trial is to determine whether rescue distal mechanical thrombectomy can improve outcomes in patients with persistent distal occlusions after successful proximal mechanical thrombectomy for acute ischemic stroke. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Acute Ischemic Stroke
- What is being tested?
- Proximal mechanical thrombectomy, Rescue distal mechanical thrombectomy and Conservative management
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 72 participants
- Where
- 1 siteCanada
- Study dates
- 1 Sep 2026to 31 Dec 2029
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Age ≥ 18 years
- Acute ischemic stroke with proximal large vessel occlusion (M1, M2, ICA, or basilar artery) treatable with mechanical thrombectomy
- Presence of one or more persistent distal occlusions (M2-M4, A1-A5, or P1-P5) after successful proximal mechanical thrombectomy
- The participant is considered suitable for either rescue distal mechanical thrombectomy or conservative management in the event of persistent distal occlusion
- Informed consent obtained from the participant or authorized representative, in accordance with the protocol and local regulations
Who cannot join
- Poor expected 3-month prognosis due to comorbid conditions
- Opposition by the participant or, in emergency inclusion circumstances, by an authorized representative
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Guylaine Gevry, BSc. Project manager contact
Canada1 site
Centre hospitalier de l'Université de Montréal (CHUM)
Montreal, Quebec, H2W 0C1
Daniela E. Iancu Associate professor of Radiology, Neuroradiologist, MD
About this study
Official title: Treatment of Persistent Distal Occlusion After Successful Proximal Recanalization in Thrombectomy - A PHASE II Trial
The goal of this clinical trial is to determine whether rescue distal mechanical thrombectomy can improve outcomes in patients with persistent distal occlusions after successful proximal mechanical thrombectomy for acute ischemic stroke.
Many patients with acute ischemic stroke caused by large vessel occlusion undergo emergency treatment with proximal mechanical thrombectomy, which removes the main clot and restores flow in a large artery. However, in some patients, one or more smaller distal arteries remain occluded after successful proximal recanalization. It is not yet known whether treating these persistent distal occlusions improves angiographic or clinical outcomes.
Read more
This study will compare two approaches:
Rescue distal mechanical thrombectomy: an additional distal mechanical thrombectomy procedure is performed during the same endovascular session.
Conservative management: no additional distal endovascular intervention is performed after successful proximal mechanical thrombectomy.
The main questions the study aims to answer are:
- Is rescue distal mechanical thrombectomy feasible in this setting?
- Is it safe?
- Does it improve angiographic and clinical outcomes?
Participants will be randomly assigned during the index endovascular procedure to one of the two study groups and will be followed with imaging and clinical assessments during hospitalization and at 90 days.
Approximately 72 participants will take part in this study at the Centre hospitalier de l'Université de Montréal (CHUM).
Read the detailed description
The 2BE3 - Phase II study is a clinical trial designed to evaluate the feasibility and safety of rescue distal mechanical thrombectomy in patients with persistent distal occlusions following successful proximal recanalization.
Endovascular thrombectomy has become the standard of care for acute ischemic stroke caused by large vessel occlusion (LVO), with substantial improvement in clinical outcomes demonstrated in multiple randomized trials. However, despite successful recanalization of the primary occlusion, a proportion of patients continue to have persistent distal occlusions or incomplete reperfusion, which may limit neurological recovery. Residual distal occlusions, particularly in medium- and distal-vessel territories, remain an important and insufficiently studied contributor to suboptimal outcomes after thrombectomy.
The optimal management of persistent distal occlusions after successful proximal thrombectomy remains uncertain. In current practice, some operators perform rescue distal mechanical thrombectomy, whereas others do not perform additional distal endovascular intervention because of concerns related to vessel injury, hemorrhagic complications, or prolonged procedure time. As a result, management remains variable and is not currently guided by high-level evidence.
This is a randomized, controlled, open-label trial with blinded outcome assessment (PROBE design). Approximately 72 adult patients with acute ischemic stroke who undergo successful proximal mechanical thrombectomy but have one or more persistent distal occlusions will be enrolled. During the index endovascular procedure, eligible participants will be randomly assigned to one of two study groups:
Rescue distal mechanical thrombectomy group: participants undergo rescue distal mechanical thrombectomy during the same endovascular session.
Conservative management group: no additional distal endovascular intervention is performed after successful proximal mechanical thrombectomy.
The primary objective of the study is to evaluate the feasibility and safety of rescue distal mechanical thrombectomy in this clinical setting. Secondary objectives include evaluating angiographic reperfusion, functional outcome at 90 days, early neurological improvement, and procedure-related safety outcomes.
Because this study is conducted in an emergency stroke setting, the consent process is adapted to the participant's clinical condition. Whenever possible, informed consent is obtained directly from the participant before inclusion. If the participant lacks decision-making capacity, consent is obtained from an authorized representative, in accordance with applicable local regulations and ethics requirements. If decision-making capacity is regained, the participant is informed about the study and continued participation is confirmed according to the protocol.
The trial is conducted at the Centre hospitalier de l'Université de Montréal (CHUM). All procedures included in the study are already used in routine clinical stroke care. Data are collected securely using the REDCap system, and imaging and clinical outcomes are assessed by independent evaluators blinded to treatment allocation.
This phase II trial is intended to generate feasibility, safety, and preliminary outcome data to inform the design of a future larger study. The results may help guide treatment decisions for patients with persistent distal occlusions after proximal thrombectomy.
- Conditions
- Acute Ischemic Stroke
- Being tested
- Proximal mechanical thrombectomy, Rescue distal mechanical thrombectomy, Conservative management
- Keywords
- thrombectomy, endovascular treatment, distal occlusion
- Medical subject headings
- Ischemic Stroke
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Proximal mechanical thrombectomyProcedure or surgery
Mechanical thrombectomy performed for the qualifying proximal large vessel occlusion before assessment of eligibility for randomization.
Rescue distal mechanical thrombectomyProcedure or surgery
Rescue distal mechanical thrombectomy performed during the same endovascular session after successful proximal recanalization to treat persistent distal medium-vessel occlusion identified on angiography.
Conservative managementOther
No additional distal endovascular intervention after successful proximal mechanical thrombectomy. Participants continue with standard medical and post-procedural care.
| Study group | Role | What they receive |
|---|---|---|
| Arm 1. Conservative management group | Active comparator | Participants first undergo standard proximal mechanical thrombectomy for acute ischemic stroke due to large vessel occlusion. If a persistent distal medium-vessel occlusion remains after successful proximal recanalization, they are randomized to no additional distal endovascular intervention and continue with standard medical and post-procedural care. Receives: Procedure: Proximal mechanical thrombectomy; Other: Conservative management |
| Arm 2. Rescue distal mechanical thrombectomy | Experimental | Participants first undergo standard proximal mechanical thrombectomy for acute ischemic stroke due to large vessel occlusion. If a persistent distal medium-vessel occlusion remains after successful proximal recanalization, they are randomized to rescue distal mechanical thrombectomy during the same endovascular session. Receives: Procedure: Proximal mechanical thrombectomy; Procedure: Rescue distal mechanical thrombectomy |
What is being measured
The primary outcome is the main question the study is designed to answer.
Number of participants successfully randomized among screen-eligible participants
Number of screen-eligible participants who are successfully randomized during the index endovascular procedure.
Measured: Periprocedural
Secondary outcomes (12)
Median modified Rankin Scale (mRS) score at 90 days
Median score on the modified Rankin Scale (0 to 6), where lower scores indicate less disability.
Measured: 90 days
Proportion of functional independence as measured by the modified Rankin scale (0-2)
The modified Rankin Scale (mRS) is a 7-point ordinal scale (0-6) used to assess global disability and functional outcome, particularly after stroke. Scores range from 0 (no symptoms) to 6 (death), with higher scores indicating greater disability
Measured: At 90 days
Median change in NIHSS score (Delta NIHSS)
The National Institutes of Health Stroke Scale (NIHSS) is a standardized 15-item neurological examination used to quantify stroke severity. Scores range from 0 to 42, with higher scores indicating more severe neurological deficits. It is widely used in clinical trials to assess baseline severity and early neurological outcomes.
Measured: At 24 hours
Proportion of NIHSS improvement ≥ 4 points
The National Institutes of Health Stroke Scale (NIHSS) is a standardized 15-item neurological examination used to quantify stroke severity. Scores range from 0 to 42, with higher scores indicating more severe neurological deficits. It is widely used in clinical trials to assess baseline severity and early neurological outcomes.
Measured: At 24 hours
Median score of reperfusion (mTICI)
Reperfusion will be assessed using the modified Thrombolysis in Cerebral Infarction (mTICI) scale (0-3) Higher grades indicate better reperfusion. Final angiographic outcomes will be adjudicated by a blinded core laboratory.
Measured: Immediate post-procedure.
Rate of complete reperfusion (mTICI 3)
Complete reperfusion is defined as mTICI grade 3 on final angiography, indicating full restoration of antegrade flow in the affected vascular territory. Assessment will be performed by a blinded core laboratory.
Measured: Immediate post procedure
Procedure time
Procedure time is defined as the interval between arterial puncture and acquisition of the final angiographic run. It reflects procedural efficiency.
Measured: During the endovascular procedure
Number of intracranial thrombectomy passes
The number of device passes required to achieve final reperfusion during the endovascular procedure. Fewer passes may reflect higher procedural efficiency and effectiveness.
Measured: During the endovascular procedure
Disposition
Patient disposition at 90 days will be categorized as home, rehabilitation center, hospital, or death, reflecting post-stroke functional status and care needs
Measured: At 90 days
Rate of mortality
All-cause mortality will be assessed to capture early and late death following the index event and intervention
Measured: At 24 hours and 90 days
Rate of procedural complications
Procedural complications include vascular perforation, arterial dissection, and embolization to new vascular territories occurring during the endovascular procedure.
Measured: During the endovascular procedure
Median score of reperfusion (AOL)
Reperfusion will be assessed using the modified Thrombolysis in Cerebral Infarction (AOL) scale (0-III) Higher grades indicate better reperfusion. Final angiographic outcomes will be adjudicated by a blinded core laboratory.
Measured: immediate post-procedure
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted16 Apr 2026
- Study start1 Sep 2026 (estimated)
- Primary completion31 Mar 2029 (estimated)
- Study completion31 Dec 2029 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Acute Ischemic StrokeStudies of the same condition, open and under way.
- More trials run by Centre hospitalier de l'Université de Montréal (CHUM)The sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- This is a Phase II, single-center, randomized, controlled, open-label trial with blinded outcome assessment (PROBE design). Participants with acute ischemic stroke and persistent distal occlusions after successful proximal mechanical thrombectomy are randomly assigned (1:1) during the index endovascular procedure to either rescue distal mechanical thrombectomy or conservative management. Randomization is stratified by age, thrombolysis use, and occlusion location. Although the treatment team is aware of treatment allocation, key angiographic and clinical outcomes are assessed by independent blinded evaluators. The study follows a pragmatic design with broad inclusion criteria and minimal protocol-imposed procedures beyond standard care.
- Masking
- None (open label)
- Enrolment
- 72 participants (estimated)
Sponsor and investigators
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07533253
- Sponsor's protocol ID
- 2026-12956
- Acronym
- 2BE3-PhaseII
- Status last verified
- Apr 2026
- First submitted
- 3 Feb 2026
- Last updated
- 16 Apr 2026
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: We may consider sharing de-identified individual participant data (IPD) upon reasonable request, after study completion and publication of primary results. Any data sharing will be subject to applicable ethical approvals, data use agreements, and privacy regulations.
Study at a glance
From the registry record, last updated by the sponsor on 16 Apr 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Treatment of Persistent Distal Occlusion After Successful Proximal Recanalization in Thrombectomy - A PHASE II Trial
- ClinicalTrials.gov ID
- NCT07533253
- Acronym / sponsor ID
- 2BE3-PhaseII / 2026-12956
- Conditions
- Acute Ischemic Stroke
- Keywords
- thrombectomy, endovascular treatment, distal occlusion
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 72 participants (estimated)
- Lead sponsor
- Centre hospitalier de l'Université de Montréal (CHUM)University, hospital or other
- Study start
- 1 Sep 2026 (estimated)
- Primary completion
- 31 Mar 2029 (estimated)
- Study completion
- 31 Dec 2029 (estimated)
- First posted
- 16 Apr 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The goal of this clinical trial is to determine whether rescue distal mechanical thrombectomy can improve outcomes in patients with persistent distal occlusions after successful proximal mechanical thrombectomy for acute ischemic stroke.
Many patients with acute ischemic stroke caused by large vessel occlusion undergo emergency treatment with proximal mechanical thrombectomy, which removes the main clot and restores flow in a large artery. However, in some patients, one or more smaller distal arteries remain occluded after successful proximal recanalization. It is not yet known whether treating these persistent distal occlusions improves angiographic or clinical outcomes.
This study will compare two approaches:
Rescue distal mechanical thrombectomy: an additional distal mechanical thrombectomy procedure is performed during the same endovascular session.
Conservative management: no additional distal endovascular intervention is performed after successful proximal mechanical thrombectomy.
The main questions the study aims to answer are:
- Is rescue distal mechanical thrombectomy feasible in this setting?
- Is it safe?
- Does it improve angiographic and clinical outcomes?
Participants will be randomly assigned during the index endovascular procedure to one of the two study groups and will be followed with imaging and clinical assessments during hospitalization and at 90 days.
Approximately 72 participants will take part in this study at the Centre hospitalier de l'Université de Montréal (CHUM).
Detailed description
The 2BE3 - Phase II study is a clinical trial designed to evaluate the feasibility and safety of rescue distal mechanical thrombectomy in patients with persistent distal occlusions following successful proximal recanalization.
Endovascular thrombectomy has become the standard of care for acute ischemic stroke caused by large vessel occlusion (LVO), with substantial improvement in clinical outcomes demonstrated in multiple randomized trials. However, despite successful recanalization of the primary occlusion, a proportion of patients continue to have persistent distal occlusions or incomplete reperfusion, which may limit neurological recovery. Residual distal occlusions, particularly in medium- and distal-vessel territories, remain an important and insufficiently studied contributor to suboptimal outcomes after thrombectomy.
The optimal management of persistent distal occlusions after successful proximal thrombectomy remains uncertain. In current practice, some operators perform rescue distal mechanical thrombectomy, whereas others do not perform additional distal endovascular intervention because of concerns related to vessel injury, hemorrhagic complications, or prolonged procedure time. As a result, management remains variable and is not currently guided by high-level evidence.
This is a randomized, controlled, open-label trial with blinded outcome assessment (PROBE design). Approximately 72 adult patients with acute ischemic stroke who undergo successful proximal mechanical thrombectomy but have one or more persistent distal occlusions will be enrolled. During the index endovascular procedure, eligible participants will be randomly assigned to one of two study groups:
Rescue distal mechanical thrombectomy group: participants undergo rescue distal mechanical thrombectomy during the same endovascular session.
Conservative management group: no additional distal endovascular intervention is performed after successful proximal mechanical thrombectomy.
The primary objective of the study is to evaluate the feasibility and safety of rescue distal mechanical thrombectomy in this clinical setting. Secondary objectives include evaluating angiographic reperfusion, functional outcome at 90 days, early neurological improvement, and procedure-related safety outcomes.
Because this study is conducted in an emergency stroke setting, the consent process is adapted to the participant's clinical condition. Whenever possible, informed consent is obtained directly from the participant before inclusion. If the participant lacks decision-making capacity, consent is obtained from an authorized representative, in accordance with applicable local regulations and ethics requirements. If decision-making capacity is regained, the participant is informed about the study and continued participation is confirmed according to the protocol.
The trial is conducted at the Centre hospitalier de l'Université de Montréal (CHUM). All procedures included in the study are already used in routine clinical stroke care. Data are collected securely using the REDCap system, and imaging and clinical outcomes are assessed by independent evaluators blinded to treatment allocation.
This phase II trial is intended to generate feasibility, safety, and preliminary outcome data to inform the design of a future larger study. The results may help guide treatment decisions for patients with persistent distal occlusions after proximal thrombectomy.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- This is a Phase II, single-center, randomized, controlled, open-label trial with blinded outcome assessment (PROBE design). Participants with acute ischemic stroke and persistent distal occlusions after successful proximal mechanical thrombectomy are randomly assigned (1:1) during the index endovascular procedure to either rescue distal mechanical thrombectomy or conservative management. Randomization is stratified by age, thrombolysis use, and occlusion location. Although the treatment team is aware of treatment allocation, key angiographic and clinical outcomes are assessed by independent blinded evaluators. The study follows a pragmatic design with broad inclusion criteria and minimal protocol-imposed procedures beyond standard care.
| Arm | Type | Receives |
|---|---|---|
| Arm 1. Conservative management group | Active comparator | Procedure: Proximal mechanical thrombectomy, Other: Conservative managementParticipants first undergo standard proximal mechanical thrombectomy for acute ischemic stroke due to large vessel occlusion. If a persistent distal medium-vessel occlusion remains after successful proximal recanalization, they are randomized to no additional distal endovascular intervention and continue with standard medical and post-procedural care. |
| Arm 2. Rescue distal mechanical thrombectomy | Experimental | Procedure: Proximal mechanical thrombectomy, Procedure: Rescue distal mechanical thrombectomyParticipants first undergo standard proximal mechanical thrombectomy for acute ischemic stroke due to large vessel occlusion. If a persistent distal medium-vessel occlusion remains after successful proximal recanalization, they are randomized to rescue distal mechanical thrombectomy during the same endovascular session. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (5 listed)
- Age ≥ 18 years
- Acute ischemic stroke with proximal large vessel occlusion (M1, M2, ICA, or basilar artery) treatable with mechanical thrombectomy
- Presence of one or more persistent distal occlusions (M2-M4, A1-A5, or P1-P5) after successful proximal mechanical thrombectomy
- The participant is considered suitable for either rescue distal mechanical thrombectomy or conservative management in the event of persistent distal occlusion
- Informed consent obtained from the participant or authorized representative, in accordance with the protocol and local regulations
Key exclusion criteria (2 listed)
- Poor expected 3-month prognosis due to comorbid conditions
- Opposition by the participant or, in emergency inclusion circumstances, by an authorized representative
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Proximal mechanical thrombectomyMechanical thrombectomy performed for the qualifying proximal large vessel occlusion before assessment of eligibility for randomization. | Procedure or surgery | Arm 1. Conservative management group, Arm 2. Rescue distal mechanical thrombectomy |
| Rescue distal mechanical thrombectomyRescue distal mechanical thrombectomy performed during the same endovascular session after successful proximal recanalization to treat persistent distal medium-vessel occlusion identified on angiography. | Procedure or surgery | Arm 2. Rescue distal mechanical thrombectomy |
| Conservative managementNo additional distal endovascular intervention after successful proximal mechanical thrombectomy. Participants continue with standard medical and post-procedural care. | Other | Arm 1. Conservative management group |
Primary outcome
Number of participants successfully randomized among screen-eligible participants
Time frame: Periprocedural
Number of screen-eligible participants who are successfully randomized during the index endovascular procedure.
12 secondary outcomes
Median modified Rankin Scale (mRS) score at 90 days
Time frame: 90 days
Proportion of functional independence as measured by the modified Rankin scale (0-2)
Time frame: At 90 days
Median change in NIHSS score (Delta NIHSS)
Time frame: At 24 hours
Proportion of NIHSS improvement ≥ 4 points
Time frame: At 24 hours
Median score of reperfusion (mTICI)
Time frame: Immediate post-procedure.
Rate of complete reperfusion (mTICI 3)
Time frame: Immediate post procedure
Procedure time
Time frame: During the endovascular procedure
Number of intracranial thrombectomy passes
Time frame: During the endovascular procedure
Disposition
Time frame: At 90 days
Rate of mortality
Time frame: At 24 hours and 90 days
Rate of procedural complications
Time frame: During the endovascular procedure
Median score of reperfusion (AOL)
Time frame: immediate post-procedure
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 16 Apr 2026.
- Individual participant dataSharing planned: Yes. We may consider sharing de-identified individual participant data (IPD) upon reasonable request, after study completion and publication of primary results. Any data sharing will be subject to applicable ethical approvals, data use agreements, and privacy regulations.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Guylaine Gevry, BSc. Project manager contact
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Proximal mechanical thrombectomy, Rescue distal mechanical thrombectomy and Conservative management in people with Acute Ischemic Stroke, run by Centre hospitalier de l'Université de Montréal (CHUM) at 1 site in Canada.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 16 Apr 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Guylaine Gevry, BSc. Project manager (+1 514 890-8000 ext. 27235, neuroradiologie.recherche.chum@ssss.gouv.qc.ca), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Number of participants successfully randomized among screen-eligible participants (time frame: Periprocedural). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 16 Apr 2026.