To evaluate the safety and efficacy of the Tigertriever 131 2 (Rapid Medical, Yoqneam, Israel) stent-retriever in acute ischemic stroke (AIS) patients with a primary medium vessel occlusion (MeVO).3
Methods
A retrospective review of the DMVO Consortium, a synthesis of prospectively maintained databases at XX academic institutions in North America, Asia, and Europe, was performed to analyze consecutive AIS patients who underwent thrombectomy with the Tigertriever13 for a primary MeVO.Patients' characteristics, procedural complications, angiographic and clinical outcomes were reviewed.
Results
Between January 2017 and January 2022, 58 patients and MeVO were included (53% female, median age 77 [63-83] years, 50% of IVtPA before thrombectomy). The Tigertriever13 was used in 46/58 (79%,) as a first-line stentretriever and in 12/58 (21%) as a rescue-therapy after failure of another technique. Overall, the successful reperfusion rate (mTICI 2b, 2c, 3) was 93% for the dedicated vessel. The first-pass effect was of 15/46 (33%) in the first-line Tigertriever group. At day 1, control imaging showed a subarachnoid-hemorrhage in 33%, a parenchymal hematoma in 9%, and a symptomatic intracranial hemorrhage (≥4 deterioration in NIHSS) in 3/58 (5%). At 3 months, 61% of the patients (33/58) had a favorable outcome (mRS 0-2).
Conclusion
Mechanical thrombectomy using the Tigertriever13 appears to be safe and effective for MeVO among different centers and physicians, as a first-line device or as a recue-therapy after an other approach failure.
Disclosures
A. guenego: 6; C; Travel Grant to PAIRS in Dubai by Rapid Medical. B. lubicz: None. A. Dmytriw: None. R. Regenhardt: None. J. diestro: None. V. pereira: None. P. jabbour: None. J. siegler: None. N. gonzalez: None. M. Levitt: None. I. Tancredi: None. A. Rouchaud: None. J. Fiehler: None. T. Faizy: None. P. Kan: None. X. barreau: None.
Background For acute proximal intracranial artery occlusions, contact aspiration may be more effective than stent‐retriever for first‐line reperfusion therapy. Due to the lack of data regarding medium vessel occlusion thrombectomy, we evaluated outcomes according to first‐line technique in a large, multicenter registry. Methods Imaging, procedural, and clinical outcomes of patients with acute proximal medium vessel occlusions (M2, A1, or P1) or distal medium vessel occlusions (M3, A2, P2, or further) treated at 37 sites in 10 countries were analyzed according to first‐line endovascular technique (stent‐retriever versus aspiration). Multivariable logistic regression and propensity‐score matching were used to estimate the odds of the primary outcome, expanded Thrombolysis in Cerebral Infarction score of 2b–3 (“successful recanalization”), as well as secondary outcomes (first‐pass effect, expanded Thrombolysis in Cerebral Infarction 2c‐3, intracerebral hemorrhage, and 90‐day modified Rankin scale, 90‐day mortality) between treatment groups. Results Of the 440 included patients (44.5% stent‐retriever versus 55.5% aspiration), those treated with stent‐retriever had lower baseline Alberta Stroke Program Early Computed Tomography Scale scores (median 8 versus 9; P <0.01), higher National Institutes of Health Stroke Scale scores (median 13 versus 11; P =0.02), and nonsignificantly fewer medium‐distal occlusions (M3, A2, P2, or other: 17.4% versus 23.8%; P =0.10). Use of a stent‐retriever was associated with 15% lower odds of successful recanalization (odds ratio [OR], 0.85; [95% CI 0.74–0.98]; P =0.02), but this was not significant after multivariable adjustment in the total cohort (adjusted OR, 0.88; [95% CI 0.72–1.09]; P =0.24), or in the propensity‐score matched cohort (n=105 in each group) (adjusted OR, 0.94; [95% CI 0.75–1.18]; P =0.60). There was no significant association between technique and secondary outcomes in the propensity‐score matched adjusted models. Conclusion In this large, diverse, multinational medium vessel occlusion cohort, we found no significant difference in imaging or clinical outcomes with aspiration versus stent‐retriever thrombectomy.
