Abstract W MP9: Early Reperfusion with a Stentriever Device: A First Step to Superior Outcomes in TREVO2

Abstract

Background: TREVO2 showed better outcomes after thrombectomy with the Trevo stentriever compared to Merci. We studied the impact of early reperfusion up to the first pass to explore the impact of device deployment on subsequent outcomes. Methods: Reperfusion during stentriever deployment and after the first pass in both arms (Merci and Trevo) of TREVO2 was quantified by cerebral blood volume (CBV) delivered to the downstream territory using perfusion angiography (perfAngio) software. Automatic, normalized extraction of CBV distal to anterior circulation occlusions was obtained from AP projections during arterial phase. CBV during deployment, after the first pass and sum of CBV up to the first pass (Σ CBV) were analyzed with respect to angiographic and clinical outcomes. Results: CBV was measured from DSA in 83 (34 Trevo, 49 Merci) occlusions in TREVO2. Clinical variables of this cohort were similar between device arms and with respect to others in the trial. During stentriever deployment, 29/34 cases demonstrated delivery of blood volume to downstream territory, averaging about 10% of the amount delivered after the first pass. Change in CBV from deployment to the first pass in 26/29 cases showed a further increase in 15 and decrease in 11, with re-occlusion in 4. CBV only after the first pass did not differ between Merci and Trevo (p=NS). CBV after first pass (p=0.06) and Σ CBV (p=0.03) both predict successful revascularization and demonstrate a moderate correlation with the time to sustained TICI 2a flow. Logistic regression analysis revealed that Σ CBV is a predictor of good clinical outcome (mRS 0-2) at day 90 (p=0.08) and use of Trevo further impacts outcome. Conclusions: Stentriever deployment achieves delivery of blood volume to the ischemic bed downstream. The amount of CBV delivered up to the first pass influences revascularization and good clinical outcomes.