Stent Retriever Research Articles

Early technique switch following failed passes during mechanical thrombectomy for ischemic stroke: should the approach change and when?

BackgroundFast and complete reperfusion in endovascular therapy (EVT) for ischemic stroke leads to superior clinical outcomes. The effect of changing the technical approach following initially unsuccessful passes remains undetermined.ObjectiveTo evaluate...

Neuroradiological diagnosis and therapy of cerebral vasospasm after subarachnoid hemorrhage.

Cerebral damage after aneurysmal subarachnoid hemorrhage (SAH) results from various, sometimes unrelated causes. After the initial hemorrhage trauma with an increase in intracranial pressure, induced vasoconstriction, but also microcirculatory disturbances, inflammation and pathological electrophysiological processes (cortical spreading depolarization) can occur in the course of the disease, resulting in delayed cerebral ischemia (DCI). In the neuroradiological context, cerebral vasospasm (CVS) remains the focus of diagnostic imaging and endovascular therapy as a frequent component of the genesis of DCI. The amount of blood leaked during aneurysm rupture (which can be detected by CT, for example) correlates with the occurrence and severity of CVS. CT perfusion is then an important component in determining the indication for endovascular spasm therapies (EST). These include intra-arterial drug administration (also as long-term microcatheter treatment) and mechanical procedures (balloon angioplasty, vasodilatation using other instruments such as stent retrievers, stenting). This review summarizes the current findings on the diagnosis and treatment of CVS after aneurysmal SAH from a neuroradiological perspective, taking into account the complex and up-to-date international literature. · Vasospasm is a frequent component of the multifactorial genesis of delayed cerebral ischemia after SAH and remains the focus of diagnosis and treatment in the neuroradiological context.. · The initial extent of SAH on CT is associated with the occurrence and severity of vasospasm.. · CT perfusion is an important component in determining the indication for endovascular spasm therapy.. · Endovascular spasm therapies include local administration of medication (also as long-term therapies with microcatheters) and mechanical procedures (balloon angioplasty, dilatation using other devices such as stent retreivers, stenting).. · Neumann A, Schacht H, Schramm P. Neuroradiological diagnosis and therapy of cerebral vasospasm after subarachnoid hemorrhage. Fortschr Röntgenstr 2024; 196: 1125 - 1133.

Mechanical Thrombectomy in Stroke-Retrospective Comparison of Methods: Aspiration vs. Stent Retrievers vs. Combined Method-Is Aspiration the Best Starting Point?

Background: There are three main methods of mechanical thrombectomy (MT): using a stent retriever (SR) only (SO), aspiration catheter (AC) only (AO) and the combined method (CM) using both the SR and AC. This paper describes a real-life, single-center experience using SO, AO and CM during 276 consecutive MTs. Methods: The primary endpoint was the frequency of first-pass complete (FPE TICI3). The secondary endpoints were final mTICI 2b-3, procedure duration, clinical outcome and the total number of device passes. The third aim of this study was to test the association between the clinical outcomes in patients treated with each method and various factors. Results: There was a significant difference (p = 0.016) between the groups' FPE TICI3 rates with 46% mTICI 3 in the AO group, 41% in the CM group and 21% in the SO group. AO resulted in procedure time shortening to a mean duration of 43 min, and the scores were 56 min for CM and 63 min for SO (p < 0.0001). There were no significant differences in clinical outcomes or in-hospital mortality. The analysis showed a correlation between good clinical outcomes and the administration of IVT: OR 1.71 (1.03-2.84) p = 0.039. Patients ≥66 years old had higher odds of a bad outcome compared to younger patients in general (OR, 1.99 95% CI, 1.17-3.38; p = 0.011). FPE TICI3 was associated with good functional outcomes in the whole treated cohort (OR, 1.98; 95% CI, 1.21-3.25; p = 0.006). Conclusions: In our series, AO proved to be the best starting point in most cases. It demonstrates good technical efficacy regarding FPE, it is fast and clinical outcomes seem to be the least age- and FPE TICI3-dependent. It can be easily converted into the combined method, which had the second-best outcomes in our cohort.

Percutaneous placement of a retrievable fully covered metal stent with anchoring flaps for the treatment of biliary anastomotic stricture following LDLT.

To investigate the outcomes following percutaneous placement of a retrievable fully covered self-expanding metal stent (fcSEMS) with anchoring flaps at proximal and distal ends for the treatment of biliary anastomotic strictures following living-donor liver transplantation (LDLT). We retrospectively reviewed the medical records of nine patients who underwent this procedure at our centre between April 2020 and March 2021. Percutaneous stent placement was technically successful in 100% patients, and all stents were successfully retrieved. No proximal or distal stent migration or occlusion was observed during the mean (±SD) stent indwelling period of 191(± 77) days. Clinical success was 89%. There was one major bleeding complication related to the biliary approach and one minor stent-related complication of calculus/sludge. During the mean (±SD) follow-up period of 595 ± 207 days after stent retrieval, only one patient developed recurrent clinical biliary stricture and symptoms. Percutaneous placement of a retrievable fcSEMS with anchoring flaps is safe and feasible for the treatment of biliary anastomotic strictures following LDLT.

Thrombectomy

Endovascular procedures have become the standard treatment for acute stroke caused by large vessel occlusion. Various strategies are available, including stent retrieval, aspiration catheter placement, and combined techniques. However, the first-pass effect can be maximized using the technique most familiar to each surgeon and institution. Therefore, it is necessary to understand the characteristics of each device and develop case-specific treatment strategies.

The Management of Persistent Distal Occlusions after Mechanical Thrombectomy and Thrombolysis: An Inter- and Intrarater Agreement Study.

The best management of patients with persistent distal occlusion after mechanical thrombectomy with or without IV thrombolysis remains unknown. We sought to evaluate the variability and agreement in decision-making for persistent distal occlusions. A portfolio of 60 cases was sent to clinicians with varying backgrounds and experience. Responders were asked whether they considered conservative management or rescue therapy (stent retriever, aspiration, or intra-arterial thrombolytics) a treatment option as well as their willingness to enroll patients in a randomized trial. Agreement was assessed using κ statistics. The electronic survey was answered by 31 physicians (8 vascular neurologists and 23 interventional neuroradiologists). Decisions for rescue therapies were more frequent (n = 1116/1860, 60%) than for conservative management (n = 744/1860, 40%; P < .001). Interrater agreement regarding the final management decision was "slight" (κ = 0.12; 95% CI, 0.09-0.14) and did not improve when subgroups of clinicians were studied according to background, experience, and specialty or when cases were grouped according to the level of occlusion. On delayed re-questioning, 23 of 29 respondents (79.3%) disagreed with themselves on at least 20% of cases. Respondents were willing to offer trial participation in 1295 of 1860 (69.6%) cases. Individuals did not agree regarding the best management of patients with persistent distal occlusion after mechanical thrombectomy and IV thrombolysis. There is sufficient uncertainty to justify a dedicated randomized trial.

Predictors of Good Functional Outcomes in Posterior Circulation Stroke After Mechanical Thrombectomy With Stent Retrievers: An Individual Patient‐Data Pooled Analysis From the TRACK and NASA Registries

Background Recent randomized clinical trials have demonstrated that endovascular therapy for basilar artery occlusion is safe and potentially effective, predominantly in the non‐White population. The aim of this study was to identify predictors of good functional outcome in posterior circulation strokes in US population after mechanical thrombectomy from the TRACK (Trevo Stent‐Retriever Acute Stroke) and the NASA (North American Solitaire Stent Retriever Acute Stroke) registries from North America. Methods Patient‐level data from the TRACK and NASA registries were pooled, and patients with posterior circulation stroke were included in this analysis. Patients were dichotomized into those with 90‐day good functional outcome (modified Rankin scale [mRS] score 0–2) and poor functional outcome (mRS score ≥3). Baseline and procedural data were compared between the 2 cohorts. Multivariate logistic regression was performed to identify predictors of functional outcome. P &lt; 0.05 was considered significant. Results Of 119 posterior stroke patients (99 [83.2%] basilar artery, 16 [13.4%] vertebral artery, and 4 [3.4%] posterior cerebral artery), 110 patients had 90‐day mRS data available on follow‐up. Good functional outcome was observed in 44 patients (40%). Patients with mRS score 0–2 were less likely to have hypertension (61.4% versus 83.3%; P = 0.01), hyperlipidemia (38.6% versus 62.1%; P = 0.016), and diabetes (18.2% versus 36.4%; P = 0.040). Patients with mRS score 0–2 had a lower mean presentation National Institutes of Health Stroke Scale score (15.2±9.95 versus 22.6±9.50; P &lt; 0.001) and more likelihood of achieving Thrombolysis in Cerebral Infarction 3 (79.5% versus 42.2%; P &lt; 0.001). There was no difference between 2 cohorts in time to puncture, use of balloon guide catheter, use of general anesthesia, and number of passes. On multivariate analysis, higher presentation National Institutes of Health Stroke Scale and hypertension were associated with worse functional outcomes. Complete recanalization and the receipt of intravenous tissue‐type plasminogen activator were associated with higher odds of achieving good functional outcomes. Conclusion In this pooled analysis of the NASA and TRACK registries, patients with posterior circulation stroke achieving good outcomes were more likely to have lower presentation National Institutes of Health Stroke Scale and fewer comorbidities. Use of intravenous tissue‐type plasminogen activator, hypertension, final Thrombolysis in Cerebral Infarction 3, and lower baseline National Institutes of Health Stroke Scale score were independent predictors of functional outcome.

In a Rare Head-to-head Trial, a New Stent Retrieval Device Is Non-inferior to an Existing Device

In a Rare Head-to-head Trial, a New Stent Retrieval Device Is Non-inferior to an Existing Device

A Study of Efficacy and Outcomes of Two Techniques of Mechanical Thrombectomy in Acute Ischemic Stroke

Abstract Background Endovascular mechanical thrombectomy (A Direct Aspiration First Pass Technique [ADAPT] and Solitaire stent retrieval techniques) as an emergency reperfusion therapy in acute ischemic stroke patients avoids secondary brain insult and thereby prevents permanent neurological deficits. As studies comparing the two thrombectomy procedures are scarce, we evaluated their efficacy. Methods In this prospective observational study done at Manipal Hospitals Bangalore, 75 patients were separated into two groups based on the final reperfusion technique employed: ADAPT group with 39 patients who underwent contact aspiration technique and Solitaire group with 36 patients who underwent stent retrieval thrombectomy. The rate of successful reperfusion (modified treatment in cerebral infarction scores [mTICI]); functional outcomes (modified Rankin scale [mRS] and National Institutes of Health Stroke Scale [NIHSS]) at 24 hours, 1 month and 3 months postintervention; and the adverse events were compared between the two groups. Results Successful reperfusion was significantly higher in the ADAPT group. Mean NIHSS and mRS scores reduced significantly postintervention for both groups, but was greater for the ADAPT group, while mortality and other adverse events were significantly greater in the solitaire group. Conclusion Mechanical thrombectomy is an effective reperfusion therapy for acute ischemic stroke patients. Comparing the two techniques revealed better outcomes for ADAPT, than stent retrieval technique.

Abstract WMP96: When to Change? Altering Strategies in Mechanical Thrombectomy May Impact Reperfusion Rates

Introduction: Earlier and greater reperfusion in mechanical thrombectomy (MT) leads to better clinical outcomes. The timing and potential benefit of switching thrombectomy techniques after failed device passes remains unclear. Methods: Retrospective analysis of a prospective comprehensive stroke center database including patients with intracranial ICA, MCA M1/M2, or Basilar occlusions undergoing MT with either Stent-Retriever (SR), Contact Aspiration (CA) or Combined technique (CT) from 2015 to 2023. Our primary endpoint was complete/near-complete reperfusion (eTICI 2c-3) at pass #2 (after pass #1 failure). Secondary endpoints included 1) eTICI2b-3 at pass#2, and 2) eTICI2c-3 with pass #3 (following failure in two consecutive passes with the same technique). We used logistic or Firth regression to compare reperfusion rates and Kaplan-Meier analysis for cumulative rates. Results: Among 3130 MTs in the study period, 1810 met inclusion criteria. Median age [IQR] was 65 [55 - 76] years and 51.5% were male. Following a failed first pass, switching from CA to either CT or SR was associated with higher eTICI 2c-3 (aOR [95%CI] 2.8 [1.3 - 6.5] and 7.4 [1.4-54.8], respectively). Changing from CT or SR to any other technique was not associated with higher reperfusion. Secondary endpoint analysis for eTICI2b-3 yielded comparable results. For the third pass, switching to CT after two repeated failed SR or two repeated failed CA attempts was associated with higher eTICI 2c-3 as compared to repeating the original strategy (SR aOR 5.8 [1.4 - 33.3]; AC aOR 5.6 [1.1 - 41.2]). We did not observe benefit in switching to alternative technique following one or two consecutive passes with CT. After three repeated attempts with the same technique, CT led to greater eTICI 2c-3 as compared to SR and CA (83% vs. 72% vs. 64%, p &lt; 0.001). Conclusions: While limited by small subgroup sample sizes, our study strengthens the hypothesis that early changes in MT technique may have an impact on reperfusion. Our data indicates that if CA fails on first pass, transition to SR or CT should be considered. After two failed consecutive SR or CA passes, transition to CT should be contemplated.

Abstract TP187: Comparison of Balloon Guide Catheter versus Non-Balloon Guide Catheter for Mechanical Thrombectomy in Distal Medium Vessel Occlusion

Introduction: While balloon guide catheters (BGCs) enhance safety and efficacy of mechanical thrombectomy in large vessel occlusions, their impact on distal medium vessel occlusion (DMVO) remains underexplored. This study aimed to compare the outcomes of BGC vs non-BGC in DMVO thrombectomy. Methods: This retrospective study focused on DMVO cases defined as occlusions in M2-M4 middle cerebral artery, anterior cerebral artery, and posterior cerebral artery. Baseline characteristics and technical and clinical outcomes were compared between the two groups, with subgroup analysis in first-line thrombectomy techniques, including ADAPT, stent retriever, and Solumbra. First pass effect (FPE) was defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score ≥ 2C after the first pass. Results: A total of 1,508 patients were included, of whom 231 (15.3%) were in the BGC group and 1,277 (84.7%) were in the Non-BGC group. The BGC group was associated with a lower mTICI score ≥ 2C (overall: 43.2% vs. 52.7%, p = 0.01; ADAPT: 42.2% vs. 57.1%, p = 0.01; Solumbra: 32.4% vs. 51.4%, p = 0.005), longer puncture to intracranial access time (overall: 15 vs. 8 min, p &lt; 0.001; ADAPT: 17 vs. 8 min, p &lt; 0.001; Solumbra: 12 vs. 8 min, p = 0.02), and longer puncture to recanalization time (overall: 97 vs. 35 min, p &lt; 0.001; ADAPT: 100 vs. 28 min, p &lt; 0.001; Solumbra: 78 vs. 46 min, p &lt; 0.001; Stent retriever: 95 vs. 45 min, p &lt; 0.001 ). The BGC group also had a lower FPE rate (17.4% vs. 30.7%, p = 0.03) in the Solumbra subgroup. In terms of clinical outcomes, the BGC group had a lower rate of distal embolization (overall: 8.8% vs. 14.9%, p = 0.02), but there were no significant differences in other clinical outcomes between the two groups in first-line thrombectomy techniques. Conclusions: Our findings showed that the use of BGC in DMVO had a lower mTICI score, reduced FPE rates, decreased distal embolization, and longer procedure times. Figure 1: Figure 2:

Abstract WP185: Intraarterial Eptifibatide as an Adjunct to Refractory Multi-Pass Mechanical Thrombectomy

Eptifibatide is a glycoprotein IIb/IIIa inhibitor. Its intraarterial (IA) administration as adjunct therapy during mechanical thrombectomy (MT) lacks substantial supportive evidence. Objective: To identify any correlation between IA eptifibatide (135 mcg/kg) during MT and recanalization, clinical and safety outcomes. Methods: Retrospective data collection was performed at a single center. MT cases for strokes between 2020 and 2022 were reviewed. To be included, two or more passes of MT using stent retrievers in combination with aspiration must have occurred. Favorable functional outcomes were identified as mRS of 0 to 2 and NIHSS of 0 to 4 at discharge. A recanalization score of mTICI 2b to 3 was considered as successful recanalization. Any ICH within 24 hours post procedure was reported. Results: Out of 96 total patients, IA eptifibatide was used in 49 patients (51%). Tables 1 and 2 list Patients’ characteristics and outcomes in both groups, respectively. There were significantly higher chances of 2 or less passes occurring after IA eptifibatide before procedure termination (OR 5.30; 95% CI: 1.89-14.89, P 0.002). However, IA eptifibatide did not influence chances of achieving successful recanalization (OR 0.592; 95% CI:0.228-1.539, P 0.28), having a favorable functional outcome at discharge (mRS ≤ 2 OR 0.58; 95% CI: 0.52-1.38, P 0.22. NIHSS 0-4 OR 0.57; 95% CI: 0.24-1.38, P 0.22), or the occurrence of any ICH within 24 hours (OR 2.86; 95% CI: 0.71-11.52, P 0.14). Conclusion: Our findings do not support the use of IA eptifibatide in MT. Such practice could be adding unnecessary steps to a time sensitive procedure. These findings need validation by prospective randomized trials.

Abstract TP191: National Trends in Rescue Therapy for Failed Thrombectomy 2009-2020

Introduction: For a subset of patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO) mechanical thrombectomy with a stent retriever and/or aspiration is insufficient to revascularize the target artery. Rescue therapy with angioplasty alone or with stenting has been utilized. This study assesses the longitudinal trends for adjunctive treatments following failed thrombectomy in the U.S. Methods: We performed a data search from the National Inpatient Sample (NIS) database using ICD9 and ICD10 procedure codes from 2009 through 2020. Data was collected for patients with stroke who underwent thrombectomy for LVO and subsequent angioplasty or angioplasty and stenting. The use of drug eluting stents, patient demographics, regional trends, length of stay, and mortality statistics were also assessed. Results: Between 2009 and 2020, the NIS data shows a significant increase in the use of stenting as adjunctive therapy to thrombectomy for LVO. In 2009, stenting with thrombectomy in LVO represented 5.6% (25/443) of patients stented with stroke from ICAD. In 2020, these cases represented 48.6% (520/1,070) of the patients stented. Over the study period, this increase in stent use during LVO treatment was significant (p&lt;0.001). There has been a mild increase in the use of drug eluting stents in rescue therapy, but not as significant as bare metal stents. Angioplasty as an adjunct to thrombectomy for LVO has steadily increased over the study period, with 87 cases in 2009 and 265 cases in 2020, representing a 205% increase. Conclusion: There has been a progressive, significant increase in the number of rescue procedures for failed thrombectomy over the study period with stent procedures outnumbering angioplasty alone. Referencing published data these cases represent approximately 2-3% of the total number of thrombectomies performed for AIS.

Abstract WP189: TIGER Study: Effectiveness and Safety of Tigertriever Are Maintained When Treating Large Clot Size

Introduction: Larger volume thrombi are associated with a lower probability of functional independence defined as a modified Rankin Score (mRS) ≤2 and a higher number of retrieval attempts. A subanalysis of the TIGER study data was performed in order to assess the effectiveness and safety of Tigertriever in small and large clot sizes. Methods: The TIGER study was a single arm, prospective, multi-center trial assessing the efficacy and safety of the Tigertriever, a radially-adjustable stent retriever, for LVO-related stroke. The trial enrolled 160 subjects, of which 150 had successful mTICI 2b-3 revascularization (94%) at end of all procedures. The interventionalists evaluated the clot length angiographically prior to the treatment, and analysis was performed to compare the Tigertriever performance in short clots with long clots. Results: Data is available from 135 (78 males) out of the 160 subjects enrolled in the study.The median clot length was 9mm with a range of 1-50mm. Subjects were divided into two subgroups: Group A; subjects with small clot length, ≤9mm (n=69) and group B, subjects with large clot length, &gt;9mm (n=66). Baseline NIHSS was significantly smaller in group A compared to group B (16.9 vs.19, respectively, P=0.02). Median clot size in group A was 6.1mm and 16.5mm in group B. The mean number of passes with Tigertriever to achieve successful revascularization (mTICI 2b-3) was slightly higher in group B, but not statistically different (1.7 in group A vs. 2 in group B, P=0.07). First pass effect (63% vs. 50% NS), good clinical outcome (62% vs. 53% NS), sICH (1.4% vs. 3% NS) and ENT (Embolization to new territory 2.9% vs. 1.5% NS) were comparable in group A and group B, respectively. Conclusions: Despite the impaired neurological functioning as indicated by significantly higher baseline NIHSS in subjects admitted with larger clot length, Tigertriever efficacy and safety were maintained when treating these large clots compared to small clots.

Microfabricated Nitinol Stent Retrievers with a Micro-Patterned Surface.

Stent retrievers are medical devices that are designed to physically remove blood clots from within the blood vessels of the brain. This paper focuses on microfabricated nitinol (nickel-titanium alloy) stent retrievers, which feature micro-patterns on their surface to enhance the effectiveness of mechanical thrombectomy. A thick film of nitinol, which was 20 µm in thickness, was sputtered onto a substrate with a micro-patterned surface, using electroplated copper as the sacrificial layer. The nitinol film was released from the substrate and then thermally treated while folded into a cylindrical shape. In vitro experiments with pig blood clots demonstrated that the micro-patterns on the surface improved the efficacy of blood clot retrieval.

A case report of left circumflex stent infection and mycotic aneurysm: a rare but life-threatening complication of percutaneous coronary intervention

BackgroundCoronary stent infections are an uncommon but deadly complication of percutaneous coronary intervention. Mortality remains as high as 40–60% even with adequate treatment. We report such an interesting case of left circumflex stent (LCX) infection and mycotic aneurysm that was successfully managed with antibiotics and surgery.Case presentationA middle-aged man who underwent percutaneous coronary intervention (PCI) to the left circumflex artery four weeks prior was referred as a case of pyrexia of unknown origin, not responding to antibiotics, and colchicine started for suspected Dressler syndrome. Although the inflammatory markers were elevated, the results of the blood culture did not show any growth. Echocardiography showed a doubtful echogenic structure in the left atrioventricular groove and mild pericardial effusion, and a stent infection was suspected. PET scan showed focal metabolic activity in the region of the LCX stent, with metabolically active supraclavicular and paratracheal lymph nodes, and a coronary angiogram revealed an aneurysm arising distal to the stented LCX. A diagnosis of stent infection and associated mycotic aneurysm was made, and the patient underwent surgery which included aneurysm repair, stent retrieval, and coronary artery bypass graft (CABG) to the major and terminal OM. The postoperative course was uneventful, and the patient was discharged without complications.ConclusionsIt is important to investigate the possibility of coronary stent infection in individuals experiencing prolonged fever following PCI. PET scans and coronary angiograms can aid in diagnosis when echocardiograms are inconclusive. Adequate antibiotic therapy and timely surgery are crucial for successfully managing coronary stent infections.

Aspiration thrombectomy versus stent retriever thrombectomy as a first-line approach for cardiogenic cerebral embolism and cryptogenic stroke in large vessels of the anterior circulation.

This study aims to compare the clinical efficacy of aspiration thrombectomy and stent retriever thrombectomy as first-line approaches for anterior circulation large vessel cardiogenic cerebral embolism and cryptogenic stroke. This retrospective observational study included patients with anterior circulation large vessel cardiogenic cerebral embolism and cryptogenic stroke treated with endovascular therapy. Patients were grouped according to the first-line approach they received: aspiration thrombectomy or stent retriever thrombectomy. The primary outcome measure was the change in the National Institute of Health Stroke Scale (NIHSS) score from preoperative to immediate postoperative and from preoperative to discharge. Secondary indicators included the rate of favorable prognosis at discharge [Modified Rankin Scale (mRS) score ≤ 2], successful vessel recanalization rate [modified Treatment in Cerebral Ischemia (mTICI) score ≥ 2b], time from successful femoral artery puncture to successful vessel recanalization, and perioperative complications. The study included 127 cases, with 1 case withdrawal after enrollment due to a stroke of another determined cause, with 83 in the aspiration thrombectomy group and 43 cases in the stent retriever thrombectomy group. The change in NIHSS score from preoperative to immediate postoperative was 5 (1, 8) in the aspiration thrombectomy group and 1 (0, 4.5) in the stent retriever thrombectomy group. The change from preoperative to discharge was 8 (5, 12) in the aspiration thrombectomy group and 4 (0, 9) in the stent retriever thrombectomy group. The aspiration thrombectomy group exhibited significantly better prognosis rates and shorter time from successful femoral artery puncture to successful vessel recanalization. There were no significant differences between the two groups in terms of successful vessel recanalization rates and perioperative complications. As a first-line approach for anterior circulation large vessel cardiogenic cerebral embolism and cryptogenic stroke, aspiration thrombectomy leads to better improvement in neurological functional deficits and prognosis rates compared to stent retriever thrombectomy.

Common design and data elements reported in active mechanical thrombectomy trials focusing on distal medium vessel occlusions and minor strokes: a systematic review

BackgroundDistal medium vessel occlusions (DMVOs) and minor strokes represent emerging frontiers in mechanical thrombectomy (MT). Although several randomized clinical trials (RCTs) are underway, the design characteristics of these trials and...

Technique and impact on first pass effect primary results of the ASSIST global registry

BackgroundPatients treated with mechanical thrombectomy (MT) for acute ischemic strokes from large vessel occlusion (LVO) have better outcomes with effective reperfusion. However, it is unknown which technique leads to better...

Radially adjustable stent retriever for mechanical thrombectomy in acute ischemic stroke: Improved first-pass effect with rapid-inflation deflation technique.

Evidence for improved first-pass effect with the novel radially adjustable radio-opaque stent retriever Tigertriever is lacking. To compare improvement in first pass success with Tigertriever using two different techniques-rapid inflation deflation (RID) and suction thrombectomy (ST). Retrospective analysis of patients with acute ischemic stroke who underwent mechanical thrombectomy with Tigertriever at a single comprehensive stroke center. Thirty patients were included. Mean age was 72.8 years. Twelve patients (48%) experienced successful first passes with Tigertriever. Successful revascularization (modified thrombolysis in cerebral infarction (mTICI) 2b/3) was achieved in all (100%) patients who received RID or ST technique for thrombectomy. Good clinical outcome (modified Rankin score = 0-2) was noted in 40% (n = 10). Total mortality in the cohort was 8% (n = 2). RID and ST groups comprised of 10 and 15 patients, respectively. Five patients underwent MT with Tigertriever as a rescue device. No difference was noted in mean age (p = 0.27), gender (p = 0.29), location of occlusion (p = 0.46), and device used for first pass (p = 0.57). A 70% first-pass success rate in RID group and 37.5% in ST group was noticed (p = 0.06). Mean time from groin puncture to reperfusion (TICI 2b//3) was statistically similar (p = 0.29, RID: 19.9 min vs ST: 25 min). Both groups noted a 100% complete recanalization rate. The rate of mortality between the two groups were not statistically different (p = 0.46). The preliminary first-pass success rates of RID technique with Tigertriever compared to ST technique, are encouraging. Longitudinal studies with longer follow up are needed to elucidate the smaller learning curve with this device.